School of Phamracy and Biomedical Sciences

UCLan Coursework Assessment Brief

Module Code: PJ3300

Cardiovascular Case Study

You are to consider the case of Ebrahim is a 54-year-old taxi driver who lives at home with his wife, and three teenage sons. He is admitted to hospital with an acute cardiac event. Follow his journey from initial hospital treatment to follow up in the community 18 months later. Consider the information provided in each section and use appropriate scientific resources to answer the questions.  Make sure you clearly indicate which section(s) you are answering. Each question is assigned a percentage weighting, use this as a guide for the amount of detail you should provide.

This is an individual piece of work that involves you working through a case study on a time-lapse basis.  You will be expected to apply your scientific and practice knowledge and understanding to address the questions regarding the patient’s case.  This assessment is worth 15% of your module.

As with all of your assessments, the learning outcomes and links to the GPhC standards and UCLan attributes are mapped onto different parts of the case study.  Please read through these aspects to help you understand what you are expected to achieve from this assessment.

The assessment has 7 sections and each part may have several subsections to guide you through the case study.  The weightings of the sections are denoted in brackets, please use these as a guide for how much detail is required for each section.

At level 6, it is expected that you are able to discuss each section in appropriate detail – this means drawing upon your taught material (including workshops, lectures, learning packs and associated directed reading). A very good answer would include accurate interpretation and appropriate use of primary sources of information from PubMed, Medline etc as well as NICE guidance and BNF to help you with synthesising your answers.  The standard university marking criteria has been included for your ease of reference.

The assessment word limit for ALL sections is 3000 (+/- 10%). We have provided more guidance at the start of the assessment regarding word limits and use of information in Tables etc.

The case study learning outcomes are:

CASE SCENARIO: Ebrahim

Ebrahim is a 54-year-old taxi driver who lives at home with his wife, and three teenage sons. He knows that he does not lead a very healthy lifestyle- he is morbidly obese with a BMI of 41 and enjoys what he calls “real food” rather than fruits and vegetables, or food that is low in saturated fats. He does not undertake any form of aerobic exercise and has smoked ten cigarettes a day since the age of 19.

Over the course of a month, Ebrahim starts to feel generally unwell. He notices that he becomes breathless when climbing the stairs, and that his chest feels tight.

One day, he leaves for work and after driving for ten minutes his left arm begins to ache intensely. Within 20 minutes he has a crushing pain in the centre of his chest, is sweating profusely, and feeling dizzy and lightheaded. He recognises these as symptoms of a heart-attack and pulls over to the side of the road to call 999.

An ambulance is with him in eight minutes and confirms via ECG that Ebrahim is having a heart attack. They transport him to the local hospital with a larger coronary care unit and the ability to perform PCI, after administering 300mg aspirin and 2.5mg IV morphine.

PART 1 (5%)

Explain how the ambulance team were able to ascertain that Ebrahim was having a myocardial infarction (MI) from the ECG.  (5%)

Standards:

·        ID and employ the appropriate diagnostic or physiological testing techniques to inform clinical decision-making

Ebrahim arrives at hospital where his diagnosis of an MI is confirmed by the medical team. Whilst waiting for further test results, you overhear him talking on the phone to his wife, and he says “I’m not going to tell them I’m a taxi driver, cause they won’t let me work for a while after a heart attack, and they’ll tell the DVLA”. He notices that you have overheard the conversation and asks to speak with you.

He begs you not to tell the medical team that he is a taxi-driver, as his family rely solely on his income, and he can’t afford not to work when he gets out of hospital.

PART 2 (15%)

Citing the GPhC standards for pharmacy professionals, explain what the best course of action would be. (15%)

Standards:

·        Recognise ethical dilemmas and respond in accordance with relevant codes of conduct

·        Support the patient in choosing an option by listening and responding to their concerns and respecting their decisions

·        Apply the principles of clinical governance in practice

Ebrahim has now returned from theatre after having a PCI procedure, where the medical team found one occluded artery, in which they placed a drug eluting stent.

PART 3 (15%)

Compare and contrast a drug-eluting and conventional stent.  In your answer you should briefly define what they are how they differ in formulation and what are their advantages and disadvantages.  In your discussion of drug-eluting stents you should name at least two examples of drugs used and also make mention at least three mechanisms of drug release with an explanation. (15%)

Standards:

·        Demonstrate how the science of pharmacy is applied in the design and development of medicines and devices

A new consultant in the hospital has been assigned to Ebrahim’s care, and you notice that she has prescribed a drug that you are unfamiliar with.

She has prescribed: Omacor, 1g daily

You explain to the consultant that this drug is not normally given post-MI at your hospital trust, but the she is adamant she wants to prescribe it, as she has used it in the past where she used to work.

PART 4 (15%)

Critically evaluate the evidence for the use of Omega-3 fatty acids post MI in secondary prevention. Give a recommendation to the consultant based on the evidence you have analysed on whether this drug should be used for the patient.  (15%)

Standards:

·        Access and critically evaluate evidence to support safe, rational and cost-effective use of medicines.

·        Use the evidence base to review current practice

After a total of 5 days in hospital after his MI, Ebrahim is now ready for discharge, and has been referred to you for lifestyle counselling.

PART 5 (15%)

Lifestyle counselling

a)    Describe the counselling you would provide Ebrahim regarding his lifestyle, make it specific to his needs. Discuss which organisations and pharmacy services you would recommend or refer him to and why. (10%)

b)   Research into one specific local service that is provided outside the pharmacy or healthcare setting. Explain how this service will be of value to Ebrahim, discuss how this will improve his health and quality of life. Provide a website link to the service. (this may include activity or social prescribing etc) (5%)

Standards:

·        Promote healthy lifestyles by facilitating access to and understanding of health promotion information

·        Play an active role with public and professional groups to promote improved health outcomes

·        Contribute to research and development activities to improve health outcomes

It has now been 18 months since Ebrahim had his MI, and he receives an appointment to see the pharmacist at his GP surgery for a medication review.

His current medication list is:

Aspirin dispersible tablets 75mg OM

Ticagrelor 90mg BD

Ramipiril 1.25mg ON

Atorvastatin 80mg ON

Bisoprolol 1.25mg OM

Blood pressure: 168/98mmHg

Pulse: 90bpm

NKDA

PART 6 (15%)

Clinically evaluate the appropriateness of each of the medicines that Ebrahim has been prescribed for long term secondary prevention of MI. Give recommendations for any changes you would make, and how you would work with the GP practice team to ensure these changes are made.  (15%)

Standards:

·        Apply knowledge of current pharmacy-related policy to improve health outcomes

·        Clinically evaluate the appropriateness of prescribed medicines

·        Optimise treatment for individual patient needs in collaboration with the prescribe

PART 7 (20%)

You identify a problem with one of the medicines that the patient is taking and realise that he should not be taking it.

a)    Identify the medicine and explain why Ebrahim should not be taking this. (2.5%)

b)   What would your actions be in dealing with this error? (2.5%)

c)    Describe how you would conduct an audit to find out if this has happened with other patients in your GP practice, and any potential harm this may have caused. What lessons could be learned from this process?  How could this error be prevented from happening in the future with other patients? (15%)

Standards:

·        Apply the principles of clinical governance in practice

·        Use the evidence base to review current practice

·        Identify, report and prevent errors and unsafe practice

1.    Use of quotation statements are discouraged in scientific writing. The point you want to make must be written in your own words

2.    You will submit parts of the assessment as a formative to receive feedback on what you can improve for your final submission.  In line with the School policy of feedback, you will receive information of ‘what you did well’, ‘what to improve’.  This may be specific details, or more generic feedback e.g. more primary sources of information required.  Generic feedback is for you to apply to the whole assessment. It is up to you to act on this feedback to improve your final version.

3.    The formative submission will invite you to submit the following parts as ONE side of A4 submission at a minimum of 12pt font. PART 6 (15%)

Assessment Release date: 10^th November 2020

Assessment Deadline Date and time:  Please submit your formative on 30^th November 2020 before 23:59 .

Please submit your summative on 24^th January 2021before 23:59

Please note that this is the final time you can submit – not the time to submit!

Your feedback/feed forward and mark for this assessment will be provided on14th December 2020 for the formative, 15^th February 2020 for the summative.

SUBMISSION DETAILS

The assessment word limit for ALL sections is 3000. We have provided more guidance below regarding word limits and use of information in Tables etc.

The School follows the University regulations for word counts which we want you to remember prior to any submission you would make

1.    Unless specifically stated otherwise, the word count is a limit with a tolerance of 10 % extra permitted as an absolute maximum.

2.    Students MUST supply the word count on the front cover of their work. This number should not include references.

3.    In text citations ARE included in the word count.

4.    Figure and Table titles and legends ARE included in the word count.

5.    Table contents are NOT included in the word count, BUT tables should be used appropriately for the nature of the work and should NEVER be used just to avoid words counting within the word count.  If it is judged that tables have been used inappropriately then the content of the table(s) will be ignored when determining the mark for the work.

6.    The reference section is NOT included in the word count.

7.    Any information in the appendices will NOT be considered if word count has been exceeded.

8.    The absolute maximum i.e. word count + 10 % will be regarded as a cut-off point and nothing beyond this count will be considered.

·        Academic support  for this assessment is provided in the cardiovascular seminars/tutorials and the weekly drop-in sessions

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