ESSAY GUIDANCE

FRONT SHEET

No Names please SID Number Title is:-

Case Study of an
Independent
Prescribing Episode Page Numbers
Include Word
Count +10% or –
10%
Student Declaration

By submitting this assessment, I confirm that:

Throughout this essay, the names of patients, clinicians, health and social care
organisations have been omitted or changed to maintain confidentiality as per NMC,
HCPC or GPhC and University of Suffolk requirements.

The NMC, HCPC and GPhC and UK legislation state that only a current registrant with
annotation for Independent and/or Supplementary Prescribing may prescribe. I therefore
confirm that whilst this essay has been written from the perspective of a prescriber. The
actual prescription issued for this consultation was written by a qualified medical or non-
medical prescriber.
FORMATTING

• 1.5 or double spacing

• Font size should be 11 for main text - larger and smaller font
sizes are permissible for headings, titles, labels, and text
within diagrams
• Type face is discretionary but should be easily read (e.g.
Arial, Calibri)
•A critical case study in essay format which incorporates
the assessment, clinical reasoning and differential
diagnosis of an Independent Prescribing Episode
•2500 words
•In a nutshell
•Clinical reasoning describes
the thinking and decision
making processes associated
with
•Clinical practice
Marking Template Polly.docx
LEARNING OUTCOMES
ON SUCCESSFUL COMPLETION OF THIS MODULE, A STUDENT WILL BE ABLE
TO:

•Critically evaluate the consultation focusing on key

concepts involved in undertaking a systematic patient
centred assessment to enable appropriate decision-making
including diagnosis informed by the relevant evidence
base
•Critically appraise the management options in a range of
clinical scenarios whilst demonstrating the application of
knowledge related to pharmacology
•Evidence a commitment to partnership and collaborative
working with a range of service users
•Synthesise and evidence the ability to prescribe safely
effectively and within the boundaries of all relevant legislation
and guidelines including supplementary prescribing
•Critically reflect on the requirements to provide
comprehensive, relevant and accessible information to
patients/carers to support prescribing decisions
•Evaluate the prescriber’s responsibilities in relation to monitoring and
review processes
• Critically evaluate the role of the prescriber in relation managing risk
and maintaining safe practice
• Critically apply the legal, regulatory and ethical frameworks to
prescribing practice
•Demonstrate critical self-awareness of own prescribing practice and a
commitment to the on-going improvement of all prescribing practice
•Demonstrate collaborative and interprofessional working to support
and inform prescribing practice
 • Assessment regulations
•The Framework and Regulations for Undergraduate /
Integrated Master’s / Taught Postgraduate Awards and other
policies relating to assessment can be found on MySuffolk.
•You should ensure you read and understand these regulations.
The Course Team strictly adheres to these regulations and it is
advisable for you to become familiar with the terms used.
Maximum Word Count: 2500 words (+ 10%) Please include your word count on your title page

Your work must be submitted in the following format: Microsoft Office Word

You are required to submit your work: via this assessment portal by 12.00 on the 29th July 2023

Anonymous Submission: Yes

Please refer to the marking rubrics in your course handbook

We are aiming to give you provisional feedback by 25/08/2023

Your ratified results should be available within 10 working days of the Exams Board which is TBC. If you are unsuccessful in your first
attempt the Board of Examiners may consider awarding a re-submission opportunity

Extensions can be applied for 7 days from our academic administrator : a.cox5@uos.ac.uk

The date for the coursework re-submission/exam resit is: TBC after the Examination Board meets
 • Referencing

•It is essential that all academic work be fully referenced.

Here at the University of Suffolk we recommend that
referencing should follow the principals of the Harvard
Referencing style. The library have produced a range of
leaflets to help you reference and cite materials you use in
your assignments; you will also receive a taught session
about referencing academic work.
•http://libguides.ucs.ac.uk/academicskills/referencing
•
COMMON MISTAKES

• Not supporting statements and/or citations with

references – Think who said this?
• Not explaining things – Think the marker/reader
doesn’t know what you mean
• Using abbreviations – Think does the reader
know what UTI is? If you are going to
abbreviate – write the sentence Urinary Tract
Infection (UTI) out once and then you can
abbreviate it throughout.
• Being too chatty – you have a limited word
count.
 Using colloquialisms – i.e “thinking outside of
the box” – “window of opportunity” “ kick
the bucket”

 The reference for the BNF is : Joint Formulary

Committee (2021) British National Formulary, 81,
March-September 2021. London: BMJ Group and
Pharmaceutical Press. Joint Formulary
Committee. It isn’t BNF.
 Use the online library Academic Skills
and access our librarian Remember this assignment is fine graded – 50%
pass at level 7 Masters Level

Please use spelling and grammar check or

Editor on your computer and proof- read your
work or ask someone else to proof -read it.
EXAMPLAR EXCERPTS
•The following is a case study of an independent prescribing episode in a primary care setting and is
structured around the Royal Pharmaceutical Society Competency Framework for all Prescribers
(2016). The case study will out-line the assessment undertaken, diagnosis reached exploring
differential diagnosis, and clinical reasoning for the treatment path chosen. The evidence to support
the treatment choices will be critically examined.
•In considering differential diagnosis concerning constipation it is
essential to consider whether there is evidence of physiological or
anatomical causes before diagnosing idiopathic constipation (NICE,
2020a). Following assessment there were no anatomical concerns of
note and no red flags present. However, Amber flags of faltering
growth and concerns regarding wellbeing were present. The NICE
(2020a) guidance goes on to suggest liaison with specialist teams to
arrange screening for Coeliacs disease and hypothyroidism. Blood
tests were requested for a coeliac screen and thyroid function,
without specialist referral at this stage with a plan that referral
would be made if indicated by serology results. FBC, glucose and
vitamin D levels were also requested due to poor dietary intake, and
considering parental concern regarding tiredness.
•There is a greater prevalence of coeliac disease and
hypothyroidism in children and adults with downs syndrome.
NICE Coeliacs guidance (2020b) considers downs syndrome as
a factor to prompt coeliac as a possible diagnosis. It could be
argued that had there been no amber flags on assessment, testing
for coeliac would still be appropriate due to the diagnosis of
downs syndrome. It is important to consider when assessing
validity of evidence that guidelines exist to guide practice; they
will not fit all individuals, and all presentations of conditions
will not follow typical presentation. It is important to consider
all past medical history and co morbidities when considering
differential diagnosis.
•Henry, (Nursing in Practice, 2015), tells us that “The cancer
pathway can be complex, lengthy and disjointed, involving a wide
variety of healthcare professionals” and goes on to state that the
needs of patients “are best realised through person-centred
approaches to care. The central tenet behind person-centred care is
ensuring that the needs and goals of the individual become central
to the process of care.” It is possible that the CNS role can be
loosely aligned to Balint’s (1957, quoted in Denness, 2013)
observations where he discusses the effect on patients “moving
from one specialist to another with nobody taking responsibility for
the actual person inside the patient.” The role ofthe CNS in this
scenario is to provide that link but the prescribing role is less clear.
As an endoscopist the author has a defined prescribing role but in
respect to understanding your own scope of practice, (RPS, 7.1) this
consultation demonstrates the need to define your personal scope of
practice when becoming an independent prescriber.
•This consultation was also a breaking bad news consultation. This NHS trust
defines this type of consultation as “any consultation that drastically and
negatively alters a person’s view of his or herfuture” (Buckingham 1996 in
ESNEFT 2020) and guidance states “…there should be a Nurse or AHP(allied
health professional), present, so that any follow-up support and information
given can be followed with continuity and a clear insight into the conversation
that occurred,” (ESNEFT 2020). It recommends that practitioners use the
“Spikes” model for breaking bad news. Initially published in2000 the model
advocates that clinicians consider the setting of the consultation; the patient’s
perception of the situation; that the patient invites the provision of information;
the clinician provides knowledge in an appropriate way; acknowledges the
Emotional needs of the patient and provides a Summary. As a CNS this model
is favoured because is supports the individualised, patient centred care that
CNS’ aim to provide, however, does it provide the type of assessment required
for prescribing? Consultations are often hybrids of different consultation
models dependant on the purpose of the consultation
•A Critical incident Analysis of an
Untoward Prescribing Incident
• 2000 words Learning outcomes assessed 1-10
•Use any reflective model to present an actual or potential
error you have observed during your period of practice
learning
•This case study looks at a critical incident in the form of a near
miss and explores the complexities of antibiotic stewardship in
the wake of a global burden of antibiotic resistance. The
incident focuses on a patient admitted to the surgical admissions
unit of a district general hospital over a weekend period.
•The admissions unit was under considerable pressure during this
period, with patients sitting in the waiting area awaiting assessment and
admission. This patient was not acutely unwell and could have
conceivably been treated in the community safely and it is not
inconceivable to suggest that waiting for a non-urgent culture result,
over the weekend period would have delayed this patient’s discharge
with limited effect on her overall management and outcome. An
ENACT Study by Public Health England, (2021), has looked very
closely at factors that influence antibiotic prescribing as part of the
national drive to reduce antibiotic prescribing and the study has shown
that among other factors, “…..insufficient consultation length or too
high workload increased chances of inappropriate prescribing
decisions,” together with “fear of consequences” of not prescribing.
•Patient and carer expectations have also been shown to influence a health
care practitioner’s decision making. This patient had attended the unit with
a very supportive family who were playing a pivotal role in her health
maintenance and arrived believing the patient to be unwell and in need of
medical intervention. A study by Covvey, et al, (2014), on the association
of poverty and antibiotic prescribing acknowledges that a “perceived patient
desire for antibiotics during a consultation has been shown to drive
clinicians’ decisions on primary care antibiotic prescribing.” Thomson et al,
(2020), who also studied the effects of poverty on community antibiotic
prescribing, demonstrated that while antibiotic prescribing is falling
nationally, that antibiotic prescribing is significantly higher in areas of
poverty but also went on to show that the pattern of broad spectrum
antibiotic prescribing was higher in affluent areas and hypothesises that
“people living in affluent areas may be able to navigate the healthcare
system more easily.”