Core Advanced Pharmacist e-portfolio

CbD

Title *

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

Date of assessment *

5.9.2022

Collaborator Details

Collaborator name *

K R

Collaborator email

Only required for sending ticketed invitations

[email protected]

Collaborator position *

Practice Nurse

Collaborator profession *

Nurse

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 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

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 *

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.  *

Below

☐

Meets

☐

Exceeds

☒

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. *

Below

☐

Meets

☒

Exceeds

☐

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.  *

Below

☐

Meets

☒

Exceeds

☐

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.

Attachments

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Mappings

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.