The Medication Prescription Errors Essay Discussion

The Medication Prescription Errors Essay Discussion

Ethical and Legal Implications of Disclosure and Non-Disclosure with Regard to Medication Prescription in the State of Texas

The prescription of medications in the United States healthcare system is reserved only for those clinicians with prescriptive authority. These are physicians, physician assistants, and nurse practitioners amongst others. As an advanced practice registered nurse (APRN) or a family nurse practitioner, one also has prescriptive authority. This is especially absolute in scenarios or jurisdictions that have full practice authority or FPA for APRNs (Dillon & Gary, 2017). The governmental agency concerned with the safe prescription and non-abuse of medications and drugs in the US is the Drug Enforcement Administration or DEA. The DEA normally issues all qualified and licensed prescribers in the US a special unique number or identifier referred to as the DEA number (AANP, 2022)The Medication Prescription Errors Essay Discussion. The DEA number has to be written on the prescription to enable the DEA and other authorities easily track the prescriber. This is especially so when errors of omission or commission are made. The purpose of this paper is to look at the ethics of disclosure and non-disclosure with regard to medication prescription errors by APRNs.

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The Ethical and Legal Implications of Disclosure and Non-Disclosure

The scenario provided is that of an advanced practice nurse who makes an error during the process of prescribing a medication to a patient. He becomes aware of this but does nothing to correct the situation. Since he thinks that the patient has not noticed that he committed an error, he lets the matter rest like that with all the risk that it portends.

All prescribers including advanced practice nurses are ethically bound to observe beneficence and nonmaleficence. These are two bioethical principles from Beauchamp and Childress’ Principlism. Beneficence means that the prescriber must always only prescribe medication that will benefit the patient with the least or no possible side effects. Nonmaleficence or primum non nocere on the other hand implies that the prescriber must not cause any intentional harm to the patient in the process of prescribing (Campbell, 2017; Haswell, 2019)The Medication Prescription Errors Essay Discussion. In the scenario under discussion, the advanced practice nurse made an error during prescription and became aware of the same in time. However, they did not act or rectify the error and took advantage of the fact that the patient had not noticed anything. That is a blatant violation of the ethical principles of beneficence and nonmaleficence.

In an ideal situation, the prescriber in this case should have recalled the patient and confessed that an error was made. There should also be documentation about the error and the actions taken to correct it. This kind of disclosure protects the patient and the prescriber, builds trust and confidence, and avoids further errors and consequences stemming from the first. Legally in the state of Texas, the Health and Safety Code § 242.604 mandates all nursing staff within the state to make a report of any medication errors or unforeseen adverse medication reactions to the resident physician (FindLaw, 2021)The Medication Prescription Errors Essay Discussion. From yet another legal angle, the prescriber as in this case owes the patient a duty of care and so any negligence on their part that may result to harm to the patient can lead to a tort. In medical malpractice suits, the Tort of Negligence leads to the award of damages to the affected patient. Deliberately not disclosing a prescription error is negligence.

What I Would Do As the Advanced Practice Nurse in the Scenario

In the scenario provided above, if I were the advanced practice nurse I would do a number of things. First, I would immediately notify the pharmacist of the error so that they may not issue the medications prescribed. That means I would recall the patient so that I may disclose the error and correct it. Second, I would explain to the patient what happened and apologize to them for the inconvenience. I would go ahead and inform them that as human beings, we as prescribers are also bound to make some mistakes from time to time. I would then let them know that when that happens, we are usually more than eager to disclose the error and to correct it The Medication Prescription Errors Essay Discussion.

Indeed, I would disclose the error as I have detailed above. However, my disclosure according to the Texas Health & Safety Code § 242.604 will go further than that. I would first make documentation detailing the error and the actions taken to rectify it. This I will do both in the Computerized Provider Order Entry (CPOE) and the Patient Data Management System (PDMS). The Texas Health & Safety Code § 242.604 requires me to report such an error to the resident physician. This is exactly what I will do in conformity with the law.

I will make a formal report to the resident physician detailing the error and the actions that I took to rectify the same. I will also make sure that I document the incident so that it can be discussed later by the Quality Improvement Committee with a view to preventing a recurrence of the same. This is because the quality of care is impacted by such errors and many a times patient outcomes are negatively impacted by errors such as medication errors. The consequences to this are far-reaching to both myself as a practitioner prescriber and the institution that I work for. Errors that ultimately lead to harm befalling the patient such as overdosing, toxicity, or adverse reactions usually result in malpractice suits. As a practitioner I risk having my license to practice withdrawn and also being ordered to pay damages by a court of law. The organization will also be liable to pay damages through the doctrine of vicarious liability The Medication Prescription Errors Essay Discussion.

The other part of my disclosure would entail informing the DEA of the error that I made. Depending on whether the medication I prescribed and which had the error in prescription was a scheduled (controlled) medication, I may also have to inform the Texas Prescription Monitoring Program (PMP)The Medication Prescription Errors Essay Discussion. Schedule II, III, IV, and V medications and their regulation fall under their regulatory and monitoring authority. That is the same case with the DEA as discussed above. I would do all this since I am aware that all these actions help in collecting data and compiling statistics about such errors. Proper disclosure and openness such as I have detailed above also assists the monitoring and regulatory authorities with coming up with preventive measures.

The Process of Prescribing Medications

The process of medication prescription is an elaborate one. It begins with the correct identification of the patient by name, diagnosis, and prescription history. This first step is very crucial as improper identification of the patient means that the wrong patient will get the wrong medications. The consequences of this are dire. The second step is to take history and perform a detailed physical examination. In his second step, laboratory tests and diagnostic studies such as an X-ray or CT scan may be ordered. These assist with making the correct diagnosis. The third step involves making a diagnosis complete with differential diagnosis. The next step is about stating the treatment objectives or what the prescription will aim to achieve. This includes a timeline after which the patient will come back for a follow up visit to review treatment outcomes.

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The next step in the prescription process is performing the actual prescription. Because of the mandatory requirement to use electronic health record (EHR) systems for this, the act of prescription is done in the CPOE of the EHR (Alotaibi & Federico, 2017)The Medication Prescription Errors Essay Discussion. To reduce errors in prescription, current state-of-the-art EHR systems are intertwined with Computerized Clinical Decision Support Systems or CCDSS (Kwan et al., 2020). This allows the system to warn the prescriber if they are about to make a prescription error such as in dosing or potential drug interactions. The penultimate step is to educate the patient on the possible side effects of the prescribed medications. Then last but not least is follow up for assessment of progress and possible change to the medication regime if progress has not been made. Integration of the CCDSS with the EHR is the single most important strategy to minimize medication errors in practice.

Conclusion

Medication prescription errors usually occur in practice. However, prescribers have an ethical and legal obligation to disclose such errors and take corrective action. Using their unique DEA number, this disclosure would entail also informing the DEA and the state PMP is the drug involved is a controlled substance. Incorporating a CCDSS into the EHR system is a proven strategy to help in preventing medication prescription errors The Medication Prescription Errors Essay Discussion.

References

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

American Association of Nurse Practitioners [AANP] (2022). How to get information about obtaining a DEA number. https://www.aanp.org/practice/practice-management/business-resources-for-nurse-practitioners/how-to-order-a-dea-number

Campbell, L. (2017). Kant, autonomy and bioethics. Ethics, Medicine and Public Health, 3(3), 381–392. https://doi.org/10.1016/j.jemep.2017.05.008

Dillon, D. & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93. https://doi.org/10.1097/naq.0000000000000210

FindLaw (April 14, 2021). Texas Health & Safety Code [HEALTH & SAFETY § 242.604]. Reports of medication errors and adverse reactions. https://codes.findlaw.com/tx/health-and-safety-code/health-safety-sect-242-604/#:~:text=An%20institution’s%20nursing%20staff%20must,in%20the%20resident’s%20clinical%20record

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Kwan, J.L., Lo, L., Ferguson, J., Goldberg, H., Diaz-Martinez, J.P., Tomlinson, G., Grimshaw, J.M., & Shojania, K.G. (2020). Computerised clinical decision support systems and absolute improvements in care: Meta-analysis of controlled clinical trials. BMJ, 370(m3216), 1-11. http://dx.doi.org/10.1136/bmj.m3216 The Medication Prescription Errors Essay Discussion

Week 5 Legal Profession Paper

Medical and prescription-related errors are among many nursing care issues resulting in adverse patient health outcomes. However, it is essential to acknowledge that nurses have a significant role in reducing any instance or situation that may impair the patient’s mental and physical well-being. In most cases, the leading prescription errors concern the wrong dosage. Hence, it is upon the healthcare providers, especially the advanced practice nurses, that have the authority to prescribe drugs to ensure that they follow all instructions as postulated by the nursing legal, ethical, and moral principles when handling the patient population. Therefore, the paper will explain the legal and ethical implications of nondisclosure and disclosure, guided by Texas law. Also, the paper will evaluate the role of an advanced practice nurse in the provided case scenario and explain the writing prescription process and the most effective strategies for minimizing medical errors.

Legal and Ethical Implications of Nondisclosure and Disclosure

When patients seek healthcare interventions within the healthcare setting, they expect to receive safe and quality healthcare services. However, in most cases, nurses find themselves in a dilemma when healthcare prescription errors occur since they must face the consequences, particularly legal and ethical ones (Korb-Savoldelli et al., 2018)The Medication Prescription Errors Essay Discussion. Most times, nurses are unsure whether to disclose or fail to inform the relevant authorities or the patients whenever a prescription error occurs. Generally, the nurse’s decision in such an instance significantly impacts the patient’s safety and care outcomes. Nurses should always acknowledge the need to strictly adhere to the medical administration procedures, especially by following the five medication administration rights to minimize medication errors.

The case scenario for the assignment points out that as a community health clinic nurse, a prescription error is made, and it is essential to note that the error is not intentional. Consequently, there is a high possibility that the patient involved may not realize that a mistake has been made. However, an ethical dilemma arises due to the acknowledgment of the existing bioethics principles and legal implications that may arise due to nondisclosure. From the bioethics principles point of view, the prescription error nondisclosure is more unethical to the patient. That is because, as a nurse, nurses need to recognize that the beneficence and nonmaleficence principles are essential principles that nurses need to observe with care. According to Korb-Savoldelli et al. (2018)The Medication Prescription Errors Essay Discussion, the beneficence principle requires the nurse to ensure that all activities and actions directed to the patients should be compassionate. Also, the principle of nonmaleficence requires the nurses to ensure that no harm happens to the patient. Therefore, nondisclosure of the prescription error is unethical, and nurses should reach out to the relevant authorities to help make informed decisions.

The disclosure construct in healthcare is usually placed under legal and ethical frameworks. The main reason is to ensure that nurses strictly follow the code of ethics to enhance patient outcomes. Therefore, professional bodies like the American Nurses Association and the existing healthcare organizations in the United States have formulated different policies and standards that help curb medication errors and thus increase patient safety. According to Korb-Savoldelli et al. (2018), the National Quality Forum and the Joint Commission have set clear guidelines prompting nurses to disclose any medication error as soon as it happens. Also, individual states have stipulated different laws about medical error disclosure to avoid events that can cause adverse effects on the patient population. For instance, in Texas, Section 242.604 deals with adverse reactions and medical error reports, prompting nursing staff in an institution where the medical error has occurred to report to the assigned physicians as soon as possible (Texas Public Law, n.d)The Medication Prescription Errors Essay Discussion. That is, as they are warranted by the resident’s condition assessment and ensure that the reactions and errors are recorded within the resident’s clinical record.

Reports of Medication Errors and Adverse Reactions

Advanced Practice Nurses (APNs) are skilled professionals who aim to enhance patient healthcare outcomes. According to Alghamdi et al. (2019), when errors occur, APNs must acknowledge the virtue of reporting such errors despite the implications that the nurse may face due to medical errors. That is because human is to err; in most cases, nurses may make errors unintentionally, like in the case scenario. However, the critical point during a prescription error is first to accept that an error has been made and that the APN has to use all the powers they have to ensure that the error will not adversely affect the patient. Hence, in the case scenario, the critical factor to consider when dealing with the disclosure and nondisclosure dilemma lies in the nursing bioethics principle. That means the nurse has to acknowledge the essentiality of autonomy, beneficence, nonmaleficence, and justice principles. For instance, it will be ethical for the patient to acknowledge the prescription error and decide on the steps they may take after such realization The Medication Prescription Errors Essay Discussion.

Nurses must also understand that beneficence and nonmaleficence principles are fundamental during such a moment. That is because, through disclosure of such prescription error, the nurse will have acted in favor of the patient while ensuring no harm happens, thus the need for timely reporting. The justice principle also comes into play, especially when making the healthcare decision, in that the patient’s health needs to be addressed appropriately, such as offering them free treatment to prevent any adverse effects (Alghamdi et al., 2019)The Medication Prescription Errors Essay Discussion. Hence, an APN will need to disclose the issue, particularly to the healthcare organization’s ethical committee or a colleague, to help make informed decisions. Such disclosure is also essential since it helps the healthcare management plan effectively to address such an issue to increase safe and quality healthcare services delivery.

Writing Prescription Process And The Most Effective Strategies In Minimizing Medical Errors

The proper writing prescription process must guide the nurses and other interdisciplinary professionals. The most effective writing prescription process is for the healthcare provider to evaluate factors like the essence of providing the drug to the patient health condition to prevent providing irrelevant medication (Kron et al., 2018). Also, the healthcare provider needs to assess the viability of the drug to the patient presenting symptoms to avoid providing medication that may have little or no impact on the patient’s health. The healthcare provider also needs to evaluate the drug’s possible contraindications, sensitivities, and allergies to the patient, especially by assessing if the side effects may bring along adverse effects. Also, healthcare providers need to assess the dosage where they need to look at factors like age since children’s dosage varies with that of adults. Other important factors include the route of administration and assessing if it is the most appropriate route (Kron et al., 2018)The Medication Prescription Errors Essay Discussion. Overall, the best strategy that can help in minimizing medical errors is effective communication and leadership. That is because effective communication will encourage collaboration within the interdisciplinary team, thus ensuring that they work together to benefit the patients. For effective leadership, like transformational leadership, the nurse leader can identify various factors that cause medical errors, like nurse burnout, and propose implementing better technologies like barcode medication and electronic health record systems to increase nurse productivity.

Conclusion

The paper has evaluated the effects that come along with medical errors, particularly prescription errors. These issues concern errors in disclosure or nondisclosure, which puts most nurses in a dilemma due to their ethical and legal implications. However, regardless of the medical error, nurses guided by the nursing bioethics principles and legal framework stipulated by their states must ensure that every action they take in such situations will increase the patient’s well-being. Hence, nurses must disclose these errors to ensure that informed decisions are made to prevent negatively affecting patient outcomes. Also, nurses must ask different questions during the writing process to ensure they administer the proper medication. Consequently, effective strategies to reduce medical errors include effective communication among interdisciplinary teams and transformational leadership The Medication Prescription Errors Essay Discussion.

References

Alghamdi, A. A., Keers, R. N., Sutherland, A., & Ashcroft, D. M. (2019). Prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care settings: a systematic review. Drug safety, 42(12), 1423-1436. https://doi.org/10.1007/s40264-019-00856-9

Korb-Savoldelli, V., Boussadi, A., Durieux, P., & Sabatier, B. (2018). Prevalence of computerized physician order entry systems–related medication prescription errors: A systematic review. International Journal of Medical Informatics, 111, 112-122. https://doi.org/10.1016/j.ijmedinf.2017.12.022

Kron, K., Myers, S., Volk, L., Nathan, A., Neri, P., Salazar, A., … & Schiff, G. (2018). Incorporating medication indications into the prescribing process. The Bulletin of the American Society of Hospital Pharmacists, 75(11), 774-783. https://doi.org/10.2146/ajhp170346

Texas Public Law (n.d). Sec. 242.604:Reports of Medication Errors and Adverse Reactions. https://texas.public.law/statutes/tex._health_and_safety_code_section_242.604 The Medication Prescription Errors Essay Discussion

Consider the following scenario:

You are working as an advanced practice nurse at a community health clinic. You unintentionally make an error when prescribing a drug to a patient. You do not think the patient knows that you made the error.

To prepare:

Consider the ethical implications of disclosure and nondisclosure.
Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
Consider what you would do as the advanced practice nurse in this scenario including whether you would disclose your error.
Review the Institute for Safe Medication Practices website Links to an external site.. Consider the process of writing prescriptions, and think about strategies to avoid medication errors.
To complete:

Write a minimum 4-page paper in APA format (excluding cover page and references) that addresses the following:

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state of Texas.
Describe what you would do as the advanced practice nurse in this scenario including whether you would disclose your error. Provide evidence for your rationale.
Explain the process of writing prescriptions and include strategies to minimize medication errors.
Include four or more appropriate scholarly sources from the last five years throughout the paper.

Rubric
NURS 676 Legal Profession Paper Rubric
NURS 676 Legal Profession Paper Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeEthical and Legal Implications of Disclosure and Nondisclosure
80 to >65.6 pts
Accomplished
Ethical and legal implications of disclosure and nondisclosure are clearly identified and discussed. State laws are referenced.
65.6 to >60.0 pts
Emerging
Ethical and legal implications of disclosure and nondisclosure are somewhat identified and discussed. State laws may not be referenced.
60 to >0 pts
Unsatisfactory
Ethical and legal implications of disclosure and nondisclosure are absent or severely lacking in detail. State laws may not be referenced.
80 pts
This criterion is linked to a Learning OutcomeRationale
80 to >65.6 pts
Accomplished
The rationale and the evidence for disclosing or not disclosing the error are clearly explained and supported.
65.6 to >60.0 pts
Emerging
The rationale and the evidence for disclosing or not disclosing the error are somewhat explained and supported.
60 to >0 pts
Unsatisfactory
The rationale and the evidence for disclosing or not disclosing the error are absent or severely lacking in detail/support.
80 pts
This criterion is linked to a Learning OutcomePrescription Writing Process
50 to >41.0 pts
Accomplished
The process of writing prescriptions to minimize medication errors is clearly explained and supported.
41 to >37.5 pts
Emerging
The process of writing prescriptions to minimize medication errors is somewhat explained and supported.
37.5 to >0 pts
Unsatisfactory
The process of writing prescriptions to minimize medication errors is absent or severely lacking in detail/support.
50 pts
This criterion is linked to a Learning OutcomeScholoarly Sources
20 to >16.4 pts
Accomplished
Four or more appropriate scholarly sources published in the last five years are included throughout the paper.
16.4 to >15.0 pts
Emerging
Two to three appropriate scholarly sources published in the last five years are included throughout the paper.
15 to >0 pts
Unsatisfactory
Less than two appropriate scholarly sources published in the last five years are included throughout the paper.
20 pts
This criterion is linked to a Learning OutcomeMechanics and APA
20 to >16.4 pts
Accomplished
Written in a clear, concise, formal, and organized manner. Responses are mostly error free. Information from sources is paraphrased appropriately and accurately cited.
16.4 to >15.0 pts
Emerging

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Writing is generally clear and organized but is not concise or formal in language. Multiple errors exist in spelling and grammar with minor interference with readability or comprehension. Most information from sources is paraphrased and cited correctly.
15 to >0 pts
Unsatisfactory
Writing is generally unclear and unorganized. Errors in spelling and grammar detract from readability and comprehension. Sources are missing or improperly cited.
20 pts
Total Points: 250