Core Advanced Pharmacist e-portfolio

CP

Title *

Case Presentation of managing a patient with hay fever (Allergic Rhinitis) via the use of independent prescribing in a community pharmacy

Date of assessment *

5.9.2022

Collaborator Details

Collaborator name *

Dr Z A

Collaborator email

Only required for sending ticketed invitations

[email protected]

Collaborator position *

General Practitioner

Collaborator profession *

Medic

Collaborator declaration *

I can confirm I have read the RPS collaborator guidance and have the appropriate experience to complete this assessment. I confirm I have completed the assessment objectively and independently.

Yes ☒

Details of Case

Summary of case(s)*

I presented a case of a patient that I had treated for hay fever over multiple visits/reviews. The case involved using clinical history taking and my independent prescribing qualification skills over a number of visits.

Clinical setting(s)*

Community Pharmacy

Level of complexity*

Low ☒     Medium ☐     High ☐

Collaborator Assessment

Professionalism

Is accountable and responsible for own decisions. Works within ethical guidelines and legal frameworks. Actively practices honesty and integrity. Works safely within own level of competence, knows when to escalate or refer *

Below

☐

Meets

☒

Exceeds

☒

Not applicable

☐

Comments: strengths and/or areas for development *

No concerns. Really professional and patient-centred approach throughout.

Clinical reasoning

Gathers focused information relevant to the person and their condition. Performs appropriate clinical examinations and assessments. Requests and interprets appropriate investigations and examinations. Makes an appropriate working diagnosis or decision. Applies the evidence base and professional judgement to support holistic person-centred care.  *

Below

☐

Meets

☒

Exceeds

☐

Not applicable

☐

Comments: strengths and/or areas for development *

The pharmacist was able to correctly make a diagnosis based on identifying the classic symptoms – i.e. rhinorrhea, pruritus (nose, throat, mouth), nasal congestion (mouth breathing, snoring), sneezing etc. They were also able to correctly classify these as persistent and moderate-severe (e.g., troublesome and causing impairment of daily activities). Finally, they were also able to describe the screen for but absence of any red flag symptoms.

Clinical management

Applies clinical knowledge and skills to manage options and medicines appropriately and safely. Assesses and critically evaluates appropriate information to make evidence-based decisions. Makes appropriate use of referrals and prioritises care appropriately. *

Below

☒

Meets

☐

Exceeds

☐

Not applicable

☐

Comments: strengths and/or areas for development

At the initial presentation the pharmacist had advised the patient to try nasal douching. Allergen avoidance was not an option due to the symptoms correlating with grass pollen exposure, and it was not possible to totally avoid this. On visit one, the pharmacist had also prescribed a beclometasone aqueous nasal spray, as the most troublesome symptom was nasal congestion. A follow-up appointment was then booked for 4 weeks to check on the progress of the patient. This all seemed appropriate.

At visit two, the patient’s symptoms had only mildly improved and were still disturbing many of their daily activities, including work. The pharmacist therefore added in Cetirizine (while also continuing the beclometasone aqueous nasal spray), after checking for any new red flags and/or any contraindications to Cetirizine use. A follow-up appointment was then booked for 4 weeks later, to check on the progress of the patient. This all seemed appropriate.

At the third visit, the patient’s symptoms were the same and were still disturbing many of the patient’s daily activities, including work. At this point the pharmacist referred the patient to the GP for further assessment. The pharmacist confirmed that the patient still had no red flag symptoms. When we discussed the third line options, the pharmacist was aware what these were, and was able to confirm that they could have been tried in this case. When we discussed why the pharmacist was not confident to start them, the pharmacist was unsure.

We both agreed that this case was an excellent example of guideline-driven (foundation-level) practice of hay fever (Allergic Rhinitis), but did not in itself have any significant complexity and that it probably did not meet the complexity or level of practice needed for ‘advanced practice’ (i.e. living in the grey and making decisions when priorities are overlapping or evidence is limited and/or you need to deviate from the guideline approach).

Organisation & efficiency

Effectively, efficiently and safely manages multiple priorities. Manages own time and workload calmly. Organises and delegates tasks appropriately to optimise effectiveness within the pharmacy and wider team, to enhance patient care.  *

Below

☐

Meets

☐

Exceeds

☐

Not applicable

☒

Comments: strengths and/or areas for development *

Not applicable in this case

Presentation

Presents in a clear and concise way, appropriately uses visual material, conveys knowledge of the patient and rationale for management decisions, demonstrates logical integration of knowledge, clinical presentation, diagnosis and recommendations into a concise and flowing case study. *

Below

☐

Meets

☒

Exceeds

☐

Not applicable

☐

Comments: strengths and/or areas for development *

Mappings

Consider what learning outcome(s) this record provides evidence for and map to all that apply

[Not mapped as not at sufficient level of practice]