Presentation on theme: "The Prescribing Pyramid Kimberley Tordoff. Aim of the session To appraise the use of the prescribing pyramid in relation to non medical prescribing decisions."— Presentation transcript:
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
ReflectRecord KeepingReviewNegotiate a contractChoice of productWhich strategyConsider the patient The prescribing pyramid
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?
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
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 th_diagram.pdf th_diagram.pdf Nursing & Midwifery Council ( NMC) (2008) The code: Standards of conduct, performance and ethics for nurses and midwives May London NMC
Note for facilitator Divide the class into inter-professional groups Now proceed to Activity on prescribing pyramid
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