Feb 23, 2024 Assignment: NURS 6521 Ethical and Legal Implications of Prescribing Drugs
Assignment: NURS 6521 Ethical and Legal Implications of Prescribing Drugs
Assignment: NURS 6521 Ethical and Legal Implications of Prescribing Drugs
NURS6521 Advanced Pharmacology
Ethical and Legal Implications of Prescribing Drugs
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.
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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.
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Assignment: NURS 6521 Ethical and Legal Implications of Prescribing Drugs
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.
Assignment: NURS 6521 Ethical and Legal Implications of Prescribing DrugsConsider 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
Assignment: NURS 6521 Ethical and Legal Implications of Prescribing DrugsWrite 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.
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 United States, advanced practice nurse practitioners have varying degrees of prescriptive authority, over certain medications and medical devices. They must thus display a comprehensive understanding of the legal implications associated with prescribing drugs, in addition to their ethical obligations (Billstein-Leber et al., 2018). Clinical practice ethical guidelines recommend all clinicians with prescriptive privileges, ensure that their patients are protected from harm. The provided case study however demonstrates a situation where a nurse practitioner prescribed an adult dose of a drug to a 5-year-old. The purpose of this paper is to elaborate on the ethical and legal implications associated with this scenario, and effective mitigating strategies to prevent such occurrences in the future.
Ethical and Legal Implications
In this scenario, the medication error displayed poses substantial ethical implications for the prescriber, pharmacist, patients, and the patient’s family. The nurse practitioner as the prescriber is required to uphold ethical principles governing patient safety. It was thus an act of unprofessionalism to make such a mistake of giving a child an adult dose, knowing very well the harm that the drug could cause. Ethically, the nurse is required to ensure beneficence in the process of care provision, which was violated by the incidence of medication error (Tigard, 2019). Consequently, clinicians are required to uphold justice in practice, which required the nurse to follow the necessary process required to address the medication error, rather than neglecting the patient. With this act, the nurse exposes the patient to the possibility of a legal lawsuit.
The pharmacist on the other hand is required to counter-check the prescription once received. In case of a medical error, the pharmacist must contact the prescriber and discuss the identified error before taking the necessary actions required to address the issue (Robertson & Long, 2018). However, if the pharmacist fails to identify the medical error, then he or she will also bear the ethical and legal burden associated with posing harm to the patient due to the medication error made by the nurse practitioner.
The patient, on the other hand, is a minor, who will suffer substantial harm from a drug overdose. The parents, who bear the legal responsibility of taking part in making healthcare decisions for their child, can sue both the prescriber and the pharmacist for the medication error (Varkey, 2021). Consequently, the patient’s parents have a legal right to information concerning the medication prescribed to their child, and how to take it, which should have been provided by the pharmacist.
Strategies to Address Disclosure and Nondisclosure
Disclosing medication error is an ethical act thus must be exhibited by all authorized prescribers in case they are faced with such a situation. In South Carolina, provisions for medication errors reporting are organized according to the South Carolina Code of Regulations. Medication errors are recognized in this state as one of the most crucial treatment-caused risks to the patient. As such, the South Carolina Department of Disabilities and Special Needs demands clinicians to report every medication error that may occur in the course of care provision (
Strategies for Appropriate Decision Making
When faced with such a situation as an advanced practice nurse, I will always decide on disclosing the information to the patient. Medication safety is a crucial aspect in safeguarding patients from harm during the care delivery process. As such, in case of an error, the nurse needs to come forward to avoid legal penalties associated with non-disclosure(Varkey,2021). I will utilize two main strategies to decide on how to disclose the matter to the patient.
First, I will explain to the patient how the medication error occurred to regain trust essential for a healthy patient-provider relationship. I will then expound on how the harmful impact of the error can be ameliorated and provide appropriate steps which will be taken to ensure that such an error will never happen again. This will help regain the patient’s confidence in the care plan hence promoting positive care outcomes.
Writing Prescriptions to Minimize Medication Errors
The process of writing a prescription mainly involves six steps. First, the prescriber must evaluate the patient’s problem, then specify the therapeutic objective (Mullen et al., 2018). After which the prescriber will select the most effective drug therapy, and initiate the therapy, with appropriate consideration of the dosage, frequency, and duration of drug use. The prescriber will then give information and instructions to the patient and evaluate therapy regularly.
To minimize incidences of medication errors, the prescriber must consider several factors before prescribing any medication. Such factors include whether the medication is the best choice in the management of the patient’s condition, whether there are any contraindications, whether the dosage is correct, whether the patient is allergic to any of the drug components, and appropriate storage for the drug among others.
Conclusion
Several ethical considerations have been outlined to promote appropriate prescriptive practices upholding patient safety and preventing harm. As such, in case of medication error like in the provided case study, the nurse is required to disclose the matter to the patient and implement appropriate strategies to address the issue.
References
Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP guidelines on preventing medication errors in hospitals. American Journal of Health-System Pharmacy, 75(19), 1493-1517. https://doi.org/10.2146/ajhp170811
Mullen, R. J., Duhig, J., Russell, A., Scarazzini, L., Lievano, F., & Wolf, M. S. (2018). Bestpractices for the design and development of prescription medication information: A systematic review. Patient education and counseling, 101(8), 1351-1367. https://doi.org/10.1016/j.pec.2018.03.012
Robertson, J. J., & Long, B. (2018). Suffering in silence: medical error and its impact on health care providers. The Journal of emergency medicine, 54(4), 402-409. https://doi.org/10.1016/j.jemermed.2017.12.001
Tigard, D. W. (2019). Taking the blame: appropriate responses to medical error. Journal of Medical Ethics, 45(2), 101-105. http://dx.doi.org/10.1136/medethics-2017-104687
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119
The instructions say “Be sure to reference laws specific to the state of South Carolina
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
You made very good points in your discussion question. The blood pressure medication was already absorbed where the drug moved to the administration site and distributed where it went to the area where action can take place on the drug. (Rosenthal & Burchum, 2021). Of course, we know that dialyzing does get rid of the drug quicker and does not have as much as an effect on the individual. Your plan is good. It is important to educate the patient on not taking blood pressure medications before dialysis and that the hypotensive effect does not potentiate.
Angiotensin receptor blockers (ARBS) and ACE inhibitors are drugs that are commonly used first line for dialysis patients and the liver does metabolize ARBS does not experience appreciable removal in dialysis (Fravel et al., 2019). They also share that the kidneys do get rid of certain ACE inhibitors, like lisinopril and do experience removal in a substantial amount (Fravel et al., 2019). However, in this patient’s case, the pressure can already be low by the time they get to the dialysis clinic.
According to Rosenthal & Burchum (2021) , responses to drugs can either reduce or increase when there are interactions, making the issue much worse. It would be also good to have the patient to have a reminder note on dialysis days somewhere in her home to help her to remember not to take the medications. Being that this is so habitual for the patient, it can be difficult to break. Also, it would be good to have supportive family or friends to call her or either be with her the morning before dialysis to remind her or a courtesy call from the dialysis clinic as well. Perhaps on an organized pill box, there can be a note of open area where the pills are not available for her as a reminder.
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