Assessment & Consultation

OVERVIEW

This section provides a reminder of some of the many factors to consider when making a clinical decision, with a focus on prescribing decisions.

It also provides access to some of the resources that may help with the professional, legal and ethical requirement to be able to articulate how you have fulfilled your duty of care when making prescribing decisions.

While it is important to identify and select a consultation model most suited to your area of practice, this resources is uses the RAPID-CASE consultation model (Figure 1). This was first published in the textbook, "Principles and practice of nurse prescribing" (Gould and Bain, 2022) and also applied to clinical scenarios in several journal articles.

Figure 1: RAPID-CASE From: Gould, J. and Bain H. (2022) Principles & practice of nurse prescribing. First edition. London. https://uk.sagepub.com/en-gb/eur/principles-and-practice-of-nurse-prescribing/book265193

RAPID-CASE

This consultation model for prescribing is based on the RPS (2021) Competency Framework for all prescribers and the 1999 National Prescribing centre's 7-steps to safe prescribing. Link to further information

Clinical Decision-making

Assessment and consultation for clinical decision-making

Pressures on the health service have included fewer medical practitioners and a growing need for prescribers. The impact on practice has not yet been fully evaluated, but one consequence may be greater expectations on prescribers to fill service gaps. This may lead to prescribing questioning the boundaries of their scope of practice.

The aim of "RAPID-CASE" along with other resources on this site, is to prompt prescribers to always be able to provide a clear rationale for their decision-making.

There are many different influences on decision-making. Figure 2 illustrates some of the possible outcomes from a clinical encounter, and Figure 3. reminds of some of the many influences.

Figure 2. Decision-making outcomesFrom: Gould, J. and Bain H. (2022) Principles & practice of nurse prescribing. First edition. London. https://uk.sagepub.com/en-gb/eur/principles-and-practice-of-nurse-prescribing/book265193
Figure 3. Influences on decision-makingFrom: Gould, J. and Bain H. (2022) Principles & practice of nurse prescribing. First edition. London. https://uk.sagepub.com/en-gb/eur/principles-and-practice-of-nurse-prescribing/book265193

JCN Article using RAPID-CASE

References and recommended reading

  • Ali M (2017) Communication skills 1: benefits of effective communication for patients. Nursing Times; 113: 12, 18-19.

  • Black J., and Simende A., (2020) Ten top tips: assessing darkly pigmented skin Wounds International Available at: https://www.woundsinternational.com/resources/details/ten-top-tips-assessing-darkly-pigmented-skin

  • Britton, R. & Danielson, E. (2014) Macleod’s clinical examination. 13th edition. Amsteredam, [Netherlands], Elsevier.

  • Cathala X, Moorley C (2020) Performing an A-G patient assessment: a practical step-by-step guide. Nursing Times; 116: 1, 53-55

  • Conforth A. (2013) Holistic wound assessment in primary care British Journal of Community Nursing 18 12

  • Denness C. (2013) What are consultation models for? Available at: http://journals.sagepub.com/doi/full/10.1177/1755738013475436

  • Diamond-Fox, S. 2021. Understanding consultations and clinical assessments at advanced level. British Journal of Nursing. vol. 30, no. 4, pp.238-243.

  • Gunowa N, Hutchinson M, Brooke J, Jackson D. (2018) Pressure injuries in people with darker skin tones: A literature review. Journal of Clinical Nursing 2018 Sep; 27(17-18):3266-3275. Available at: https://pubmed.ncbi.nlm.nih.gov/28887872/

  • McIntosh T., Stewart D., Forbes-McKay K., McCaig D., Cunningham S.(2016) Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review, Family Practice, Volume 33, Issue 6, 1 December 2016, Pages 572–579,

  • Mukwende, M., Tamony, P., Turner, M (2020): Mind the Gap: A handbook of clinical signs in Black and Brown skin. St George's, University of London. Available at: https://doi.org/10.24376/rd.sgul.12769988.v1

  • Munroe B, Curtis K, Considine J, et al. (2013) The impact structured patient assessment frameworks have on patient care: an integrative review. 2013. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138388

  • Neighbour, R. (1987) The inner consultation, Oxford, UK: Radcliffe Medical Press.

  • Newton C. (1991) The Roper-Logan-Tierney Model in Action. MacMillan, Houndmills, Basingstoke.

  • Pendleton D, Schofield T, Tate P, Havelock P. (1984) The Consultation: an approach to learning and teaching, Oxford, Oxford University Press, 1984.

  • Peterson MC, Holbrook JH, Hales D, Smith NL, Staker LV: Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. (1992) Western Journal of Medicine 1992 Feb; 156:163-165

  • Rawles, Z., Griffiths, B. & Alexander, T. (2010) Physical examination procedures for advanced nurses and independent prescribers: evidence and rationale. London, Hodder Arnold.