1. Prescribing Pyramid Activity
Kimberley Tordoff

2. Interprofessional Group Activity - Your challenge (1.5 hours)
Get into your groups
Each group to choose one or two of the following cases
Discuss the case your case relating the issues it raises in relation to the prescribing pyramid. Allow 30 minutes
Feedback of each group to the rest of the class .(1 hour)

3. Case 1 George is 55 years old and homeless.
He turns up at your walk in centre slightly intoxicated complaining of a sore big toe.
On closer inspection the right hallux is inflamed and oozing a small amount of pus

4. Case 2 Mr Harry Singh , 71 years old, a retired accountant
He has been brought to your walk in clinic. He fell a week ago in the street and cut his face. He has diabetes and hypertension both controlled by oral medication. His health is otherwise ok but his eyesight has deteriorated recently and he has had a number of falls recently usually outside. The wound is on his left cheekbone and is 2cm long.
A colleague saw him last time but she is not on duty.
She prescribed a hydrocolloid dressing. The wound doesn’t smell but is very sloughy.

5. Case 3 Mrs Patel has been working in a restaurant for nearly 12 hours.
At the end of her shift she scalded her hand with boiling water when she dropped a pan.
The skin is still intact but her hand is swollen with an extensive blister that goes up the lateral aspect of her forearm.
She appears in a lot of pain but doesn’t speak a lot of English.

6. Case 4
Lisa is 7 years old and fell off a climbing frame two days ago and hurt her left wrist.
Her mum says that she cannot pick things up with the left hand and she is complaining of it hurting.
Apart from pain there is no obvious injury

7. Case 5 Louise is 16 years old and has just finished her GCSE’s.
She lives at home with her parents and younger brother who has learning difficulties.
At the weekend her and her boyfriend aged 15 years old had unprotected sex at a party when they were both a little drunk.
Louise has come to see you to get contraceptive advice, she is distressed as she did not mean to have intercourse. She doesn’t want her parents to find out.
She doesn’t want to go on the pill, but requests something more natural.
She also has some pain from ‘down below’ and keeps needing to go to the toilet.
In taking her details you realise that she is the daughter of a local GP

8. Case 6
Mr Robinson is a 68 year old who had a colostomy formed for cancer of the colon six months ago.
His wife died recently and he is finding it difficult to cope with his colostomy on his own and says it is sore and he can’t get the bags to stay on.
He is very embarrassed about this and has stopped going out as he is very self conscious.
His stoma appears very sore.

9. Case 7 Mrs Jones is 44 years old
She had a mastectomy for breast cancer 3 years ago and since then she has been taking Tamoxifen.
She has recently developed secondaries in her spine and had radiotherapy.
She is very weak and has lost a lot of weight as she has lost her appetite.
When you see her in clinic she is complaining of back pain, a sore mouth and feeling tired.

10. Summary
Before you prescribe it is important to consider the prescribing triangle and principles of good prescribing
Ideally your prescribing should be effective but above all it must be safe
Reflection and good record keeping are the marks of a skilled professional

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