Nurse Prescribing Case Study

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

(DoH, 2005, p8). A diagnosis and treatment plan is agreed on by the independent prescriber and from this the supplementary prescriber can review and amend doses as seen appropriate with the patient. DoH (2005) initially suggested supplementary prescribing was more appropriate for a longer-term setting because an agreed CMP is required prior to prescribing. Nuttall & Rutt-Howard (2011) states many professionals often feel limited in supplementary prescribing as they are boundaried by the CMP. By adopting this outlook, patient’s presentations in the longer-term setting would then be classed as all being uncomplicated and predictable. DoH (2005) reports supplementary prescribing allows clinicians to develop their confidence. By understanding not all patients are the same and that complex cases are common, the supplementary prescriber can therefore exercise skills in observing and reviewing any changes in clients and report back to the independent prescriber in a safe manner and develop their

This paper will demonstrate the author’s ability to prescribe safely from the Nurse Prescribing Formulary (NPF 2009-2011). A prescribing situation undertaken by myself while supervised by my mentor will be discussed. The patients name, address, date of birth and GP details have been changed to ensure patient confidentiality in accordance with the Nursing and Midwifery Council (NMC)(2004). The patient therefore will be referred to under the pseudonym Prince Charming.

Each year, roughly 1.5 million adverse drug events (ADEs) occur in acute and long-term care settings across America (Institute of Medicine [IOM], 2006). An ADE is succinctly defined as actual or potential patient harm resulting from a medication error. To expound further, while ADEs may result from oversights related to prescribing or dispensing, 26-32% of all erroneous drug interventions occur during the nursing administration and monitoring phases (Anderson & Townsend, 2010). These mollifiable mishaps not only create a formidable financial burden for health care systems, they also carry the potential of imposing irreversible physiological impairment to patients and their families. In an effort to ameliorate cost inflation, undue detriment, and the potential for litigation, a multifactorial approach must be taken to improve patient outcomes. Key components in allaying drug-related errors from a nursing perspective include: implementing safety and quality measures, understanding the roles and responsibilities of the nurse, embracing technological safeguards, incorporating interdisciplinary collaborative efforts, and continued emphasis upon quality control.

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

‘Independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, nurse, and pharmacist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing. In partnership with the patient, independent prescribing is one element of the clinical management of a patient. It requires an initial assessment, interpretation of that assessment, a decision on safe and appropriate therapy, and a process for ongoing management. The independent prescriber is

All staff at Gap know that this should be strictly adhered to as the aim of the policy is to protect us and the children against medication errors. The dose and frequency of a child’s medication should be very clearly stated and must always be followed exactly, this is because there is considerable risk of harming a child if they are given medication that has not been prescribed to them or if the medication they do need is given to them at the wrong time or in the wrong amount. If a member of staff were to issue a child with incorrect medicine then they could well face losing their job or end up entering a lawsuit, especially if a child becomes seriously ill.

Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation,

In the UK, nurse prescribing was born out of the need to increase efficiency in the NHS by making best use of its resources. Nurse-led services are one means of improving healthcare provision and a string of legislative change has gradually broadened the scope of nurse prescribing in the UK. (Courtenay et al 2007).

The National Prescribing Centre recognize some fundamental differences in the absorption, distribution and excretion of medicines between adults and children. The differences are published in the National Prescribing Centre’s bulletin, produced by

As clinical site co-ordinator with many years of clinical experience I feel competent in the drug administration via a variety of routes. Generally the patients I attend have become acutely unwell with most prescriptions not having the third eye of a pharmacist and most drugs being delivered intravenously. It is imperative therefore that the prescription and drugs always be thoroughly checked which relies on good communication throughout. Furthermore, most emergency drugs have a protocol for administration developed by the hospital. However within this situation the nurse is generally the last defence before any medication error actually occurs, therefore it is the nurses responsibility to ensure the prescription is correct and to challenge prescription written

The patient is a 76-year-old Hispanic gentleman brought to the ED by his wife because the patient has been anxious for 2 weeks and now unable to sleep much of the night. He denies any chest pain but has had on-and-off palpitations that seemed not to be related to activity or a particular time of day. He denies any shortness of breath, lightheadedness or loss of consciousness. He had two episodes of syncope three years ago. He was diagnosed with having an MI. He was at that time treated at St. Mary's Hospital in Passaic and underwent cardiac catheterization and he has had some stenting done to his coronary arteries. He saw his PMD approximately a week ago who prescribed some sleeping medicine and neurology consult which the patient has

Historically, the American Medical Association (AMA) has continuously contended the progression of nursing practice, in particular advanced nursing practice (Keeling & Bigbee, 2005). They have done so by opposing the advances of nursing practice claiming the broader and more specialized roles of advanced practice nurses (APNs), which includes diagnosing and prescribing, encroaches on physician practice and claim nurses are not educationally sufficiently prepared to take on these roles (Summers & Summers, 2007). The medical profession posits APNs should be supervised by physicians in their advance practice roles. Examples of such opposition are evident in for example AMA’s posting of a recent speech given by Nancy Nielsen (2009) stating

All three providers have agreed that prescribing a pharmacologic and non-pharmacologic treatment regimen must result from clinical judgment based on a thorough assessment of the patient and the patient’s environment, present and past medical history, current home medication, the determination of differential diagnosis and appropriate diagnostic procedure, a review of potential alternative therapies and specific knowledge about the drug chosen and the disease process it is designed to treat (Woo & Robinson, 2016; p.6).

Registered nurse prescribing was introduced in UK and Ireland in response to the public need for access to timely health services.