The Prescribing Pyramid Kimberley Tordoff Aim of the

The Prescribing Pyramid Kimberley Tordoff

Aim of the session • To appraise the use of the prescribing pyramid in relation to non medical prescribing decisions

Learning Outcomes By the end of the session learners will be able to Knowledge • Describe the seven principles of good prescribing • Describe the concept of the prescribing pyramid Skills • practice using the prescribing pyramid • challenge other members of the multi-disciplinary group on decisions Attitudes • Continue to build up relationships with their peers through group work

The prescribing pyramid Reflect Record Keeping Review Negotiate a contract Choice of product Which strategy Consider the patient

1. Consider the patient… The Consultation • Prepare as much as you can & establish rapport • Identify reasons for consult • Explore the patients Ideas, Concerns and Expectations of the problem (ICE) • Obtain essential information • Impact of problem of the problem • Differential diagnoses • Re evaluate information, ensure shared understanding, consider more tests, and interpret results for diagnosis • Decide treatment options discuss with patient, Q&A • Summarising, terminating the consultation, writing-up

1. Consider the patient • WWHAM! What's Wham got to do with it? Who is it for What are the symptoms How long have the symptoms been present Any action taken Medication What information would you want to know about the patient/symptoms

The determinants of Health • • • Age, sex, hereditary factors Lifestyle factors Social & community networks Living & working conditions Socio-economic, cultural & environmental conditions Dahlgren & Whitehead 1991

Medications Drug History and Allergies • Ask patient to list medications they are on, or show their repeat prescription, or bring in their meds. • Ensure you have a written record in your notes of the name, dose, frequency and route. • Are they actually taking them as prescribed? • Enquire about Over The Counter (OTC), herbal and illicit…you may be shocked! • Any allergies or reactions to meds or foods or environmental factors and record them and any treatment given.

2. Strategy • Is diagnosis established? • Is there a need to prescribe? • Is referral elsewhere indicated? • What does the patient expect?

3. Choice • Appropriate • Effective • Safe • Cost “Sign, " © 2011 Adam Williams, Used under a Creative Commons Attribution-Noncommercial-Share. Alike 2. 0 Generic license: http: //creativecommons. org/licenses/by-ncsa/2. 0/deed. en_GB • Acceptable

Safety Issues • For any given therapeutic intervention, the potential benefits of the treatment must always be balanced against the known safety concerns.

Avoiding Adverse Drug Reactions • • • Use as few concurrent drugs as possible Use the lowest effective dose Check if patient pregnant or breast feeding Is the patient at extremes of life? Do you know all of the drugs that the patient is taking • Check for Over The Counter medicines • Drug allergies or previous reactions to medications

4. Negotiate • Concordance • Compliance • Medicines adherence

Review • Where • When • How • Who

Record • Why is it important • What are the barriers to this in practise

Record Keeping Guidelines • • • Accurate Legible Unambiguous Contemporaneous Relevant Enough to enable other professionals to provide effective care Dated, timed and signed Practitioners must not tamper with original records in any way Electronic records are clearly attributable Kept securely (NMC, 2008)

Reflect • On your prescribing decision • On the episode as a whole • Discuss with colleagues

References Dahlgren & Whitehead (1991) Social Model of Health www. nwci. ie/download/pdf/determnants_heal th_diagram. pdf Nursing & Midwifery Council ( NMC) (2008) The code: Standards of conduct, performance and ethics for nurses and midwives May London NMC www. nmc. org. uk

Note for facilitator • Divide the class into inter-professional groups • Now proceed to Activity on prescribing pyramid

This work was produced as part of the TIGER project and funded by JISC and the HEA in 2011. For further information see: http: //www. northampton. ac. uk/tiger. This work by TIGER Project is licensed under a Creative Commons Attribution. Non. Commercial-Share. Alike 3. 0 Unported License. Based on a work at tiger. library. dmu. ac. uk. The TIGER project has sought to ensure content of the materials comply with a CC BY NC SA licence. Some material links to third party sites and may use a different licence, please check before using. The TIGER project nor any of its partners endorse these sites and cannot be held responsible for their content. Any logos or trademarks in the resource are exclusive property of their owners and their appearance is not an endorsement by the TIGER project.