Prescription of a Drug for an Ailment for Patient - Case Study Example

Patient Case Study Regarding Prescription of a Drug for an Ailment (Student Name) (University Name) (Instructor Name) (Date) Introduction A prescription is one of the health care programs which take the form of instructions implemented by a medical practitioner or a physician that govern a patient’s plan of care. These instructions are the orders to be executed by a patient, a care giver, a pharmacist or another general practitioner but commonly, prescriptions are known to given orders to take certain medicines (Courtenary & Griffiths, 2010). However, due to the increasing complexity in the field of medical practice and presence of pre-packed manufactured medical goods, prescription has widened to include not just drug prescription but also medical assessment, laboratory examinations and imaging studies in order to optimize the efficiency of the medical practice and the safety of the patients. Where good medical prescribing is not easy, any general practitioner needs to be very careful when giving out one as there are legal implications for giving wrong prescriptions whether it is in the form of under prescription, over prescription, inappropriate prescription or prescription errors (Courtenary & Griffiths, 2010, p.24). According to UK’s General Medical Council document; Tomorrow’s Doctor, all graduate doctors should be acquainted with and be aware of the efficient and secure use of medicines as a basis for prescribing and be competent to write prescriptions for various types of drugs. This is also expected from all other prescribers. In 1999, the National Prescribing Centre came up with what are commonly known as signposts to assist general practitioners and other prescribers to prescribe appropriately. These signposts are in form of seven principles (NPC, 1999). Below is a critical analysis of the prescription provided to Mr. Jones using the NPC (1999) Seven Principles of Good Prescribing: 1. Review of the patient When Mr. Jones, a normally fit and well person developed high temperature, right side chest pain, shortness of breathing, cough and thick green sputum, he sought some medical help. As the first principle of good prescribing as provided by NPC (1999), the practitioner took a full chest exam on Mr. Jones which included measuring of his temperature, respiration and pulse. This is the first step that should be undertaken by any general practitioner before prescribing medication to a patient and is referred to by NPC as, ‘examining the holistic needs of the patient’ (NPC, 1999). This principle involves taking the patient’s medical and social history as a means of thoroughly assessing the needs of the patient. The patient’s drug history involves making references to alternative treatments sought by the patients such as herbal or homeopathic medications, and references to any over-the-counter medicines used. It is also important to ask the patient to provide information about any drug(s) he/she is allergic to or which he/she has ever developed allergy from (Beard, 2010). According to Mr. Jones’ case, the practitioner made use of the first signpost very effectively as the medical history of Mr. Jones was taken where his pulse was found out to be regular and normal body temperature. His drug history was also reviewed where no history of drug allergies was found and he had not sought any other form of medication for the problem he was suffering. However, the practitioners should have assessed the social history of Mr. Jones by asking if he had been involved in any activity which would have contributed to his conditions such as tedious activity involving straining of chest muscles like lifting heavy objects, whether he had ever had an accident where his chest was hurt, heavy smoking or any other relevant activity. Other information that can be required during the assessment include asking the patient when the pain started, which specific part of the body the pain is being felt (by touching the area) and is the frequency or the severity of the pain. 2. Review of consultation model used – Neighbour (1987) Model of Consultation After Mr. Jones had presented his situation to the medical practitioner, the practitioner ought to have asked himself the question of ‘what is the appropriate strategy to take?’ (NPC, 1999) Before giving a patient any prescription, it is important for the prescriber to explore other treatment options other than medicines. In some cases, a patient may want to be given a prescription for other motives other than to gain healing and it is therefore important that a prescription is given only when there is a genuine need for it. In order to ensure prescription is given only for a genuine need, a prescriber can adapt the Neighbour’s (1987) consultation model which provides five check points concerning “where shall we for the next and how shall we get there” (Consultation Models, 2010, p.252). The first step is known as connecting and it involves establishment of a good patient –doctor/prescriber relationship. The doctor/prescriber needs to have good interpersonal relationship skills to enable him/her build a good rapport with the patient. After making a connection, the next step is summarizing and it involves the doctor/prescriber putting down what he/she is hearing from the patient. For this to be achieved, the doctor can use his eliciting skills to enable him discover the patient’s ideas, concerns and expectations. A good example is where the doctor starts up a conversation and then gives the patient a chance to pick up the conversation with much interruption so as to enable him/her to get the problem off the chest. The doctor also needs to summarize back the patients so as to ensure that he has recorded is correct (Models of the Consultation, 2003). Having listened and summarized the patient’s condition, the doctor/prescriber’s next step is to handing over. This means that the doctor and the patient table their agenda after which they both agree up on them. Here, good negotiation and influencing skills are required especially by the doctor/prescriber so that only the genuine agendas for medication are agreed upon. Sometimes a patient may have other medication agendas for medication other than gaining cure such as, getting medicine for a family member or relative; getting medicine because it was recommended to him by a friend; getting medication to legitimize the sick role or even getting medicines as a way to gain attention from family and relatives. Therefore, it is important that only the genuine agendas are achieved (Models of the Consultation, 2003). Safety netting is the next step in the Neighbour’s consultation model. The doctor needs to answer the question of ‘what if’ as a means of ensuring the safety of the patient. Having ensured that he has not missed anything that he ought to have known from the patient, the doctor should give instructions for follow-up where deemed necessary. In addition, safety netting requires use of doctor’s predictive skills to recommend a contingency plan to the patient in case the worst happens. Lastly, after taking the patient through the above mentioned step, the doctor needs to evaluate himself in terms of whether he can be able to handle the next patient. This step is referred to as house keeping (Consultation Models, 2010, p.252). The doctor needs to ensure that he is emotionally, mentally and physically fit to avoid jeopardizing the consultation process for the next patient. In response to Mr. Jones’s case, the Neighbour’s consultation model can be traced especially the fourth step which involves safety netting. The prescriber in Mr. Jones case advised him to return after four days if he didn’t feel better (follow-up), otherwise, he was to return again in one weeks time to review his breathing symptoms unless they had settled (contingency plan). In addition, he was advised on the side effects and the likely allergic reactions of the antibiotics which he was given. It can then be said that the prescriber in Mr. Jones’s case was cautious about the safety of his patient. For the previous three steps; connecting, summarizing and handing over, it can be said that they were also followed (even though not directly mentioned in the case) as Mr. Jones’s personal details are given, a summary of the symptoms and tests done is also given and lastly the prescription given to Mr. Jones is also given. 3. Formation of a diagnosis For any prescriber or a doctor to be able to form the right diagnosis concerning the patient’s conditions, it is important that all the first four steps in the Neighbour consultation model are followed as mentioned above. Formation of diagnosis means coming up with an opinion, a conclusion or a verdict concerning what to do with the patient and it specifically refers to making a decision concerning the prescription to give. The principle third and fourth principles under the NPC Seven Principles of Good Prescribing can be applied. It is important to consider the choice of the product prescribed to the patient in terms of effectiveness, appropriateness, safety and cost. The prescriber should consult sources like NPF, BNF, local GPs and others to ensure that the product being prescribed is effective. Appropriateness of a drug prescribed is achieved by tailoring the prescription to meet individual patient’s needs (NPC, 1999). Special caution should be taken on the age, medical history, physical condition and others when administering a prescription. Adverse drug reactions (ADRs) should also be noted and it is the GP’s responsibility to ensure that they are reported to the Medicines Control agency. Once a patient has reported an ADR, he should report to the practitioner who prescribed for him so that appropriate course of action can be taken. To ensure that a prescription is cost effective to the patient, it is important that the prescriber uses the drug generic name as specified by NPF (Information and Guidance on prescribing in General Practice, 2006). The fourth principle involves negotiating a contract as prescription is a concordance between the patient and the prescriber (NPC, 1999). Every prescriber should recognize that the patient has a central role in making decisions concerning the prescriptions to be administered. According to the UKCC document, Guidelines for Professional Practice, the prescriber should effectively communicate to and make the patient understand what the prescription is for, how to take it, what is the dosage, how long it takes to work, and its possible side effects. After effective communication has taken place between the patient and the practitioner, it is then possible to make an informed treatment decision which is the basis of formation of a correct diagnosis (Information and Guidance on prescribing in General Practice, 2006). For the correct diagnosis to be achieved in Mr. Jones’s case, the doctor/prescriber have made sure that he exhausts all the relevant information concerning Mr. Jones’s health . Other than getting the information concerning his physical fitness, his age and the symptoms he was experiencing, the doctor could have ‘dug’ deeper for more information such as, when and how the pain started, past experiences with chest problem, family background concerning cardiopulmonary disorders and other relevant information. This forms part of patient assessment where the cause of the pain can be easily identified. After assessing Mr. Jones, the doctor would have tried to make a connection between the symptoms described by Mr. Jones and the clinical picture of signs and symptoms associated with causes of chest pain. Furthermore, the doctor would have informed Mr. Jones what were the possible causes of his illness so as to facilitate Mr. Jones to understand the prescription he was given. 4. Justification of the therapeutic decision The therapeutic or rather the healing decision taken by Mr. Jones’s doctor was to give him amoxicillin 250mgs tablets for one week. Any therapeutic decision taken by a general practitioner should balance between potential benefits of the treatment and safety concerns of the patient (NPC, 1999). It should also be guided by the NPC seven principles of good prescribing. The therapeutic decision taken in Mr. Jones’s case can be justified as follows; To begin with, the prescriber conducted a patient assessment on Mr. Jones where his personal information was gathered, the symptoms he was experiencing were identified and clinical examinations and their results were given. The first NPC (1999) principle of good prescribing was effectively executed combined with first three steps in Neighbour’s consultation model; that is, connecting, summarizing and handing over. Afterwards, the prescriber gave Mr. Jones a prescription which can be justified as being cost effective (amoxicillin is a cheap OTC medical product), appropriate for the patient’s condition (amoxicillin is an effective antibiotic for relieving chest pain) and effectiveness of the product was considered assuming that the prescriber was aware of all prescribing policies and regulation as per the NPF, GPs and other local prescribing guidelines and policies. Another justification is that the safety of the patient was considered as Mr. Jones was advised on the allergies and side effects he was likely to experience. Furthermore, he was given a contingency plan where he was supposed to return after four days if he did not get better and after one week to review his breathing symptoms if they would not have settled. 5. Reflection model used According to the UKCC Code of Professional Conduct, it is important for general practitioners to reflect their prescribing decision so as to help improve their prescribing knowledge and practices. Gibbs’s Reflective Cycle gives six steps which can aid general practitioner in the reflective practice. The first step is description of what happened during the prescription process, the followed by reflecting on the feeling which were present. Evaluation then follows where by the practitioner reflects on what was good and what was bad about the prescribing experience. An analysis of the experience is then done. It involves analyzing if there is any sense that can be made out of the experience. Based on the finding of the analysis, a conclusion can then be made concerning the whole prescribing experience including making a conclusion of what else one could have done apart from what was done. The cycle is summarized by drawing up an action plan of what can be done next time if such a situation or a similar one occurs in future. Conclusion In every therapeutic intervention, the general practitioner should always ensure that a balance is achieved between the benefits of the intervention administered and the safety concerns of the patient. Prescription of drugs is a very important part of treatment and the prescriber should ensure that a good prescription is administered to the patient, even though a good prescription can be hard to achieve at times. However, for a practitioner to be able to achieve a good prescription with ease, the principles of good prescribing as provided by NPC (1999) should be adhered to by the practitioners combined with Neighbour’s model of consultation and Gibbs’s model of reflection when prescribing a drug to a patient. It can therefore be concluded that a good prescription was achieved in Mr. Jones’s case as the prescriber in question clearly addressed the potential benefits of the prescription givens and the safety concerns of Mr. Jones. References Aronson, K. (2006). A Prescription for Better Prescribing. British Journal of Clinical Pharmacology , 487-491. Beard, M. (2010). Assessment and Management of Patients with Chest Pain. Retrieved Ocotber 31, 2010, from http://www.swarh.com.au/UploadRegionalEd/378586615Management_of_the_Acutely_Ill_Patient.pdf Consultation Models. (2010). 249-257. Courtenary, M., & Griffiths, M. (2010). In Independent and Supplementary Prescribing: An Essential Guideline (pp. 23-25). Cambridge University Press. Danni, R. (2009). Patient Assessment. Retrieved October 31, 2010, from http://www.mapharm.com/pat_assessment.htm Information and Guidance on Prescribing in General Practice. (2006, March 26). Retrieved October 31, 2010, from British Medical Association. Models of the Consultation. (2003). Retrieved October 31, 2010, from SkillsCascade.com: http://www.skillscascade.com/models.htm NPC. (1999). Signposts for Prescribing Nurses - General Principles of Godd Prescribing. Prescribing Nurses Bullentin , 1-4. Read More