The aim of this assignment is to demonstrate the use of safe and effective prescribing in practice. I will achieve this by presenting and analysing a prescribing scenario which I have encountered in my current area of practice within a District Nursing Team.
During the case study the patient I have chosen will be referred to as Jean. This is to maintain her anonymity in line with the Nursing and Midwifery Council (2008) guidelines of confidentiality.
I feel it is important for the purpose of my scenario to acknowledge the new skills which I have acquired whilst undertaking the V150 and explain the background to Nurse Prescribing.
The Cumberledge Report (DHSS, 1986) made the initial
recommendations for nurses to prescribe. The report identified that, although nurses often new what they wanted they spent valuable time waiting around for prescriptions to be signed by G.P’s. As the nurses were already contributing to the prescribing decision; particularly around wound care products, enabling them to
prescribe would be a more effective use of resources.
An advisory group went on to produce The Crown Report
(DOH, 1986). This recommended that a certain nurses holding District Nurse or Health Visitor qualifications should be allowed to prescribe from a limited formulary. As a result of this The Medicinal Products: Prescription by Nurses Act (1992) became the primary legislation.
This allowed community nurses with a District Nursing or Health Visiting qualification to prescribe from a limited formulary in the Nurse Prescribers Formulary (NPF).
Whilst this enhanced the role of the nurse, reviews continued and legislation was passed. Implementation of the Health and Social Care Act (2001) enabled extended independent nurse prescribing. This was however still limited to those nurses with a specialist practitioner qualification. This changed in 2007 with the
introduction of the V150 prescribing course. The V150 allowed first level nurses with no specialist practitioner qualification to undertake necessary training to prescribe from the Nurse
Prescribers Formulary for community practitioners.
To help me structure my case study I will make use of the
Prescribing Pyramid from the National Prescribing Centre (NPC, 1999). The prescribing pyramid provides a seven step process which includes the core principles of prescribing. During my case study I will consider each individual step of the pyramid before I approach the next step.
Jean was referred to the District Nursing team by her GP with a trauma wound. She had a laceration to her left calf which had been caused by a supermarket trolley. It was necessary to undertake a holistic assessment in order to plan the wound care management.
It was also necessary to determine whether or not a prescription was needed, as this is not always the case (NPC, 1999). It was therefore essential that we achieved an effective consultation, this was done with the aid of a consultation model. I used the model to help guide my actions and focus on the important points. I used the Pendleton et al model (1987) and it helped to provide a logical structured approach to achieve an affective outcome. Having introduced myself to Jean the initial consultation began. I explained the reason for the referral from the GP which helped to allay any fears or anxieties Jean was experiencing.
Ellis et al (2003) identified that the use of verbal and non-verbal communication skills ensure effective communication.
Jean initially appeared anxious, but once I reassured her that she would be included in any decisions made and that I would explain each stage of the assessment to her, she appeared to relax. I gained Jeans consent and proceeded with the consultation. I obtained a full surgical and medical history from Jean which was documented as per NMC guidelines. This showed me that Jean was in good health and had no underlying...
References: Cutting,K. White,R. Edmunds,M. (2007) The safety and efficacy of dressings with silver- addressing clinical concerns. International Wound Journal.4 p.177-184
Department of Health,(1989) Report of the Advisory Group on Nurse Prescribing
Department of health and Social Security, (1986) Neighbourhood Nursing: a focus for care, (Cumberledge Report) London, HMSO.
Ellis,R. Kenworthy,N. Gates,B. (2003) Interpersonal Communication in Nursing: theory and practice. 2nd Edition London, Churchill Livingstone.
Health and Social Care Act (2001) OPSI
Nursing and Midwifery Council (2009) Record Keeping: Guidance for nurses and midwives. London, NMC.
Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. London, NMC.
Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers. London, NMC.
National Prescribing Centre (1999) Signposts for prescribing nurses-general principles of good prescribing. London, Prescribing Nurse Bulletin.
Nurse Prescribers Formulary (2009-2011) London, BMJ Group and RPS.
Patel, S (2007) Understanding Wound Infection and Colonisation. Wound Essentials, 2. p132-142.
The Medicines Act 1968, (Amendment) Regulations (1992). Statutory Instrument 1992, No 604 OPSI
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