The Nursing and Midwifery Council (NMC 2006) inform us of standards of proficiency for nurse and midwife prescribers and includes undertaking an approved educational programme. A case study has been used to demonstrate learning outcomes of the educational programme. It is important to note that accountability and responsibility within the authors NMC (2008) code of conduct meant that prescribing was to be carried out by the decision maker. On completion of the educational programme the author intends to prescribe as an Independent Nurse prescriber.
This case study will maintain patient confidentiality and for the purpose of academic writing will be named Robert as guided by the Data Protection Act (1998) Robert is a 71 year old single, divorced male and lives in a block of flats surrounded by, what he describes as "other drinking friends". He has two adult sons that he gets to see occasionally. He states he feels isolated; he has little money as he is on benefits, does not receive any help with his housework and is struggling to cope. He smokes 40 rolled cigarettes and a 70cl bottle of vodka daily.
Has suddenly stopped his alcohol and is experiencing chest pain. Clinical information was obtained from Roberts’s medical notes, as recommended by Young, Duggan and Franklin (2009) and NMC (2006) to be able to complete an effective consultation for prescribing. These notes also highlighted that Robert had presented to Emergency Department (ED) twelve times in the past year with similar symptoms as on this occasion. A study by Baker, Stallard and Gibson (2013) found that many people frequently attended ED, did so with medically unexplained symptoms. However, conditions were found in studies conducted by Baston (2005), Skinner, Carter and Haxton (2009) found that the top three reasons for frequent presentations to ED were for alcohol, mental health and chest pain. Additionally, Kirby and Dennis (2011) concluded that chronic conditions will present frequently. Ultimately, this may point to Robert becoming a frequent attender with a comparable history of anxiety, COPD, alcoholism, chest pain and being an older adult.
Roberts chest pain was assessed using the mnemonic (SOCRATES) as a tool suggested by Young et al (2009). The pain was to the left side of his chest (Site) which came on this morning (onset). Described as a sharp stabbing pain (character) that radiated to all over his body (radiation). No associated vomiting of fever (association). The pain was there constantly and nothing would relieve it (timing) and using a pain scale, Robert scored the pain as an eight (severity)
‘Red flags’ are described by Young et al (2009) and Merck Manual (2014) as warning signs of a more acute emergency condition. Roberts’s red flags were ‘shortness of breath’ and ‘chest pain’ with a differential diagnosis of acute coronary syndrome (ACS) / Pulmonary embolism. These potential diagnoses were ruled out in the ED using the investigations according to the clinical trust guidelines. Blood tests, investigations and vital signs were recorded as within acceptable limits, with the exception of a heart rate of 110bpm.
Robert is currently taking prescription medications which include Vitamin B Compound Strong Two tablets twice daily, Thiamine 100mg three times daily as directed by the NICE (2010) guidance to prevent the onset of Wernicke’s-Korsakoffs syndrome in patients that are at risk of malnutrition and have alcoholic liver disease. Diazepam 5-10mg as required for generalised anxiety and Warfarin dependent on his INR blood results, anticoagulation for the prevention of blood clots. He does not take any other medications such as herbal, over the counter or borrowed.
The patient consultation and history taking was assessed in parallel with consultation by a doctor. Young, Duggan and Franklin (2009) and Kurtz, Silverman, Benson and Draper (2003) suggest for effective consultations and history taking, a structured approach should be taken and this will