The Scottish Government (SG) (2010) highlight the importance of providing the safest, most appropriate care and interventions for each patient, likewise, the Nursing and Midwifery Council (NMC) (2015) demand this high standard of care. In order to prescribe medicinal products, nurses and midwives must have a recorded nurse prescriber qualification, therefore prior to successfully completing this qualification the nurse has to be supported and mentored by a nurse prescriber. This case study will focus on my role as a student nurse prescriber and discuss the prescribing decisions I made for an individual patient, supported by my nurse prescribing mentor. Using the pseudonym, “John” and “Sally” to represent the patient and mentor respectively thus protecting the individuals confidentiality in line with the NMC (2015) guidelines.

John is a 72 year old gentleman with a diagnosis of pancreatic cancer. John was admitted to the district nurse case load for palliative care. Initially on assessment Johns symptoms were well controlled with oral medication. He lived with his daughter who was his main carer and she assisted John with all activities of daily living. A number of care plans were developed and agreed with John and his daughter, one in particular was for symptom management. Johns past medical history was noted on the initial assessment along with his medication and any allergies.

John was currently taking oral opioids and had been prescribed lactulose and senna to prevent constipation; this is inline with the Scottish Palliative Care Guidelines (2013). Constipation is a common cause of distress and is almost invariable after administration of opioid analgesics BNF 70 (2015).

John had been a patient with my district nurse team for a few months, we had been visiting on a weekly basis to assess, provide support and manage any symptoms. John had stated to me one day that his bowels had not moved in five days. I completed a full assessment discussing Johns normal bowel pattern, appetite and fluid intake, change in mobility and any change in medication The assessment was able identify if John was constipated or if the constipation was secondary to an underlying undiagnosed complaint BNF 70, (2015). John agreed for me to palpate his abdomen, it was much distended, but he was not feeling any discomfort.

I discussed different options with John, one being a PR examination and the use of a microlax enema if required, John declined at present. We discussed changing John’s oral laxities medication to sodium picosulphate. Sodium picosulphate was prescribed for seven days and we reflected on the side effects of the medication, the main ones being abdomen cramps, nausea and vomiting. I advised John to stop the medication if any side effects occurred. The pharmokenetics of sodium picosulphate is 6 to 12 hours. Diet and fluid advice was also discussed. As I am currently not a nurse prescriber I contacted Johns GP and explained my assessment. The GP agreed to change Johns laxatives to sodium picosulphate and for the district nurse to review in two days.

The results indicate that, for nurse prescribers to fulfil their new role effectively, a variety of mechanisms are necessary. These supporting infrastructures are vital to the success of nurse prescribing and are likely to result in a more confident and competent prescribing workforce.

+