Feb 23, 2024 Assignment: NURS 6521 Prescribing-Drugs Paper
Assignment: NURS 6521 Prescribing-Drugs Paper
Assignment: NURS 6521 Prescribing-Drugs Paper
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.
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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
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What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority.
Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.Review the scenario assigned by your Instructor for this Assignment.Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
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 you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. 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, including whether you would disclose your error. Be sure to justify your explanation.Explain the process of writing prescriptions, including strategies to minimize medication errors.Assignment Scenario:
During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.Chapter 1, “Prescriptive Authority” (pp. 1–3)Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/…This website outlines the code of federal regulations for prescription drugs.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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.
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
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 histor
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