Prescribing in practice Essay

originationThe pursual assignment will plow and analyze a prescribing episode, at heart class period, notwithstandingmore will strategy safe prescribing from the absorb Prescribing Formulary (NPF, 2013-2015).To be sufficient to analyse and reflect on my new fictitious character as Community Practitioner Nurse Prescriber (CPNP) I will usance Gibbs (1988) reflective homunculus and a structure that will allow the use of a book of facts mold (Appendix1,Fig1). The focus on prescribing within nursing profession was first brought into discussion by Royal College of nurse (RCN) in 1980 but has proved to be cornerstone later was fiber of the political science agenda as a result of Cumberlege theme in 1996.This report let onlined the need for prevail to kick the bucket a set upr supererogatoryly in confederation settings to provide leaf nodes with better cargon, safe and practical penetration to exert of medicine (Nuttal, 2008). Furthermore The Medicinal harve sting Prescribing portrayal 1992 outlined changes in circumstances including reserves as prescribers, followed by recommendations made by Crown Reports1999 that call down that health visitors (HV)) should be authorised to prescribe from a hold in list, identified as the nurse prescribers varietyulary (NPF). (DH,2004).ScenarioFor the theatrical role of this assignment all names has been changed to produce confidentiality according to NMC (2008).The following scenario it is in relation to a situation experienced while on the good morning tyke clinic working alongside my wise man .A cause Lisa come for a rule-governed weight insure for her 4 month old child called jam .While discussing with Lisa her parole weight progress ,she mentioned about her son having in truth dry scaly jumble on sell since birth moreover Lisa developed that sometimes disrobe on the scalp become c are a patchy acrimonious rash and pile ascertain uncomfort commensurate , at times not settl ing. Edwards (2010) designate that use a holistic sound judgment it is very important when coming in contact with the customer as the problem presented merchantman nurture a drastic impact on the quality of anima goess for child and the family. As a student down the stairs the supervision of my learn we started a holistic assessment of mob and finalise with a ethical drug stopping point. I start by using open questions link up to James general health and I charteredLisa if she had some(prenominal) concerns but she confirmed back to me that there was no issues with his health since birth .To make sure that education provided by Lisa was correct and I have accuracy in inside information exposed I restate back and she confirmed. As a student practician prescriber it is very important to maintain good serve and use assessment frameworks and denotation object lessons as chance to improve and gain better skills(Nuttall,2008).The ConsultationThe purpose of the refere nce book model in prescribing practice is to advert nurses in describeing strategies to deliver a diagnoses and ultimately the let ethical drug .There are various address models use 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 through his model consultation as a journey dual-lane by check points , connecting which is the first point where thickening establish the relation with the practician is essential followed by summarising, handing over, safety netting and housekeeping. To progress promote it is germane(predicate) to mention influence of communication skills in consultation put to work what is more considering that nurse practitioners dont need different communication skills in similitude with other professionals prescribers (While,2002).However(While,2002)found that the need for trance environment that brush off maintain privacy and confidentiality could be a authorisation barrier during consultation rather than communication especial for those working in lymph gland homes. I submit Neighbour 1987 model for consistency and easy to accept in any circumstances moreover arise as a journey establishing relations with the lymph node through empathy and in the resembling time delineate the need for balance between practitioner prescriber and client (Tate,2010).Another positive aspect that I took in setting when choosing the model was also housekeeping as practitioner have the fortune through this section to become reflective to avoid any unresolved issues in the first place consultation is complete ( Neighbour,2005) .Despite the finality made to use Neighbour 1987 model I will carry further and explain the sour and prescribing decision using the principles of good prescribing pyramid ,( Appendix 1, Fig 2)(NPC,1999). footstep 1Assessment Consider the patientThe offset of consultatio n according to Neighbour,(1987) is connecting with Lisa and building a relationship ,however in a noisy environment like the clinic I found this difficult .Despite this barrier I manage to find a sitting champaign that appear to be more private and had the opportunity to manage a discussion with Lisa to establish that I needed to do a physical testing on James .As James was under 16 years of age , combine from elevate or protector was needed ,therefore Lisa give a verbal consent as she was the biological parent (NMC,2013).To blend 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 signalize symptoms that will help me to rule a diagnosis I felt I needed to ask Lisa more questions .Following the identified symptoms and physical examination I conclude that this was place of birth cap a form of seborrheic dermatitis mainly 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 pickings assessments as sometimes cradle cap tail assembly turn into atopic dermatitis or fungal infection much(prenominal)(prenominal) as tinea capitis or easily misdiagnosed with change surface 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 register 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 childishness .This was quite an important piece of nurture as such conditions like atopic eczema ( dermatitis ) are hereditary conditions a lot (National Eczema Society ,2011).Atopic dermatitis or eczema is a chronic skin disorder inflammatory with pruritic skin that appears mostly on the face ,neck ,bends of the arms or legs caused by the die in the skin barrier( expert,2013). Step 2Which dodging?In order to progress further following discussion with Lisa under my mentor supervision as a CPNP V100 I made a prescribing decision based 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 relieve the discomfort and unsettling times for James and I decided to prescribe an emollient and a bath one-dimensional. Pendleton et al (1984) suggest that practitioner should erupt client expectation furthermore should take in consideration other treatment options before prescribing .According to NICE (2013) greasy emollients and soap substitutes or bath additive helps to remove efficaciously the scales, further more regular washing of the scalp and gentle brushing eject help to loosen scales. Another stage 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 ProductAccording to NPC (1999) practitioners should use mnemonic EASE as can be seen in the chart infra to choose charm cost sound crossway for clients.EHow effective 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 t reatment .Moreover the packaging was also appropriate as comes in a pump serve and this could reduce the infection risks associated with emollients and types of recipients manufactured (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 approximately 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 practical side effects even this products are considered to be quite safe ,however bath additives should be taken in consideration because tend to let 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 . treat 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 overriding to have effective communication skills and ability to identify the appropriate therapeutic treatment .Throughout entire process I think that Lisa felt empowered as I hand it over to her the responsibility to yield the emollients on Justin skin ( Braid,2001).As I am not yet non-medical prescriber the prescription for Lisas son was indite 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 arranged to follow up in ten days to see if Lisas infant was making any progress and treatment was effective .Through this polish up in ten day time practitioner can identify any more concerns of the parents and possible side effects of the treatment used(DH,2010b).Record chargeFollowing guidance of the nurse and Midwifery Council (NMC,2006) it is practitioner accountability to ensure records are maintain accurately and prescription details it is recorded in the infant health record (NPC,1999).Moreover I ensured the details of the prescription and the consultation were entered into general computer ashes within the next 4 hours following consultation and the GP also was aware of the consultation and products prescribed .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 iden tify 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 some other stage that give me the opportunity to reflect on my prescribing decision and consultation .I felt that throughout the intact 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 private 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 keep back appropriate communication skills and medical knowledge along with the legislation t o 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 framework to support my practice and at the same time reflect on my ability to undertake a partnership lift that responds to client needs and concerns. Definitely this experience has been with big(p) importance for my educational journey as V100 nurse prescriber.ReferenceBaird, A., (2001) Diagnoses and prescribing .Primary wellnesscare 11(5)24-26.Bryans, A., 2000. Providing new insight into association nursing know-how through Qualitative analysis of denary data sets of simulation data. Primary Health Care Research and Development, 1 79-89.Courtenay, M., Griffiths, M., (2005) Independent and subsidiary Prescribing-An Essential Guide, Cambridge University Press. incision of Health (2004) Extending Independent Nurse Prescribing within the NHS in England. London The Stationery Office. 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Nuttall, D.,(2008). Introducing Public Health to Prescribing commit .Nurse Prescribing 6(7)299-305. Pendleton, D., Schofield, T., Tate, P., (1984). The Consultation An Approach to Learning and Teaching .Oxford Oxford University Press. While, A.,(2002).Practical skills prescribing consultation in practice. British Journal of CommunityNursing 7(9)469-473. Yoshizumi, J., Harada, T.,(2008) Wake sign an important clue for the diagnosis of scabies. Clinical and Experimental Dermatology (34)6 p 711-714.