Prescribing in practice Essay

IntroductionThe future(a) duty assignment entrust hash out and contemplate a prescribing episode, inwardly practice, moreover will outline safe prescribing from the Nurse Prescribing Formulary (NPF, 2013-2015).To be sufficient to analyse and deliberate on my sensitive role as partnership practician Nurse Prescriber (CPNP) I will intention Gibbs (1988) reflective fabric and a structure that will allow the use of a computer address lesson (Appendix1,Fig1). The focus on prescribing at heart nursing profession was first brought into interchange by Royal College of care for (RCN) in 1980 but has proven to be cornerstone after was part of the government agenda as a result of Cumberlege report in 1996.This report outlined the essential for tally to be number a rankr especially in friendship settings to provide thickenings with stop care, safe and practical access to medication (Nuttal, 2008). Furthermore The Medicinal intersection doom Prescribing Act 1992 outline d changes in circumstances including nurses as prescribers, pursueed by recommendations make by Crown Reports1999 that suggest that health visitors (HV)) should be authorised to prescribe from a limited list, spot as the nurse prescribers pharmacopeia (NPF). (DH,2004).ScenarioFor the conception of this assignment all names has been changed to verify confidentiality according to NMC (2008).The following scenario it is in relation to a situation experienced while on the morning baby clinic working alongside my mentor .A mother Lisa come for a regular weight check for her 4 month old(a) infant called pile .While discussing with Lisa her password weight progress ,she mentioned about her son having very dry scaly unclothe on sell since receive moreover Lisa explained that some ages contend on the scalp become wish well a patchy crusty rash and crowd feel awkward , at times not settling. Edwards (2010) suggest that utilise a holistic assessment it is very valuable when co ming in contact with the leaf node as the problem presented can prepare a drastic electrical shock on the quality of life for child and the family. As a bookman under the care of my mentor we started a holistic assessment of pile and finalise with a prescription medicine light uponing. I start by using open questions related to jam general health and I askedLisa if she had both concerns but she confirmed spur to me that there was no issues with his health since lineage .To make sure that teaching provided by Lisa was correct and I pretend accuracy in details exposed I repeated back and she confirmed. As a student practitioner prescriber it is very important to maintain good practice and use assessment frameworks and consultation molds as casualty to improve and gain better skills(Nuttall,2008).The ConsultationThe purpose of the consultation flummox in prescribing practice is to assist nurses in citeing strategies to deliver a diagnoses and at long last the appro priate prescription .There are various consultation models utilise in practice with normative or descriptive character , however for the purpose of this case scenario I will concentrate on Roger Neighbour 1987 consultation model. Moreover Neighbour (2005) outline by means of his model consultation as a locomote divided by check points , connecting which is the first point where node establish the relation with the practitioner is essential followed by summarising, handing over, asylum netting and housekeeping. To progress further it is relevant to mention influence of communication skills in consultation process furthermore considering that nurse practitioners dont need different communication skills in comparison with other professionals prescribers (While,2002).However(While,2002)found that the need for appropriate environment that can maintain privacy and confidentiality could be a potential barrier during consultation rather than communication especial for those working in client homes. I choose Neighbour 1987 model for accord and easy to apply in either circumstances moreover nominate as a journey establishing relations with the client through empathy and in the aforementioned(prenominal) time identify the need for balance between practitioner prescriber and client (Tate,2010).Another positive aspect that I took in considerateness when choosing the model was also housekeeping as practitioner have the chance through this section to become reflective to avoid any unresolved issues onwards consultation is complete ( Neighbour,2005) .Despite the ratiocination made to use Neighbour 1987 model I will move further and explain the process and prescribing decision using the principles of good prescribing pyramid ,( Appendix 1, Fig 2)(NPC,1999).Step 1Assessment Consider the patientThe beginning of consultation according to Neighbour,(1987) is connecting with Lisa and structure a relationship ,however in a noisy environment kindred the clinic I found this difficult .Despite this barrier I manage to find a sitting area that appear to be more individual(a) and had the prospect to manage a discussion with Lisa to establish that I requisite to do a physical inquiry on jam .As James was under 16 years of age ,consent from parent or withstander was needed ,therefore Lisa give a verbal consent as she was the biologic parent (NMC,2013).To proceed further I use mnemonic OLDCARD to asses James with Lisas assistance trying to interact with her and find out if any physical or affective changes occurred.Bryans (2000) suggest that during assessment the practitioner should use knowledge, experience, recognition and prioritisation ,so to proceed further with a holistic assessment and identify symptoms that will help me to rule a diagnosis I matt-up I needed to ask Lisa more questions .Following the identified symptoms and physical examination I fill up that this was cradle cap a form of seborrheic dermatitis in the main affecting skin on the scalp with patches and thick scaling and sometimes yellow crusty (Sheffield et al,2007).It is important to rule out other conditions when winning assessments as sometimes cradle cap can turn into atopic dermatitis or fungal infection such as tinea capitis or well misdiagnosed with crusted scabies (Yoshizumi and Harada,2008).Further continuing my assessment I was able to conclude that none of this conditions were present in James situation .It was important to discuss with Lisa during consultation family history that could provide additional support for my final diagnostic conclusion .Going thru such topic area Lisa explain that her husband James dad was suffering with atopic eczema since childhood .This was quite an important piece of information as such conditions like atopic eczema ( dermatitis ) are hereditary conditions often (National Eczema companionship ,2011).Atopic dermatitis or eczema is a chronic skin dis tack together inflammatory with pruritic skin that appe ars mostly on the face ,neck ,bends of the arms or legs caused by the break down in the skin barrier( NICE,2013). Step 2Which Strategy?In order to progress further following discussion with Lisa under my mentor supervision as a CPNP V100 I made a prescribing decision found on the physical examination and the information provided I concluded that James was suffering from cradle cup (seborrheic dermatitis)(NICE,2013).Furthermore Lisa confirmed that James did not have any allergies and was not on any medication .It was important to mitigate the discomfort and unsettling times for James and I decided to prescribe an demulcent and a bathing tub linear. Pendleton et al (1984) suggest that practitioner should discover client expectation furthermore should take in consideration other handling options before prescribing . fit to NICE (2013) greasy emollients and soap substitutes or bath additive helps to remove powerfully the scales, further more regular washing of the scalp and gentl e brushing can help to loosen scales. Another point in time followed in the Neighbour (1987) is handing over period but after Justin skin on his scalp was carefully examined no evidence of infection was identified so no referral to the General Practitioner (GP) was necessary.Consider the choice of reapingAccording to NPC (1999) practitioners should use mnemonic EASE as can be seen in the chart below to choose appropriate cost effectual output for clients.EHow powerful is the product?AIt is appropriate for the client?SHow safe is it?EIs the prescription cost effective?To make the appropriate decision for Lisas infant, under the supervision of my mentor I used the Nurse Prescribers Formulary (NPF) and decided toprescribe Oilatum Junior bath additive and cream as I considered this combination more effective in Justins treatment .Moreover the packaging was also appropriate as comes in a pump action and this could reduce the infection risks associated with emollients and types of re cipients manufacture (NPF,2013-2015). When deciding the prescription products and quantities I also took in consideration Lisa requirements furthermore according to NICE guidelines emollients should be prescribe in large quantities nearly 250-500 grams per week and in the same time cost effective (NICE,2007).It is important when prescribing emollients to discuss with clients /parents /carers possible side effect even this products are considered to be quite safe ,however bath additives should be taken in consideration because tend to leave the skin slippery after bathing the infant( BNFC,2014) .When prescribing a product especially for infants it is important to educate the parent/carer how to use the product and make sure they are aware of any risks and side effects .Negotiate a contractAccording to (Courtenay and Griffiths,2005) when prescribing we should view the process as a shared decision-making between client and prescriber .The prescribing decision stands as a contract so it was important to remind myself that I should take in consideration Lisa satisfaction with my decisions .To achieve all my actions it was paramount to have effective communication skills and ability to identify the appropriate therapeutic treatment .Throughout blameless process I think that Lisa snarl empowered as I hand it over to her the responsibility to apply the emollients on Justin skin ( Braid,2001).As I am not yet non-medical prescriber the prescription for Lisas son was create verbally by my mentor and information leaflets regarding seborreic dermatitis were given to Lisa for further guidance.ReviewAccording to Neighbour (1987) consultation model this step relates to safety netting and refers to follow up of the consultation and possible outcomes. Furthermore together with my mentor we lay to follow up in ten days to see if Lisas infant was making any progress and treatment was effective .Through this recapitulation in ten day time practitioner can identify any more concerns of the parents and possible side effects of the treatment used(DH,2010b). record KeepingFollowing guidance of the Nursing and tocology Council (NMC,2006) it is practitioner right to ensure records are maintain accurately and prescription details it is save in the infant health record (NPC,1999).Moreover I ensured the details of the prescription and the consultation were entered into general computer system within the next 4 hours following consultation and the GP also was aware of the consultation and products cocksure .According to (NMC,2006) details of the consultation and prescription should be entered into the computer system within forty eight hours with exception for special circumstances.ReflectionUsing Gibbs reflective cycle during consultation process with Lisas infant I had the opportunity to identify positive and negative aspects and reflect on the scenario. In the same time final part of Neighbours consultation model refers to Housekeeping and this stands as another stage that give me the opportunity to reflect on my prescribing decision and consultation .I felt that throughout the whole process I used safe and effective decisions even at times I felt a bit nervous however my mentor feedback was positive in regards to my performance .One aspect that I found difficult was the environment ,at the time the baby clinic was busy and noisy and it was difficult to find a snobbish area to conduct the consultation ,but such issues I could reflect on it for my future prescribing practice .ConclusionThrough this experience I able to develop on my new role as V100 prescriber using specific tools like the consultation model and good prescribing steps .Furthermore I had the opportunity to apply appropriate communication skills and medical knowledge along with the command to conclude with a safe and effective prescribing practice . A new CPNP I can utilize different assessment tools based on a consultation model along with a decision making framew ork to support my practice and at the same time reflect on my ability to undertake a partnership approach that responds to client needs and concerns. Definitely this experience has been with great importance for my educational journey as V100 nurse prescriber.ReferenceBaird, A., (2001) Diagnoses and prescribing .Primary Healthcare 11(5)24-26.Bryans, A., 2000. Providing new insight into community nursing know-how through Qualitative analysis of multiple data sets of manakin data. Primary Health Care Research and Development, 1 79-89.Courtenay, M., Griffiths, M., (2005) self-supporting and Supplementary Prescribing-An Essential Guide, Cambridge University Press. Department of Health (2004) Extending Independent Nurse Prescribing within the NHS in England. London The Stationery Office. 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