The Patient Arrived On Time For Her Session

When Jill arrive back in North Carolina she called Dr. Smith office and was told she needed an appointment before she could get medication. The next available appointment was in 4-days. Jill than showed up in person at Dr. Smith office to try to get a prescription. The reception explained that there policy was to make an appointment for prescription refills and it was her responsibility to know there policy. Jill’s Primary care finally wrote her a prescription, however when she went to fill her prescription and her insurance declined the prescription because it was already filled in Boston the day before. The pharmacist resolved the situation and filled Jill’s prescriptions. The lack of effective communication with his patient was responsible for her medication crisis. The system level failures were the lack of communication by all parties involved in Jill

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

I have gained full consent to use this lady as my patient in my care study. Consent is important as you must always gain permission from the patient in regards to their care plan and keep them fully informed. ‘It is vital that the person consents before any treatment, care, examination or assessment’ (Brooker et al., 2007, p.157). ‘Confidentiality is a fundamental part of professional practice that protects human rights’ (NMC, 2008). To maintain my patient’s confidentiality throughout my care study I am going to call her Annie. Annie is a 72 year old lady whose care I have been involved with on placement. Annie’s medical history included; previous left hip replacement, osteoporosis, high blood pressure, high cholesterol and

D-This writer met with the patient upon her request to complete the dose change request form to lower her dose as the patient experience she wants to start tapering off methadone as the patient haven't used any illicit drugs for several months. This writer completed the dose change request form with the patient pressence and also, assessed the patient that she has not experience any withdrawals since prior increase based on her order history. The patient denies any cravings and withdrawals. Furthermore, while completing the request, this writer learned that the patient is prescribed with Albuterol inhaler and strongly urges the patient to bring in the RX script tomorrow. The patient complained that no one has ever told her of this and this

The writer inquired from the patient about what will work for him for the sake of the patient to take his recovery serious. According to the patient, he did not have a logic answer, besides the clinical intervention that was already implemented. The patient reported that he haven't used for nearly a month; however, his recent UA dated on 9/25/2017 was positive for opiates and cocaine. The patient deny relapsing, but the writer shared with the patient with regard to his past UA results as to how this result is incorrect. No response from the patient besides, " I am

D-The patient reports she is stable on her current dose and haven't experienced any withdrawals and/or cravings. The patient further mentioned that work is going okay, but still exploring other job opportunities. This writer provided positive feedback towards the patient's recovery process. In addition, the patient reports she has to do a pneumonia test as it was suggested by her PCP today. This writer requested for the patient to detailed if she's experiencing any symptoms and would like to consult with the clinic medical doctor. Based on the patient, she reports she was experiencing some backaches, but now, feels okay. During the remainder of the session, the patient discussed her plans for the Easter holiday and also shared with this writer that today is her son birthday.

The patient arrived on for his counseling session. Reports stability on his current dose and denies the need for a dose increase or decrease when offered by the writer. The patient was made aware that he will be reassigned to counselor, Scott effectively immediately as his new assigned counselor will schedule his next session. The patient reports of no update with his medical pertaining to a referral to another PCP as he is currently still seeing the same medical provider.

D-This writer was advised by the front desk to meet with the patient immediately as she is causing a scene in the lobby area because she's upset that she could not smoke outside of the clinic for 5 minutes. Upon meeting with the patient, she would sit down and then gets up and began to pace in the office in tears as she vents her frustration. This writer attempts to calm the patient to listen as to what is upsetting the patient. The patient then shout using profanity about the Clinical Director, Program Director and Nursing, by saying, " Fuck Heather E., Fuck Carol, and Fuck Jacob." This writer immediately address the profanity and advised the patient to stop because that type of language is unacceptable. The patient response was, " Why should I care.

D-The patient arrived on time for her appointment and this writer apologized for meeting with the patient late as this writer was meeting with another patient prior, which interefere with this patient appointment time. The patient was clearly understanding and waited patiently. Reports stable on her dose. Denies cravings/withdrawals. However, the patient is still actively using and reported, it has nothing to do with withdrawals or cravings. The patient is unable to provide a proper reason for her use, besides shrugging her shoulder as she says, " i do not know why." Patient last used was yesterday, cocaine- $40 worth. The patient then reported, she only uses cocaine less then once a month. This writer addressed alternatives.

D-According to the patients she has a surgery on 04/22/2016 for stems in both legs. The patient signed an ROI for Dr. Vandisht for this writer to contact the doctor to obtain a letter stating that the patient can inf fact dose on the day of her surgery. The patient showed this writer with some improvement of her hand with a condition she is unfamiliar that her dermatologist gave her an ointment that cleared her skin. The patient is scheduled to see her dermatologist on 04/29/2016. The patient spent the session discussing an issue with her Fern Manor and its staff members. The patient then signed a ROI for her Pulmonary Doctor. There's still no communication with her older daughter, but the patient still reaches out to her daughter.

This writer received a call from the dosing window by Nurse Joann while in session regards to Elizabeth and having a scar under her eye. Upon meeting with Elizabeth, she appeared to be unease that she could not dose. This writer strongly advised the patient to calm down as this writer needs to gained clarification from the Nurse as to what is going on. There is concern about the scar under the patient eye; however, the patient proclaims that she is clumsy and fell down. The nurse informed the patient about the need to speak with the on call doctor for an order to be put in place in order for the patient to dose. Based on the nurse comment, the patient was getting upset and bit emotional. This writer then questioned the patient in order for

D-Met the patient. Please note the patient had dose early during the day and attended the cocaine group. The patient updated this writer on the suggestion she was dealing with yesterday with her new relationship and thank this writer for the advice. She says, " Man, everything is good now...I am good, Charlene." She then discussed her experience at the cocaine group whereas she described it as "okay." She dislike the fact that a patient in the group was making comments about her appearance, but according to the patient she handled the situation well without having an outburst, she only feels that the facilitator could have intervene when the other patient was being disrespectful, but overall the group was "okay" as the patient reported. The

2.What are two questions you would ask in relation to the substance abuse of this patient?

The patient arrived on time for the counseling session. Reports feeling unstable on her dose and requested for a dose increase of 5mgs. Please note, the patient relapse last night and her relapse use listed above this header. According to the patient, she reported the following withdrawals: cramping in the stomach, backaches, feeling sick, chills. and sweats." This writer completed the HCRC internal form for a dose change and questioned the patient as to how long she has been dealing with the withdrawals and her response was, " Couple of days." This writer then says, " Edna, if you were feeling this way since last week, you need to report it immediately to avoid a relapse."

D-The patient requested an increase on her dose as she reports that she is experiencing chills. When asked as to what alternatives has done to address the chills rather than using illicit drugs. The patient reports she's been taking each day at time and used relaxation techniques; however, at times the "chills" can be unbearable to the point the patient does not want to relapse because she's been drug free for over a year, at which this writer provided positive feedback for the patient recovery process. Furthermore, this writer and the patient discussed the suspension of the patient take home bottles as the patient reports that the reason why the bottles were suspended was due to her medication; however, the patient reports she provided the clinic with an updated letter from her psychiatrist and notification that she is no longer prescribed with Hydroxyzone and wants to apply for all of her take homes. This writer addressed with the patient about program policy about medication/take home bottles. Furthermore, two of the patient's medication needs an updated RX script before the patient request can be reviewed. Also, a letter from her psychiatrist once again about the patient compliance with treatment and medication management. The patient reports she can get the updated script by next as this writer will assist obtaining an updated letter from her psychiatrist about the patient's overall treatment. This writer completed the dose change request form to increase the patient's dose by 5mgs.