Prescribing event?

Abstract

This report provides information on a prescribing event, which is conducted for a 70-year-old woman, who is bed bound as a result of superficial wound on left sheen. The prescribing event is adequately structured to present important details related to patient’s condition, as her holistic needs have been thoroughly considered by the student district nurse, who has been accompanied by her practice teacher during the event. The prescribing decision taken by the nurse related to prescribing a primary dressing and Allevyn Gentle Border as a secondary dressing. It has been identified that this decision is evidence-based considering its extensive benefits, as outlined in research.

Introduction

The purpose of the essay is to describe and critically analyse a prescribing event in which I was involved in my nursing practice. The focus is on providing an evidence-based rationale of the prescribing event.

Confidentiality Statement

As a student district nurse, Mary Brown is allowed access to the records of the client in this case, research subjects and operational business information. Information which is directly related to the client and may include paper records or oral communication is identified as strictly confidential. Thus, Mary Brown is limited to the minimum amount of confidential information that is required to accomplish the intended purpose of the prescribing event.

Description of the Prescribing Event and Analysis of the Situation

The student district nurse received a referral from the G.P. that Mrs D has a wound on the left sheen, is bed bound and needs wound assessment and treatment. The nature of the prescribing event is anticipated because I knew beforehand the reason for visiting the client. Except the student as an active participant in the event, other participants present were practice teacher, patient, and patient’s husband. The case is represented by a 70-year-old, bed bound female, with superficial wound to left sheen. Although the skin around the wound has been identified as extremely dry and fragile, the student nurse has also recognised it is well creamed. Upon assessing the client, no other broken areas have been noticed. Patient is using pads for incontinence, gets carers 4 times a day, has hospital bed and mattress, cushion and a hoist. According to patient’s husband, she scratched the wound’s area and it broke.

In the process of examining the holistic needs of the client, the student has considered the history of the present complaint (Marcum et al., 2010). This included conducting OPQRSTU mnemonic by exploring pain history checklist, such as onset of pain, palliative factors for pain, quality of pain, region of body or area affected, severity of pain, timing of pain, and how it affects ‘U’ in patient’s daily life. The student has clearly differentiated that patient’s complaint is simply a wound rather than a lesion (Tjia et al., 2012).

Moreover, the student has thoroughly explored patient’s past medical history, family history and social history by relying on the cooperation of patient’s husband. Specific question were asked in order to determine patient’s susceptibility to chronic pain and injury. Patient’s exposure to hazards has been determined is minimal considering that the bed bound woman is a non-smoker (Marcum et al., 2010). In this case, the student nurse has decided to prescribe 50-50 Paraffin cream. As part of the medication assessment in the prescribing event, the student asked patient for allergies. However, no allergies were mentioned by client at that point. Other aspects of considering patient’s holistic needs included clinical investigations and physical examination. The student measured patient’s temperature and took a swab for microbiological analysis (Bradley et al., 2007). The physical examination involved careful physical assessment of the wound and wound’s area.

Decision Making and Actions Taken
P. and Tissue Viability Nurse referral has not been indicated because the student nurse has confirmed that the diagnosis is clear and does not need referral. This means that there are no any severe aspects related to patient’s diagnosis. In the decision making process of the student district nurse, certain considerations have been made in an attempt to reach a relevant prescribing decision (Bradley et al., 2007). By concluding that patient’s wound is simple and lacks any signs of severity, the student concluded that the selection of a primary dressing and Allevyn Gentle Border as a secondary dressing is justified because it is evidence-based (Junqueira and Carneiro, 2005). Patient expectations for a fast recovery of the wound have been thoroughly considered by the nurse while making that particular decision for administering specific types of dressings.

It is important to note that the decision of the nurse to prescribe a primary dressing and Allevyn Gentle Border as a second dressing is reasonable considering the wound’s condition which has been determined after professional assessment and careful physical examination (Guarnera et al., 2007). The primary dressing that was prescribed for patient has been indicated as a paraffin gauze dressing. It has important features, such as soft paraffin base, comprehensive size range, and sterile leno weave presentation. The major benefit of the prescribed primary dressing is that it can soothe and protect the wound as well as open up the passage of viscous exudates, which can take place into the prescribed secondary dressing (Chaby et al., 2007). The fact that the prescribed primary dressing is not medicated shows that it can be ideally used with a topical antiseptic of choice.

It can be indicated that the mnemonic EASE has been applied in the decision making process of the prescribing event. The product has been identified as rather effective, as all products from the Allevyn Gentle Border range have been especially designed for individuals with fragile and extremely sensitive skin (Chaby et al., 2007). This type of dressing has a soft silicone gel adhesive, which makes it a convenient option for patient’s condition considering the capacity of the dressing to minimise trauma to the wound when the dressing should be changed. Moreover, this contributes to avoiding patient pain and ensuring adequate care (Guarnera et al., 2007). The effectiveness of the prescribed dressing is evident at its triple-action technology, which contributes to maintaining optimal balance in fluid while the wound is being healed.

The choice of Allevyn Gentle Border as a secondary dressing is an appropriate decision made by the district nurse because the dressing provides optimal comfort to patient and it is easy to be applied and removed. The product is suitable for this patient, as no allergies have been reported during the initial assessment conducted by the student (Chaby et al., 2007). In addition, the use of the prescribed secondary dressing is completely safe, as patient can even take shower without any problem given that the dressing is shower-proof. The prescription is cost-effective, as a box of 10 Allevyn Gentle Border dressings (7.5 cm x 7.5 cm size) costs approximately ?22.44, and a box of the same type of dressings (10 cm x 10 cm size) is approximately ?29.99 (Hurd et al., 2009).

In a research by Hurd et al. (2009), the focus has been on presenting sufficient evidence of the effectiveness of Allevyn Gentle Border. The authors of the research based their evaluation on a multi-centre clinical assessment, which was conducted in 2008. One of the most important conclusions provided by researchers was that this type of dressing was suitable for the specific wound type treated in almost 95% of patients who participated in the study (Chaby et al., 2007). It has been emphasised that patients’ wounds had healed prior to the end of the specified study period. There was substantial evidence indicating a reduction in wound area and depth upon presenting the final assessment of patients. Moreover, there was significant evidence of a reduction in the precise level of exudates in the wound, which applied to the period between baseline and final assessment (Hurd et al., 2009). There was also a visible reduction in the median percentage of devitalised tissue upon concluding the final assessment of patients.

In order to assess the appropriateness of the prescribed dressing, the student district nurse demonstrated the initial consideration that the process of prescribing wound products cannot occur generically. The nurse has determined that this type of dressing is appropriate to patient’s condition. As presented in research, Allevyn Gentle Border dressing is found to maintain moisture, implying the inability of sticking to the wound (Chaby et al., 2007). The prescribed dressing belongs to the group of hydrocolloids. The qualities of hydrocolloid dressings have been considered by the student in providing an optimal healing environment, insulation and autolytic debridement. In terms of outlining the advantages of this type of dressing, it is essential to note that hydrocolloid dressings are impermeable to bacteria and other contaminants (Guarnera et al., 2007). The most important advantage is that they do not adhere to the wound but to the intact skin near the wound. However, a significant consideration should be given to the fact that hydrocolloid dressings are not recommended for wounds with extremely heavy exudates, or in the presence of infection.

The frequency of dressing changes depends on the severity of patient’s wound (Hurd et al., 2009). Yet, it is important to note that the primary dressing should be changed on a daily basis, while the secondary Allevyn Gentle Border dressing should be changed every 3 days (King, 2003). There have not been considerable side effects associated with the use of the prescribed secondary dressing except slight nausea in rare cases.

In the process of negotiating a contract, it is essential to note the aspects of concordance and adherence. The student demonstrated a high level of negotiated concordance in the sense that sufficient information was provided to client including possible side effects, the costs of dressing and the impact on lifestyle. In an attempt to promote greater adherence of client to the prescribed treatment, the student district nurse clearly informed client about the two types of dressings that were prescribed, as well as how to use them and their benefits (Bradley et al., 2007). It has been suggested to both client and her husband to record the time of dressing changes, which served as an additional motivating factor to client to monitor the condition of her wound. The nurse demonstrated her competence in conducting effective communication with client considering that she is from the elderly population, which implies a focus on making the prescribed treatment simple (Hurd et al., 2009). Therefore, the contract between the nurse and client was considered effective in terms of concordance and adherence.

Implications for Future Practice

This event is quite important for my future practice and learning because it has provided me with a relevant opportunity to apply all essential steps of a prescribing event in practice. Such a practical experience in prescribing has made me more self-confident in the procedures required to indicate a properly conducted prescribing event in the future (Bradley et al., 2007). I would follow the same model of prescribing for any future similar situation, as I find it effective and reliable in bringing an optimal treatment option to client. I have extensively focused on client’s holistic needs, as this is considered fundamental in delivering adequate care and make an informed decision regarding client’s complaint (King, 2003). I am prepared to expand my prescribing experience in the future by actively participating in similar events and acting in accordance with strict nursing and prescribing principles outlined in the field.

Reflection

The prescribing event provided an opportunity to learn more about the stages of prescribing and making the best possible decision in a similar situation as the one faced by client. However, I am aware that such a decision may differ upon considering the details of another case, with different aspects of complaints. This means that I should be adequately prepared to encounter different prescribing scenarios (Hurd et al., 2009). I have not experience any major problems during this experience. Yet, I have learned a lot about wound care in relation to this incident. The treatment of this condition may be challenging under particular circumstances especially among the elderly population (King, 2003). Self-monitoring and management of wound may be inappropriately done and thus such individuals may need the assistance of a family member or nurse in order to adhere to the schedule outlined in the prescribing event.

Conclusion

This report provided significant information about a prescribing event in which a student district nurse participated, accompanied by her practice teacher. The prescribing event was based on an incident with a 70-year-old female, who was identified as bed bound due to superficial wound to left sheen. The nurse critically analysed the situation and demonstrated a prescribing decision that a primary dressing should be used as well as Allevyn Gentle Border as a secondary dressing (Hurd et al., 2009). The prescribing decision was adequately justified given that the nurse provided solid evidence of the benefits of using this type of dressing. However, the only limitation considered in this event is that the nurse may not have invested sufficient time to explore the case in detail (Chaby et al., 2007). Despite this limitation, the student expressed an opinion of increased self-confidence that could help her in similar prescribing situations in the future.

References

Bradley, E., Hynam, B. and Nolan, P. (2007). ‘Nurse Prescribing: Reflections on Safety in Practice’. Social Science & Medicine, vol. 65(3), pp. 599-609.

Chaby, G., Senet, P., Vaneau, M. et al. (2007). ‘Dressings for Acute and Chronic Wounds: A Systematic Review’. Archives of Dermatology, vol. 143, pp. 1297-1304.

Guarnera, G., Tinelli, G., Abeni, D., Di Pietro, C., Sampogna, F. and Tabolli, S. (2007). ‘Pain and Quality of Life in Patients with Vascular Leg Ulcers: An Italian Multicentre Study’. Journal of Wound Care, vol. 16, pp. 347-351.

Hurd, T., Gregory, L., Jones, A. and Brown, S. (2009). ‘A Multi-Centre In-Market Evaluation of Allevyn Gentle Border’. Wounds UK, vol. 5(3), pp. 32-44.

Junqueira, L. C. and Carneiro, J. (2005). Basic Histology. Rio de Janeiro, Brazil: Lange.

King, B. (2003). ‘Pain at First Dressing Change after Toenail Avulsion 2: Findings and Discussion of the Data Analysis’. Journal of Wound Care, vol. 12, pp. 69-75.

Marcum, Z. A., Handler, S. M., Wright, R. and Hanlon, J. T. (2010). ‘Interventions to Improve Suboptimal Prescribing in Nursing Homes: A Narrative Review’. The American Journal of Geriatric Pharmacotherapy, vol. 8(3), pp. 183-200.

Tjia, J., Gurwitz, J. H. and Briesacher, B. A. (2012). ‘Challenge of Changing Nursing Home Prescribing Culture’. The American Journal of Geriatric Pharmacotherapy, vol. 10(1), pp. 37-46.