A non-medical prescription for an insect bite

 Non-medical prescribing has become an important aspect of the manner through which individuals are better able to ensure that they receive healthcare more effectively. It is an effective way of making sure that nurses play a more prominent role in patient care because they are able to handle a diversity of problems without necessarily having to consult medical practitioners, a process that can be extremely time consuming (Black, 2013). The patient that is to be seen is one that received an insect bite some four days ago and since that time, she has had the skin surrounding swollen and it has not only become painful and hot to the touch, but it has also become red. The pain has continued to be worse and it has spread throughout her leg; a situation that needs to be taken very seriously. The prescription for the condition was written by a very qualified prescriber and this was because it involved a situation where there was need to ensure that the best interests of the patient were considered. Furthermore, the extent of the consequences of the bite promoted a situation where there was need for the most qualified individual to prescribe the medication because through such an initiative, it was possible to cater for the needs of the patient. However, there was also need to ensure that there was the involvement of the non-medical prescriber in the prescription process because it would not only have provided them with the experience necessary to ensure that they handled similar situations in future, but it would also have enhance efficiency in healthcare provision in such a way that only the most serious cases were referred to the general practitioner.

The names of the patient, clinician, and healthcare institution in this study have been changed in order to maintain the privacy of all the individuals involved. This is based on the guidelines provided by the NMC to ensure that there is the professional handling of cases (NMC, 2015; Pearce & Winter, 2014). The case of the patient is one that needs to be handled in as confidential a manner as possible because it allows the individual to have greater confidence in the caregiver. Furthermore, it is essential to make sure that the care process of the patient is conducted in such a way that there is the advancement of their interests at all times because it is through this process that it becomes possible to ensure the creation of an environment where the patient is able to become more forthcoming concerning the issues that are plaguing them. Moreover, confidentiality in the treatment process allows for better patient outcomes since the nurse is able to better handle the patient under their care with more attention that is essential in making sure that the treatment process is conducted effectively. The achievement of this goal cannot be underestimated because it makes it possible for the nurse to develop a closer relationship with the patient which is critical in ensuring that the treatment is conducted effectively enough. This paper will be structured in such a way that a diversity of issues concerning non-medical prescribing for an insect bite will be addressed. Among these will be the following: the assessment approach selected, a justification for the therapeutic intervention, a critical discussion of the evidence, a discussion of the non-pharmaceutical interventions, and legal and ethical issues.

Assessment of the Patient

The patient, Mrs. S stated that she was concerned that her condition was not getting better and had become very worried three days after the insect bite that the affected area was actually getting worse. Upon being questioned, the patient complained that she had been suffering from malaise and that she had instances where she either felt very hot or very cold. Furthermore, despite the considerable discomfort that she was feeling, she reported that she managed to consume food and drinks normally. She was an individual that lived with a husband that did not smoke, and she personally only took alcohol occasionally. Moreover, she was an individual that did not have any medical history that was relevant, and never consumed any drugs that were not prescribed. She also stated that she did not have an adverse of allergic reaction to any drugs that had previously been prescribed for her. It is essential to make sure that the social, medication, medical, and allergy history of the individual is undertaken because it ensures that there is an avenue through which to address a variety of complaints. Furthermore, it ensures that there is the development of key information that can be made use of to effectively bring about the prevention of errors in prescriptions. It also prevents instances where non-medical practitioners end up overlooking key information that is necessary to help in the maintenance of patient safety. Helping the patient to get the best outcomes involves getting as much of their history as possible for that a clearer picture of their condition can be established in the process of prescribing.

It is pertinent that there is the establishment of trust between the patient and the practitioner from the outset in order to help in the faster giving and reception of information between them. In the case of Mrs. S, the practitioner maintained eye contact, while at the same time making use of open questions to ensure that as much information as possible was given (Latter, Maben, Myall, & Young, 2007). Furthermore, there was a process where there was the summarizing of the history that had been provided by the patient through the use of clarification points, which helped in making sure that nothing of importance was missed. The latter process also provided the patient with an opportunity to add any information that she felt pertinent or that she had not yet disclosed; helping in the development of a clearer portrait of her medical history and how it could have an effect on her prescription. Moreover, the practitioner also made use of closed questions on occasion, especially when there was need to obtain more specific information that was related to the information that had already been provided. This is advisable because it ensures that the practitioner is able to obtain more specific information following the patient becoming relaxed in their presence; resulting in their being more open. It is essential that an effective communication strategy is developed because it helps to enhance the information that the patient supplies and allows for a more effective diagnosis of the medical condition. The achievement of this goal helps in the development of prescriptions in a more efficient way.

Justification for Therapeutic Intervention

Prior to the development of a final diagnosis, it was essential to ensure that there was the exclusion of differential diagnoses. The latter were deep vein thrombosis (DVT) (Thompson, 2015) or venous eczema but these were not considered because the case of Mrs. S was one that involved an insect bite. Such a straightforward history, in addition to the examination findings as well as her observations showed that an alternative diagnosis had to be reached. The working diagnosis that was arrived at was cellulitis, which was considered to be the most likely condition that the patient was suffering from. The entire process of examination and determining the condition was one that had to be handled carefully because there are instances where wrong diagnoses tend to end up leading to the provision of wrong prescriptions. Therefore, it was necessary to make sure that there was the development of a situation where the diagnosis was conducted in such a way that kept the patient’s interests at heart at all times. Moreover, the diagnosis of cellulitis to the exclusion of all others was an important step because it allowed the practitioner to begin the process that would bring about an effective therapeutic intervention. Under such circumstances, it became necessary to make an analysis of cellulitis, especially its origins, so that it could be possible to bring about a situation where there was an effective prescribing process.

Cellulitis is the infection of the skin and the subcutaneous tissue which is brought about by bacteria and can have some serious consequence on the individual affected (Pasternack & Swartz, 2015). It is brought about by a diversity of bacteria, the most common among which is streptococci and staphylococcus (Karppelin et al., 2015). Moreover, this condition tends to affect a specific number of areas in the body including the face, the arms, and legs, but there is often a potential that it might come about at any part of the body. While a definitive antibiotic regime for the curing of cellulitis has yet to be found, it is essential to note that studies have shown that most antibiotics cure between 50% and 100% of bacterial infections. The selection of the correct antibiotic was aided by the antibiotic guidelines that are updated annually because they include a classification system which ensures that there is the advancement of a situation where there is the advancement of a situation where there is effective prescription. Furthermore, the correct dose, duration, and route are also provided for in the guidelines, which ensure that the treatment of cellulitis is conducted in such a way that there is the promotion of the interests of the patient. The achievement of this goal ensures that there is the creation of effective prescription in such a way that the patient will achieve full recovery in the fastest time possible. In the case of Mrs. S, the guidelines of the treatment of cellulitis advised oral flucloxacillin as a first line of treatment (Brindle et al., 2017). This drug was to be taken thrice a day and it was expected to be effective because it is a moderately narrow spectrum antibiotic that is means specifically for the treatment of cellulitis.

Discussion of Evidence

The evidence shows that the therapeutic intervention was one that would be extremely effective because the prescribed antibiotic is made specifically for the condition diagnosed. However, despite the prescription, the option of not having any medication was discussed with Mrs. S because it was essential to consider the potential side effects that flucloxacillin might have on her. A result of this situation was that she did not want to stay without any medication and instead stated that it would be better if she had some medication to cater for the various problems that she was having as a result of her infection. Involving Mrs. S in considering her treatment option ensured that she was able to gain the confidence of the practitioner because it allowed for her ready acceptance of the recommended treatment. Therefore, the flucloxacillin was prescribed and there was the clarification of the dose and duration before the patient was discharged (Quirke, O’sullivan, Mccabe, Ahmed, & Wakai, 2014). The last action was undertaken with the hope that the patient would, because of being involved in the decision making process concerning treatment, undertake to make use of the prescribed antibiotics in concordance with the requirements. The negotiation and agreeing with patients concerning their management plan is an essential aspect of patient-centered care because it ensures that there is the advancement of their interests while at the same time improving the care of the said patient. Having received training in non-medical prescribing, the practitioner was able to further recommend the use of paracetamol tablets because it had both analgesic and anti-pyretic properties that were essential for helping the patient attain a level of comfort. The patient was also given the responsibility of getting the prescription on her own because it allowed her to realize the responsibility that she had towards herself while at the same time enabling her to get a better understanding of the use of the prescribed drugs following her taking the prescription to the chemist. There patient was required to return to in case she saw that her situation had not improved after several days for follow up and further assessment of her condition.

The ability of the non-medical prescriber to undertake the task of making prescriptions can be considered pertinent to the enhancement of patient care. This is because it involves a situation where there is need to ensure that there is not only patient consent, but also the creation of strong initiatives aimed at bringing about the swift treatment of the patient (Cope, Abuzour, & Tully, 2016). The case of Mrs. S can be considered essential in showing the manner through which the practitioner can be able to not only make an effective diagnosis, but also undertake prescribing to bring about an end to such symptoms. The achievement of this goal ensures that there is the patient does not end up spending too much time waiting for the presence of a medical practitioner while at the same time promoting a situation where the patient is able to receive the best care possible. A diagnosis of cellulitis and recommendations made for its treatment through the use of antibiotics have made it possible for the non-medical prescriber to show the considerable role that they can play in prescribing. This is because the practitioner was able to question and receive answers from the patient concerning their condition and medical history, and make use of the information received to provide a prescription. Such an undertaking is pertinent to the creation of a more effective non-medical prescribing environment because it allows the practitioner to empower the patient through the provision of advice and information to the patient. It was also essential to ensure that there was the development of concise documentation of the consultation process in addition to the decision to make the prescription because it can be used for further reference in case Mrs. S’s condition does not improve. It was also important that Mrs. S’s stay in the hospital was made as short as possible and this was to such an extent that once her prescription was ready, she was immediately discharged. This decision was also based on the fact that Mrs. S’s condition could be easily treated from home because the insect bite had not hindered her mobility, and had instead only developed a bacterial infection that could be treated using an antibiotic.

Conclusion

The case of Mrs. S above has shown the importance of making sure that there is effective communication during the consultation process with patients. This is because it provides structure to the consultation and allows the non-medical prescriber to develop an idea concerning the best way through which to handle a diversity of situations in both the current and future practice. The practitioner is also able to gain a better understanding of how to handle such cases that are rarely reported as insect bites. Insect bites tend to be rarely reported unless the condition involved becomes serious or the individual involved suffers from an allergic reaction or an infection. Therefore, it becomes possible to learn more about insect bites and the possible infections that might come about as a result, such as cellulitis, which ensures that there is the gaining of useful experience that can be used in handling similar cases in future. Thus, there is the development of more effective means of administering appropriate treatment by the non-medical prescriber while at the same time reducing incidents of the incorrect prescription of antibiotics and other drugs.

 

 

 

 

 

 

 

 

References

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Brindle, R., Williams, O. M., Davies, P., Harris, T., Jarman, H., Hay, A. D., & Featherstone, P. (2017). Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis. BMJ open, 7(3), e013260.

Cope, L. C., Abuzour, A. S., & Tully, M. P. (2016). Nonmedical prescribing: where are we now? Therapeutic advances in drug safety, 7(4), 165-172.

Karppelin, M., Siljander, T., Haapala, A.-M., Aittoniemi, J., Huttunen, R., Kere, J., . . . Syrjänen, J. (2015). Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study. European Journal of Clinical Microbiology & Infectious Diseases, 34(4), 669-672.

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NMC. (2015). The code: professional standards of practice and behaviour for nurses and midwives. London: NMC.

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Pearce, C., & Winter, H. (2014). Review of non-medical prescribing among acute and community staff: Chris Pearce and Helen Winter describe a survey that highlights a need for greater support of non-medical prescribers. Nursing management, 20(10), 22-26.

Quirke, M., O’sullivan, R., Mccabe, A., Ahmed, J., & Wakai, A. (2014). Are two penicillins better than one? A systematic review of oral flucloxacillin and penicillin V versus oral flucloxacillin alone for the emergency department treatment of cellulitis. European Journal of Emergency Medicine, 21(3), 170-174.

Thompson, A. E. (2015). Deep vein thrombosis. Jama, 313(20), 2090-2090.