NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

In the case scenario, a friend calls and requests me to prescribe her medication. Although I have the autonomy, I do not have the friend’s medical history. However, I still write the prescription. This paper explores the ethical and legal implications of this scenario, approaches to address disclosure and nondisclosure, and the procedure of writing prescriptions.

Ethical and Legal Implications Of The Scenario On All Stakeholders Involved

Prescribing or giving medications to family members and friends, except for an emergency is regarded as unprofessional conduct and can call for disciplinary measures. The ethical problem surrounds the fact that the relationship with a friend or relative can cloud a practitioner’s judgment (Sorrell, 2017). Based on the state, the prescriber in this scenario can face legal consequences for prescribing to their friend. Writing a drug prescription for friends in a social setting can prompt legal action. Since the prescriber has the autonomy to prescribe, the ethical and legal consequences would center on what is best for the person prescribed and whether local ethic boards have an outlook on the matter (Sorrell, 2017). The prescribed medication may result in an adverse drug event since no assessment was conducted, which fails to uphold ethical principles of beneficence and nonmaleficence.

The ethical and legal implications of the act would not only fall on the prescriber but also the dispensing pharmacist. Ethical implications for the pharmacists would include the failure to uphold beneficence and nonmaleficence. The pharmacist ought to have reviewed the diagnosis for the patient before dispensing to ensure the medication is appropriate for the patient’s medical condition (Sorrell, 2017). Failing to review the medical information puts the patient at risk of adverse drug effects if the drug is not appropriate for the patient. Furthermore, the patient may face legal implications for getting a prescription without being assessed and diagnosed by a healthcare provider.

Strategies to Address Disclosure and Nondisclosure As Identified In the Scenario

Disclosure of medical error refers to the communication between a health provider and a client, family member, or a client’s proxy whereby the provider admits that a medical error occurred. North Carolina has a statute that protects reports made by a health provider making an apology for an adverse treatment outcome. The statute on disclosure, states that health providers should offer to implement remedial or corrective treatment interventions, as well as voluntary acts to assist the affected patient (North Carolina Medical Board, 2017). However, the North Carolina statute does not protect any confessions of fault or a provider’s acknowledgment of responsibility. In the case that the medication has an adverse event on the prescriber’s friend or the prescriber realizes they prescribed the wrong medication, the prescribing clinician should inform the patient (Eniola & Gambino, 2019). The clinician should explain how the error occurred and the actions to be taken to correct the error and its effects.

Strategies That You, As an Advanced Practice Nurse, Would Use To Guide Your Decision Making In This Scenario

In this scenario, my decisions would be based on the North Carolina laws and ethical principles. I would reveal the medication error to the patient by explaining how it occurred as stated by the state law to avoid legal action and implications such as having my APN license revoked (Eniola & Gambino, 2019). In addition, I would employ beneficence and nonmaleficence in making decisions to promote ethical practice. Beneficence is the moral duty to promote good, while nonmaleficence is the duty to cause no harm. In this regard, I would take the duty to do good and prevent harm on the patient by informing them of the error and taking prompt interventions to mitigate potential harm from the medication error (Sorrell, 2017). Besides, I would explain to the patient the steps that the provider and the hospital are implementing to prevent errors in the future. This would help maintain the client’s trust in the clinician and the hospital.

NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

Process of Writing Prescriptions and Strategies to Minimize Medication Errors

The prescribing clinician should first fill in the patient’s data, including name, age, sex, and medical diagnosis. The next step is to write the prescribed medication, including the name, dose, frequency, and route of administration (de Araújo et al., 2019). Besides, the clinician should indicate the frequency of refills, particularly for patients with chronic illness. The last step should be to write the clinician’s name, address, National Provider Identifier number, and DEA number. Medication errors can be reduced by taking a detailed history of the patient’s drug allergies and current medications (de Araújo et al., 2019). Organizations can adopt technology systems such as the E-prescribing software, which generates prescriptions electronically and send them directly to the pharmacy. The software minimizes errors cause by illegible paper prescriptions. Drug interaction checkers can also be used to help evaluate potential drug interactions, thus reducing adverse drug outcomes.

Conclusion

The prescribing clinician and dispensing pharmacist face ethical implications for not upholding beneficence and nonmaleficence by prescribing medication without a patient assessment and medical diagnosis. The North Carolina statute states that the clinician should inform the client of the medical error and the corrective treatments to be implemented. Medication errors can be avoided by taking a patient history of drug allergies, current treatments, and using IT systems.

References

de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. D. A., & Toma, T. S. (2019). How to prevent or reduce prescribing errors: an evidence brief for policy. Frontiers in pharmacology, 10, 439. https://doi.org/10.3389/fphar.2019.00439

Eniola, K., & Gambino, C. (2019). Taking the Fear Out of Error Disclosure. Family practice management, 26(6), 36-36.

North Carolina Medical Board. (2017). Position Statements North Carolina Medical Board. https://www.ncmedboard.org/images/uploads/other

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). de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. D. A., & Toma, T. S. (2019). How to prevent or reduce prescribing errors: an evidence brief for policy. Frontiers in pharmacology, 10, 439. https://doi.org/10.3389/fphar.2019.00439

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The promotion of safety and quality in the prescription of medications is imperative in nursing practice. Advanced registered nurses make treatment decisions based on best practices available and utilize interprofessional collaboration to optimize treatment outcomes. Therefore, this paper explores the ethics of prescribing a new drug, which has not been approved to a 7-year-old child for asthma.

Ethical and Legal Implications

The prescription of unapproved drug to the 7-year-old child is associated with significant ethical and legal implications to the nurses’ role in practice. First, the new drug has not been tested or approved for its efficiency and effectiveness in asthma treatment. The drug has also not been used in children under the age of 12 years. As a result, it raises the concerns related to the safety of the drug(Woo et al., 2019). The drug predisposes the 7-year-old to harm because of the lack of information about its safety in children below 12 years.

The prescription of the new drug to the 7-year-old violates the nurses’ code of ethics and standards of practice. Advanced registered nurses have the professional and legal responsibility of promoting safety, quality, and efficiency in their practice. They make decisions based on best available evidence, practice guidelines, and protection of the patient’s rights in the treatment process. The professional standards of practice require them to make decisions that minimize harm while optimizing treatment benefits(Grace & Uveges, 2022). The new drug has never been tested or studied to determine its safety and efficacy profile. Therefore, prescribing the drug will violate the stated codes of practice and ethics in nursing.

Strategies to Address Disclosure and Non-Disclosure

Disclosure and non-disclosure influence the actions that nurses implement in their practice. disclosure entails the provider informing the patient and their significant others about the events that have happened to them in the care process. Advanced practice nurses have the professional obligation to inform their patients about any health interventions implemented to promote their health and recovery. The code of ethics by the American Nurses Association requires that nurses should promote and advocate the patients’ rights, safety, health, and wellbeing(Passini et al., 2023). Non-disclosure entails not informing the patients about any events that have happened to them in the care process.

The state of California requires that healthcare providers to disclose any information that influences health and outcomes to the patients. The disclosure includes providing information about any error that has been made in the delivery of the care. The patient then makes the decision to either share the information with other people or not. The disclosure will also extend to the hospital’s management for the implementation of interventions that will minimize error occurrence in the future. Disclosure of information would promote patient’s autonomy, beneficence, and non-maleficence in the treatment process(Fairchild, 2021). Non-disclosure will translate into nurse’s lack of professional responsibility and negligence, which violates provision 3 of the American Code of Ethics for nurses.

Strategies to Guide Decision Making

One of the strategies that I will adopt to guide my decision-making is interprofessional collaboration. I will involve the other healthcare providers in assessing if we should prescribe the new drug to the 7-year-old. Interprofessional collaboration will ensure the collective examination of the potential alternatives that we may consider to optimize outcomes in the treatment process. Collaboration will also enable the team to examine any evidence that supports the use of the new drug in the treatment and potential risks if any(Donnelly et al., 2021). Therefore, interprofessional collaboration will ensure the adoption of an ethical and most relevant solution in the scenario.

The second strategy that I will use to guide my decision making is relying on the set organizational policies and guidelines. Health organizations have policies that guide nurses in making decisions. The guidelines limit the nurses’ involvement in activities that predispose patients to unintended harm. Relying on them will ensure that I make an informed decision about the issue(Grace & Uveges, 2022). I will disclose the error. As noted above, disclosure is crucial to promote the adoption of interventions that will minimize any harm. Disclosure will also ensure accountability and professional responsibility as an advanced practice nurse.

Process of Writing Prescriptions and Strategies to Minimize Medication Errors

Writing prescriptions should follow developed guidelines to minimize medication errors. One of the processes in writing prescriptions is writing clearly and accurately the patient’s data such as name, age, gender, and diagnosis. Information about the medication name should also be written clearly and accurately to avoid confusion. The prescriber should avoid abbreviations and illegible writing. The dosage information should be concise with clear and specific directions. The therapeutic duration of the drug should also be specific alongside the drug’s therapeutic intervention. Any supplemental instructions such as medication refill or warnings should also be included. The strategies that can be adopted to minimize medication errors include provider training and education about best practices, use of health technologies, double checking and encouraging open reporting of medication errors(Royce et al., 2019; Sutton et al., 2020).

Conclusion

The promotion of safety and quality in prescribing medications is important. I will disclose the medication error. The issue has significant and ethical implications to nursing practice. Advanced registered nurses should adopt best practices that minimize errors in their practice.

References

Donnelly, S., Ó Coimín, D., O’Donnell, D., Ní Shé, É., Davies, C., Christophers, L., Mc Donald, S., & Kroll, T. (2021). Assisted decision-making and interprofessional collaboration in the care of older people: A qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting. Journal of Interprofessional Care, 35(6), 852–862. https://doi.org/10.1080/13561820.2020.1863342

Fairchild, A. (2021). The ethical conflict of truth, hope, and the experience of suffering: A discussion of non-disclosure of terminal illness and clinical placebos. Clinical Ethics, 16(2), 130–136. https://doi.org/10.1177/1477750920959556

Grace, P. J., & Uveges, M. K. (2022). Nursing Ethics and Professional Responsibility in Advanced Practice. Jones & Bartlett Learning.

Passini, L., Bouedec, S. L., Dassieu, G., Reynaud, A., Jung, C., Keller, M.-L., Lefebvre, A., Katty, T., Baleyte, J.-M., Layese, R., Audureau, E., &Caeymaex, L. (2023). Error disclosure in neonatal intensive care: A multicentre, prospective, observational study. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2022-015247

Royce, C. S., Hayes, M. M., &Schwartzstein, R. M. (2019). Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Academic Medicine, 94(2), 187. https://doi.org/10.1097/ACM.0000000000002518

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. Npj Digital Medicine, 3(1), Article 1. https://doi.org/10.1038/s41746-020-0221-y

Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. W. S. (2019). Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study. Journal of Nursing Management, 27(5), 992–1004. https://doi.org/10.1111/jonm.12759

NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS