Core Advanced Pharmacist e-portfolio

Case based Discussion (CbD) example


Retrospectively evaluates the individual’s input into patient care. A structured discussion is undertaken remotely from the patient and is used to explore clinical reasoning, decision making and application of clinical knowledge in practice.

Examples of when it can be used

  • Discussion of a highly complex case where you have had to identify and implement treatment options where evidence is limited or ambiguous.
  • Discussion of a case where you have had to apply clinical reasoning for people with complex physical, phycological or social needs


  • Provide feedback on what the pharmacist did well and areas for development.
  • The overall rating should reflect the expected level of an advanced pharmacist as defined in the curriculum.
  • ‘Not applicable’ means that the pharmacist did not cover the identified area as it was not within the context of the procedure or case.
  • ‘Below’ means that either the pharmacist did not cover the identified area to a competent level or it was not demonstrated at all, and should have been.



Title *

Discussion about the autonomous management of a patient with hypertension unresponsive to treatment

Date of assessment *



Collaborator Details

Collaborator name *


Collaborator email

Only required for sending ticketed invitations

[email protected]

Collaborator position *

Practice Nurse

Collaborator profession *


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.



Details of Case

Summary of case(s)*


I presented a case from my hypertension clinic to one of the local senior / very experienced practice nurses. The case involved the diagnosis and management of Conn's Syndrome (Primary Aldosteronism), in the context of a patient with resistant hypertension.

Clinical setting *

General practice clinic

Focus of clinical encounter *

History Diagnosis  Management  Information provision

Level of complexity*

Low     Medium        High


Collaborator Assessment


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 *




Not applicable

Comments: strengths and/or areas for development *

Perfect! No concerns at all! I have worked with the pharmacist for many years and their professionalism is first rate.

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.  *




Not applicable

Comments: strengths and/or areas for development *

The pharmacist presented the case really well, including the past medical history, clinical signs and symptoms, and the beliefs and desires of the patient.

The pharmacist had a clear justification for suspecting of Conn's Syndrome (Primary Aldosteronism) in this patient, including resistant hypertension (BP 175/100mmHg) despite treatment with the three blood pressure lowering medications, good medication adherence (the pharmacist confirmed this via both the patient and the re-ordering history), and hypokalaemia (potassium 3.5 mmol/l).


The pharmacist autonomously ordered renin and aldosterone levels for the patients on two occasions (both of which showed an aldosterone:renin ratio of greater than 30) and a salt loading test. These tests had confirmed the presence of primary hyperaldosteronism.


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. *




Not applicable

Comments: strengths and/or areas for development *

Following the confirmation of Conn's Syndrome, and given the presence of resistant hypertension, the pharmacist was able to justify their choice for starting the patient on Spironolactone (i.e. PATHWAY-2 trial data). The pharmacist involved the patient in this decision as an equal partner, educated and safety netted them on potential ADRs and red flags, and then put an appropriate follow-up plan in place for BP and U&E monitoring.

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.  *




Not applicable

Comments: strengths and/or areas for development *

Worked excellently with all stakeholders, in an efficient and respectful manner. Also used the MDT appropriately where needed – e.g. phlebotomy services etc.


Summary of Assessment

Overall rating *

Based on your discussion, rate the overall level at which the pharmacist has shown that they are performing


Below the level expected of an advanced pharmacist

Working towards the level expected of an advanced pharmacist

Meets the level expected of an advanced pharmacist

Other relevant comments or feedback

Really good example of appropriate autonomous work.

Agreed action(s)

None needed.

Learner's reflection

Describe what you have learned. How will it change your practice in the future?


It’s useful to discuss cases – in particular where I have been able to use additional diagnostic tests and manage the person’s care through to completion.


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

  • 2.1 Delivers care using advanced pharmaceutical knowledge and skills for individuals and/or groups with highly complex needs, including where evidence is limited or ambiguous.
  • 2.2 Undertakes a holistic clinical review of individuals with complex needs, using a range of assessment methods, appropriately adapting assessments and communication style based on the individual.
  • 2.3 Demonstrates effective clinical reasoning skills, making autonomous, evidence informed, person-centred decisions about treatment for individuals or groups with complex clinical needs, managing risk in the presence of significant uncertainty.