Case Study Reflection Template

Reflect on a case study and the importance of education in safely prescribing medication. Learn about the process of education and its impact on patient care.

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Case Study Reflection Template
(please submit via turnitin and as a signed paper copy in Evidence Profile)
Prescribing Framework
(NPC Principles of Good Prescribing Framework 1999)
1 - Consider the Patient
(NPC Principles of Good Prescribe Framework 1999)
Patient name and dob/age Mr Franklin 40 yrs. Old
Presenting Complaint (PC) Patient presented with severe leg pain,
Shortness of breath, Limb Oedema, Calf pain
on Dorsiflexion, Tenderness discoloration and
erythema on lower limbs.
History of presenting complaint
(HPC) (use appropriate assessment tool
e.g. PQRST)
P - The patient noticed a significant increase
in the size of his leg coupled with tenderness.
Discoloration of lower limbs
Q – Severe calf pain on ambulation, warmth
and erythema. Pain is persistent and
described as throbbing
R – Symptoms are localized in the lower
extremities.
S – Patient described the pain as a 5, on a

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scale of 1 to 10, which gets worse when
ambulating.
T – Patient describes onset of pain as four
days ago, which was bearable then but has
been gradually increasing since.
Pain started after landing from a ten-hour
flight.
Clinical findings and observations
(signs and symptoms, clinical
observations, wound assessment etc)
Pitting Oedema of lower limbs, Tenderness
and erythema, Superficial veins observed,
Discoloured skin on lower extremities
Vital signs: Temperature 37.8, Heart Rate
100b/min, respiratory rate 22 and Blood
Pressure 150/ 90, SpO2 96%
Past medical history Migraines treated two years ago
Food poisoning
Past surgical history None
Prescribed Medication history
(Name, Dose, Frequency, Reason Started,
whether effective)
Paracetamol 1Gg QDS for head aches
Over the counter products
(complementary, herbal and illicit etc.)
None
Allergies
(To what and state nature of reaction)
Pollen
Penicillin
Adverse reaction To Penicillin-containing medication

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(To what and state nature of reaction) Rash and congestion
Family history: Father treated for Pulmonary embolism and
DVT at age 78
Any other issues:
(e.g. hepatic impairment, renal impairment)
None
Social History
Home Situation Patient lives with wife and one child aged five
in sheltered accommodation
Occupation An accountant
Hobbies Travelling, running, watching movies
Pets None
Recent Travel Travelled to vacation in Hawaii with wife and
child. Long flight of ten hours one way
Alcohol Two units on a weekly basis
Smoking Has never smoked
Recreational Drugs Has never used recreational drugs
Sexual History Patient has had one sexual partner for eight
years
Systems Enquiry
(Provide details where appropriate, or state nothing of note, but only if this is the case)
Cardiovascular Sinus Tachycardia, monitor BP
Respiratory Slightly elevated
Gastrointestinal Nil
Genitourinary Nil

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Nervous system Nil
Endocrine Nil
Musculoskeletal
Skin hair & Nails Nil
Other
Working diagnosis
(pathophysiology and evidence to support
diagnosis)
DVT. The patient’s symptoms are indicative of
DVT. Onset of symptoms was after a ten-hour
flight. Patient has Pitting oedema, skin on
extremities is warm to touch, the veins in
swollen area are enlarged and skin is
discoloured, and the present Homans sign.
These are all symptoms of DVT
Pathophysiology
As explained by Stone et al. (2017), Virchow’s
triad presents clinical conditions which are
involved in causing DVT. They include Stasis,
hypercoagulation and endothelial damage. In
this case however, the patient experienced
stasis caused by prolonged immobility by
being in a ten-hour flight. This caused venous
thrombus due to altered blood flow in the deep
veins of the leg. Reduced blood flow causes
subsequence decrease in oxygen tension and
increase in levels of haematocrit.

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Stasis leads to prolonged contact with
coagulation factors which in turn prevents
dilution of active coagulation factors. It also
prevents influx of clotting inhibitors.
Prescribing Considerations
2 - Consider the appropriate strategy: consider your competence to prescribe, legal,
ethical and professional issues.
Prescription
Apixaban,PO 10 mg BID for seven days, then 5mg PO BID for Another seven days .
This should be coupled with monitoring of vital signs and any reaction to the
medication. Progress of disease should also be monitored.
Competence
As a nurse, I have the competence to perform a physical examination and take the
vital signs of the patient. I am also aware of the side effects of anticoagulant
medication, which include excessive bleeding. In addition, as explained by (Ma et al.
2018) Nurses are the first line health care providers who respond to cases of DVT
and VTE. We are also the patient’s advocate, with the role of bridging the gap
between the patient and physician.
Apixaban is prescribed to relieve symptoms and treat DVT by resolving thrombus
through preventing blood coagulation.
3 - Consider the choice of product/ treatment plan
(apply EASE to product, using up to date supporting evidence/guidelines used)
Effectiveness

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As stated by (Fazeel, 2016), Apixaban acts by inhibiting free and clot bound factors
Xa, which causes formation of Thrombin II. It is also effective as it does not directly
affect the aggregation of platelets and does not need antithrombin III like heparin.
Apixaban is therefore effective in preventing blood coagulation, resolving thrombosis.
The drug is also recommended by the National Institute for Health and Care
Excellence (2015) for the treatment and the secondary prevention of DVT.
In addition, when compared to Rivaroxaban, (Dawwas, Brown, Dietrich and Park
2019) found that Apixaban was more effective in prevention of recurrence of DVT.
This is also evidenced in another study by (Weycker et al. 2018) who found that
apixaban, when compared with warfarin, greatly reduced the risk for recurrent
bleeding and venous thrombotic events. It is therefore evident that Apixaban is the
best drug for DVT treatment and prevention.
Appropriateness
The prescription of Apixaban is suitable for DVT treatment in this case as outlined
under its effectiveness, safety and cost. There has been numerous evidence -based
recommendations and research on the drug, all that have proven its effectiveness
and appropriateness.
The patient does not report any sensitivity to the drug, or to its contents and is not
taking any medication with reported interactions with Apixaban. The frequency is
twice a day, and with the patient admitted, adherence to medication is expected to
be strictly adhered to. The patient is expected to take the drug for fourteen days, as

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recommended by NICE (2015) and BNF (2016)
Safety
As stated by (Weycker et al, 2018) Apixaban was found to have significantly low risk
of bleeding, which is the main side effect of anticoagulants. Apixaban also reduced
the risk of recurrent Venous thromboembolism and Clinically Relevant non-medical
Bleeding. Despite this, the patient should be closely monitored for any adverse
reactions and bleeding. The main contraindication in prescribing Apixaban is active
pathological bleeding, which the patient does not have. It is therefore safe to
prescribe Apixaban to the patient.
Cost Effectiveness
A study conducted by (Lanitis et al. 2017) found that Apixaban was the most cost-
effective drug for both initial and extended treatment of venous thromboembolism in
the UK. This was in comparison with low molecular weight heparin and Vitamin K
antagonist. Another analysis by Gu and Wu (2017), also found that Apixaban was
more cost-effective when compared with Rivaroxaban.
4 - Negotiate a contract to achieve concordance with the patient
(communication and consultation skills, how was the patient involved in decision making, what
information was given to the patient eg. dose schedule, duration of treatment, when to start/stop the
medication etc)
Consultation with the patient was done which included explanation of the diagnosis
and course of treatment. The patient was also informed on when to take medication,
twice a day, both for the initial and extended dosage for a total of fourteen days.
Patient was also encouraged to report any concerns or reactions to medications and

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to ask for clarifications throughout their admission period.
5 - Review and outcome
(by who, when, where and why; was the treatment effective)
A positive diagnosis of DVT was confirmed using blood tests (D-dimer) and a duplex
ultrasound (Pulivarthi and Gurram 2014). Apixaban was an effective treatment
choice for treatment. The patient was also encouraged to reduce risk of bleeding by
being cautious when handling sharp objects, avoiding injuries, and urgently alerting
the healthcare staff in case of any bleeding incidence.
The patient was also educated on reducing risk of developing another clot which is
higher in previous DVT patients. Symptoms of DVT should be reported immediately.
In addition, due to high risk of development of Pulmonary embolism patient was
advised to report any chest pain, increased heart rate, breathlessness or difficulty
breathing.
After review of the case, the cause of clot was discovered to be inactivity during the
long flight from Hawaii, which was ten hours long. The patient was then advised to
avoid inactivity and to regularly exercise.
The patient was then discharged the same day after admission when he could fully
perform the activities of daily living. An assessment was also performed on his
understanding about medication adherence and the importance of exercise. The
patient’s wife was also included in discharge instructions in order to enforce
instructions. Patient felt that he was fully independent and did not need further
hospitalization.
6 - Record keeping
(where and why)
On arrival, a patient file was opened where all the investigations, radiology tests,

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assessment information and treatment information were recorded and updated. The
physician and Nursing noted were also recorded. All the healthcare professionals,
including the nurse, physician and radiologist has access to the file which allowed a
holistic approach to the patient’s care. The medication details were recorded in the
clinical section and the prescription completed on the Medication Administration
Record (MARS) chart to ensure continuity and dose monitoring, alongside the
patient’s observations and vital signs. This also allowed easy access and monitoring
of patient’s reaction to medication and assessment of course of disease.
7 - Reflection on scenario:
(you may use a reflective model of your choice to structure your reflection, approx. 750-1000 words)
I will be using the Gibb’s reflective model in order to reflect on the understanding
about the process of the education in the safely prescribing medication. The Gibb’s
reflective cycle would be comprised of five steps that are description, feelings,
evaluation, conclusion and action plan and with the help of these step I will describe
my understanding about the importance of the education in the safely prescribe
medicine.
Here, the patient was diagnosed with DVT and showed several symptoms of pitting
Oedema of lower limbs, tenderness and erythmea, superficial veins observed,
discoloured skin on lower extremities. The vital sign were: 37.8o temperature, heart
rate 100b/min, respiratory rate 22 and blood Pressure 150/ 90, SpO2 96%. Apixaban
PO 10 mg BID for seven days and Apixaban PO 5mg BID for next seven days
prescribed. As the patient’s health literacy level is low thus the patient needed to be
educated on the safe prescription medicine. Hence, on the basis of this description
of the patient’s condition I can say that the patients needed to be educated for the
self management along with the proper medication management. However, as a

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nurse is the most valuable practitioner in the health care process and the nurse plays
a key role in the patient care, the nurse should be educated for the safe medicine
prescription as well. The description of the case highlights the importance of the
medication for the patient and on behalf of the doctor or the physician the nurse
should be able to diagnose and prescribe primary medication for the patient in case
of the emergency. Hence, the education in the safety prescribe medicine should be
provided to the nurses. This education would also help in the skill and competence
development among the nurses for the health care (Sulosaari et al. 2015).
On this context I feel that the education to the nurses for the safety prescription of
medicine along with the proper dosage of the medicines will help them to provide
improved care to the patients. The improved care would also be provided by the
nurses if they practice evidence based nursing principle and on the basis of their
diagnosis the nurses can be able to provide the proper medication to the patients.
However, the factor of the evidence based practice will also be developed among the
nurses by the proper education and motivation about the practice. I also feel that the
patients should also be incorporated in the safe medication and prescription
education as it will help in the knowledge development of the patients along with the
self management of the patients in terms of the medication. The proper education
about the safe medicine prescription would also help the patients in analysis of the
factor of the proper medication for certain diseases and symptoms. The education of
the on the context of the safely prescribe medicine would be helpful in my knowledge
and skill development in the emergency treatment providence to the patients. Also if
the patients are also educated about the safely prescription medicine then it will help
the patients and nurses to consult about the medicine and the effectiveness and
safety of the medication provided to the patients based on their past and present

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medical condition. The factor of the education in the context of the safe prescription
medicine would help in the lessening of the adverse side effects of the improper
medication in several cases as well (World Health Organization 2017).
Hence, on the basis of my feelings about the context I can be able to evaluate the
factor of the education for the safely prescribe medicine. The evaluation leads to the
aspect that highlights the importance of the education on safely prescribe medicine
for the patients and also the nurses as it helps in the skill and knowledge
development about the factor of the emergency situations. It will also help in the
improved care providence by the nurses. Hence, I should be able to learn about the
process. The education would be provided to the nurses and the patients by the
government and the health care institutions as well as the empowerment for the
public wellness (World Health Organization 2017)..
Based on this discussion it can be concluded that the education providence to the
nurses along with the patients will play a key role in the proper and improved care
providence. It will also help in the process of the life expectancy improvement, self
management of patients and also better emergency acre providence. Hence, on the
basis of this factor it can be stated that as the most important part of the health care
profession nurses should be educated about the proper medication process that
would help them to provide improved care to the patients. The knowledge of the
nurses also would be helpful in their medication administration skills and also proper
dosage of the medicine for the patients based on the severity of the patient’s
condition. On the other hand knowledge of the patients would help in the lessening
the adverse condition related to improper medication. The proper knowledge of the
patient in this context would also be helpful in the self management of medication
management.

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Based on all these factors we can recommend an action plan for the education
providence about the safe prescription medicine. Firstly it is required to develop idea
about the condition of the knowledge and skills of the nurses and the patients in this
context and that can be done by qualitative data collection. Next on the basis of the
knowledge of the condition the educators should be hired and the nurses and the
patients should be educated with priority basis. Investment in the process of the
education to the nurses should be done as well. On the other hand the patient
education in the same context should be done by the public education programs and
that should also be planned by the government and the health care institutions as
well. These processes should be helpful for the proper education providence to the
nurses and the patients (Garfield et al. 2016).
Student signature
DMP signature
Date

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References
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[Accessed Date 16 Jul. 2019]
Fazeel, Z.A., 2016. Apixaban: An oral anticoagulant having unique mechanism of
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