Transcript The Prescribing Pyramid

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
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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
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• 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
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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
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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 AttributionNonCommercial-ShareAlike 3.0 Unported License. Based on a work at
tiger.library.dmu.ac.uk.
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