Medication errors
ASSIGNMENT INSTRUCTIONS
To Prepare
Review the Resources for this module and search specific laws and standards for prescribing prescription drugs and for addressing medication errors in your state. Reflect on these as you review the scenario assigned by your Instructor.
By Day 7 of Week 1
Write a 2 to 3-page paper that addresses the following:
Explain the ethical and legal implications of the scenario on all stakeholders involved, including the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure of medication errors. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.
Assigned scenario “A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway, “alprazolam .5 mg prn #5 1mg tabs w/ 6 refills”
SAMPLE ANSWER
Ethical and Legal Implications of Prescribing Drugs
As advanced registered nurses, we are expected to provide safe and quality care by following the required nursing ethics. At times, we are placed at crossroads, where we are tempted to stretch the ethical boundaries to accommodate what would ideally be considered unprofessional practice. However, breach of ethical guidelines may not only harm the patient to whom we intend to provide care, but can also have legal repercussions. This post will reflect on a scenario involving the prescription of drugs that has potential ethical and legal ramifications.
Ethical and Legal Implications of the Case
The presented scenario involves prescribing medication to a friend without following the correct procedure that ideally should involve diagnosing the patient to understand the ailment, which will, in turn, inform the treatment plan. From an ethical perspective, we can apply the principle of beneficence and non-maleficence to both the nurse and the pharmacist (Sorrell, 2017). Beneficence calls for nurses to conduct themselves in a manner that will provide the most benefit to the patient. The principle of non-maleficence, on the other hand, demands that nurses structure their interventions in a way that will cause the least harm to a patient. In this case, while the nurse intends to assist the patient, failure to follow the correct procedures when prescribing medications could do more harm than good. Other than conducting patient diagnosis, there are other aspects that a nurse should consider when prescribing medication. For example, the nurse needs to evaluate whether the patient is allergic to the prescribed medication.
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The nurse is also supposed to inquire from the patient whether the patient is taking any other medication or product that may cause some adverse interactions with the prescribed drugs. Therefore, failure to consider such aspects goes contrary to the ethical principles of beneficence and non-maleficence (Sorrell, 2017). From a legal perspective, nurses are required to do due diligence in accordance with their training when caring for patients. Any harm that results from the failure of the nurse to follow the proper standards of care is considered malpractice, which is punishable by law. The ethical and legal ramifications lie mostly on the nurse since the duty of care presented in the case rests squarely on her for failing to follow the required standards of care when prescribing the medication.
For the patient and the family of the patient, the principle of autonomy is applicable. The nurse or prescriber of the medication is supposed to provide the patient with information to allow them make informed decision whether they will use the medication or not. The relationship between the two parties (provider and patient) is fiduciary in nature, and any information that needs to be disclosed to the other party needs to be disclosed, including existing health conditions to prevent adverse outcomes that could result from any prescriptions made. Failure by the patient or their families to disclose pertinent information upon request will remove the provider from any liability in case of any harm
Strategies to Address Disclosure and Nondisclosure
According to Florida statutes, specifically §395.1051 and §456.0575, practitioners have a legal obligation to disclose any adverse events that cause serious harm to the patient. Failure to disclose can lead to claims of fraud or fraudulent concealment (Florida Legislature, 2021). One of the strategies that one can use to disclose such events is to first assess the nature and extent to which the harm has been caused, including the likely long-term effects of the harm, then evaluate who to disclose to. When addressing disclosure, it is important to assess whether the family is ready to listen and understand the issue before making the disclosure.
When addressing the patient, it is wise to use non-technical language to foster understanding of the situation, including the steps that will be taken to rectify the situation. Both the wording and the nonverbal cues are important when addressing the patient. An empathetic tone should be used to show regret of the situation. It is also wise to accurately and objectively document the situation, including when the disclosure was made, and the witnesses present during the disclosure.
Decision-making Strategies
The first strategy I would use is to apply evidence-based practice to come up with the most informed decision n how to handle the scenario. EBP will not only guide the process of prescribing, but also diagnosing the patient, or in case of an adverse effect as a result of the prescription, the best approach on how to deal with the situation. Another strategy is to apply naturalistic decision-making, which Nibbelink and Brewer (2018) define as an alternative decision-making approach when one does not have enough time to evaluate several options. Given the scenario, the nurse may not have enough time to sift through available evidence to address the issues presented. As such, naturalistic decision-making can be an alternative strategy to go for.
The Process of Writing Prescription
Pollock et al. (2007) describe a six-step process of providing prescriptions to patients. The first step is to evaluate and define the presented condition. This includes collecting subjective and objective information from the patient to understand the underlying issue that needs treatment. The next step is to specify the therapeutic objective, for example, whether it is pain relief or treatment of infection. The third step is to select the most appropriate therapy, either pharmacologic or non-pharmacologic, or a combination of both. The fourth step is to initiate the therapy followed by patient education on how to take the medication, the side effects, and any warnings. Lastly, is to follow-up with the patient and evaluate whether the treatment plan is effective or not, bearing in mind the strategy for discontinuing the medication.
Conclusion
From the analysis of the scenario, there are several issues that were observed that could pose both ethical and legal challenges, more so to the prescriber. It is recommended for an advanced nurse to always maintain high levels of professional when dealing with patients, regardless of existing relationships. Doing so will also help to eliminate any potential harm that the patient may incur.
References
Florida Legislature. (2021). The 2021 Florida Statutes, http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/Sections/0456.0575.html
Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917–928. https://doi.org/10.1111/jocn.14151
Pollock, M., Bazaldua, O. V., & Dobbie, A. E. (2007). Appropriate prescribing of medications: an eight-step approach. American family physician, 75(2), 231-236. https://www.aafp.org/afp/2007/0115/p231.html
Sorrell, J. M. (2017). Ethics: ethical issues with medical errors: shaping a culture of safety in healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2). https://doi.org/10.3912/OJIN.Vol22No02EthCol01
Jermaine Byrant
Nicole Johnson
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