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As a community matron and a non-medical prescriber I have a fundamental role in the treatment of chronic obstructive pulmonary disease (COPD), encouraging patients to be proactive in the management of their disease. Utlising a case study I will reflect on the management of a patient with moderate COPD. John’s (1994) reflective model will be used to analsye and explore my feelings and actions, examining professional and personal growth. The seven points on the prescription pyramid (National Prescribing Centre (NPC) 1999) will be considered to plan a systematic approach to prescribe appropriately, examine evidence-based practice and reflect on cost effectiveness. To maintain confidentiality and anonymity the patient will be identified as Annie.

Assessed and accepted for case management nine months ago, Annie is a 77-year-old who has endured COPD for 17 years. A detailed history (appendix 1) and a physical examination (appendix 2) was fundamental to establish a trusting relationship in order to provide holistic care. Prior to case management, and over a seven month period Annie had requested ten general practitioner (GP) home visits for acute exacerbations of her disease, and was hospitalised on nine occasions. The GP acknowledged the decision to hospitalise was not always necessary; however choose this because of limited options. Consequently COPD continues to be responsible for over 90,000 hospital admissions every year, and not always the appropriate outcome (Barnes, 2000). Therefore as a community matron my role is to manage appropriate patients successfully in a community care setting (DoH, 2005). At the initial consultant Annie requested that she would prefer to be treated and managed at home during an acute episode of her disease. However previous admission history presented quite a challenge from a hospital avoidance perspective.

Providing a combination of nursing, medical and social care competencies; I...