Write a critical analysis essay of a prescribing episode that took place for a patient presenting with signs of ageing.

This essay is a critical analysis of a prescribing episode that took place for a patient presenting with signs of ageing. The evidence base for the use of Botulinum Toxin Type A will be evaluated and the professional responsibilities and clinical governance issues associated with this intervention will be considered.

Non-medical prescribing is prescribing by a specially trained healthcare professional working within their clinical competence as either an independent or supplementary prescriber (RPS, 2016). An independent prescriber can be defined as a “practitioner, who is responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing” (RPS,2016).

This essay is written from a community pharmacists perspective, studying to become a non-medical independent prescriber in the field of aesthetics. The GPhC states that a prescription can only be written by a non-medical prescriber who has completed the course and been entered on the register, therefore the actual prescription issued for this consultation was written by a qualified prescriber. All names of patients, clinicians, hospital or community trust have been changed for data protection and confidentiality reasons as per GPhC requirements.

A 35-year-old Caucasian female, Mrs H, attended the clinic, presenting with signs of ageing. Her areas of concern were the wrinkles around her eyes, forehead and frown. The Calgary-Cambridge consultation method was used to gather information about Mrs H and reach a shared decision on the best treatment for her desired outcome. This model encourages patient contribution and ensures the decision takes into consideration the patients best interest and therefore allows a trusting relationship to progress between the practitioner and patient (Kurtz, Silverman and Draper, 1998).

By using this model, all the necessary information was gathered, including a full past medical history, where it was ascertained that Mrs H was not taking any regular prescription medication, herbal or recreational medicines, but she did occasionally take OTC ibuprofen or paracetamol as a pain relief for headaches. She had no known allergies and any red flags associated with anti-wrinkle treatment, such as skin infections, pregnant or breastfeeding and auto-immune disorders, were ruled out. It was also discovered that the patient had not had any aesthetic treatments previously. On taking a full social and family history it was established that the patient is a non-smoker, drinks on occasion, enjoys using sunbeds and exercises regularly. Mrs H also lives with her husband and has no children. The patient completed a Cosmetic Procedure Screening Questionnaire to rule out body dysmorphic disorder (Veale et al., 2012).

A physical examination was taken, the patient was handed a mirror to help highlight her areas of concern. A realistic expectation outcome was given to the patient along with the benefits and risks associated with the proposed treatment, a prescription was written for Bocouture (a brand of botulinum toxin type A) and any aftercare advice was given that the patient must adhere to. A shared decision was agreed and the relevant information was documented. In order to make an informed decision the patient was given a ‘cooling off period’ to think about all the options discussed. The importance of this was highlighted in the Keogh report which reviewed the regulation of cosmetic interventions (Keogh, 2013).