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Reflection Domain 2 – Prescribing
Please choose to expand on the following competencies
7 . PRESCRIBE SAFELY
STATEMENTS SUPPORTING THE COMPETENCY
7.1. Prescribes within own scope of practice, and recognises the limits of own knowledge and skill.
7.2. Knows about common types and causes of medication and prescribing errors, and knows how to
minimise their risk.
7.3. Identifies and minimises potential risks associated with prescribing via remote methods
7.4. Recognises when safe prescribing processes are not in place and acts to minimise risks
7.5. Keeps up to date with emerging safety concerns related to prescribing.
7.6. Reports near misses and critical incidents, as well as medication and prescribing errors using appropriate
reporting systems, whilst regularly reviewing practice to prevent recurrence.
FURTHER INFORMATION ON THE SUPPORTING STATEMENTS FOR COMPETENCY 7
a. Remote methods include telephone, email, video or communication via a third party.
b. Minimising risks include using or developing governance processes that support safe prescribing,
particularly in areas of high risk such as transfer of information about medicines and prescribing of repeat
medicines.
c. Reviewing practice include clinical audits.
Reflection must have 1000-1100 words
Level 7 -1000 words (does not include background or references)
•Reflect on an episode of care, something you were involved in or observed
•Include how your supporting article / guideline or research you have included in your portfolio has facilitated you to develop your clinical practice in relation to the competency domain
.•Must be written in 1stperson
Reflections
•Headings –‘Background’ and ‘Reflection
’•Background should include (200 words):
•Clinical area and background•What reflection you are choosing and why
•Reflective model used
•Chosen supporting article
•The competencies related to this reflection
•Reference your chosen article throughout your reflection but also use other primary sources to support it
This is an example of reflection
The
numbers in brackets are the competency the activity / information relates to.
This person chose to use Gibbs reflection cycle, and did so very effectively. You
can use any reflection model you choose.
A male patient attended our service and is known to frequently request medical
items that are not evidence-based, in this instance he asked to be given bleach
for his lower leg wounds. He has unmet mental health needs and is awaiting
further assessment by a mental health team however he does not lack capacity
when discussions take place about treatment options. Consultations with him
always make me feel like I’m not ‘reaching’ him to explore valid treatment
options so I often have to end the consultation and both of us appear to be
frustrated. I often feel guilty about this breakdown in our consultations, so to
prepare for my next consultation with him I undertook some research and found
a really useful article by XX pertaining to Motivational Interviewing (MI). In my
patient group, MI is a good way of addressing health issues, understanding
patient beliefs in a non-judgemental way and supporting the patient to find their
own solutions with guidance (XX). XX further describe MI as being a useful
patient-centred approach to support positive changes in behaviour.
According to XX part of a prescriber’s role is to carry out a comprehensive
assessment, diagnose the health issue and come up with an evidence-based
treatment plan with the patient. [Professionals] however, have been known to
fall into the trap that XX noted; whereby health discussions were seen as
‘lecturing’ or pushing people into making huge changes in their lives instead of
working with individuals towards making agreed changes. I learnt very quickly
that simply telling this patient “you can’t just use bleach on your legs because
x”, would not make him change his beliefs and behaviours but instead would
create resistance and a barrier between us (2.3). When I read this particular
article on MI, it helped me to stop talking at my patient and start conversing
with him instead to try and understand his health beliefs and slowly encourage
him to come to a solution rather than providing my own medical agenda.
I set aside extra time with him to discuss his worries in more detail and soon
began to understand his point of view so was able to direct him to alternative
wound-care choices that were safer and evidence-based but also acceptable in
his mind as being the less ‘medicated’ option (2.6). His attendance in the clinic
increased and over several consultations he agreed to try my suggestion which
he saw improvement with and then future consultations became shorter and he
would seek my advice proactively.
From feeling frustrated and guilty initially, I then felt like we had achieved a huge
breakthrough because I realised I had changed the way I communicated with
him to show that I took his beliefs into account during the consultation and was
able to explain treatment options in a way he understood so that he could make
an informed decision (3.3). What worked well was that we compromised and I
was able to use up-to-date, evidence-based treatment that my patient was
happy with rather than trying to reach the same outcome by forcing my solution
onto him (3.2). This enabled me to introduce other previously less-welcomed
medical approaches to him which he discussed more openly and engaged with
(2.8).
The challenge was that this approach did not feel ‘natural’ at first and my
consultation felt clunky as well as the fact that I was trying to resist my own
‘righting reflex’. With practice I was able to use the model to focus the
discussion and support my patient to reach his own solution, even if it wasn’t
one I would try first (2.1). I realised it wasn’t about giving up on evidence-based
medicine, it was about finding a way to understand what motivated my patient
to seek help, what was acceptable treatment to him and giving him a clear
understanding and choice of what treatments were available whilst prescribing
safely and within my own competency (3.1, 3.5).
Motivational Interviewing has changed my prescribing practice as it really helps
to shape the way my consultations are carried out and build on the patientprofessional relationship that is needed for a successful outcome. In my patient
group, where often my patients are discriminated against and have poorer
health outcomes it is vital that they receive good quality care. It has helped me
to feel more confident in my prescribing decisions too such as people requesting
antibiotics when no clinical need for them is found. Rather than in the past
saying “no antibiotics are required for your viral infection”, I can use MI
techniques to understand the patients beliefs and expectations and shape the
consultation in a way that they feel satisfied they have been fully assessed and
given safety-net information to ensure they have been take seriously. XX found
that in XX, 48% of people in the UK took a prescribed medication within the last
week (that wasn’t inclusive of contraception or nicotine replacement therapy).
I also understand that around 50% of patients prescribed medication do not take
it as instructed and many of the reasons for this include them not feeling listened
to, not making decisions on treatment options with the professional but by the
professional, not clearly understanding how the medication will help the
condition and in some cases not having trust that the medical professional
understands the condition as well as not being given clear information on
adverse side effects (XX). By taking the time to use MI techniques and reaching
a shared decision with the patient, the outcome is greatly improved, the money
wasted on prescriptions not taken properly or multiple consultations is reduced
and in the wider aspects of public health, the NHS can be in a better position
from a reputational point of view as well as financially. Individually my practice
has changed for the better by using MI as highlighted in this reflection with the
positive outcome for a patient with unusual health beliefs.
Please use Harvard stybcile Author-Date system.
Thank you
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