NURS 6512 Ethical and Legal Implications of Prescribing Drugs
NURS 6512 Ethical and Legal Implications of Prescribing Drugs
It is a responsibility of a Nurse Practitioner (NP) to collect patient data by taking his or her medical history and conducting examination prior to initiating any prescription of medication. This move is essential for a NP to accurately diagnose the patient and offer an appropriate treatment plan (Rossi, Lipsey & Henry, 2018). In the case at hand, although the NP had autonomy to prescribe, the NP neither took patient history nor conducted physical examination, which is a contravention of ethical principles. Besides, the NP ought to understand the move was against the laws and regulations that operate in Texas to guide the practice. Therefore, the NP risk facing legal implications should the patient report any adverse effects due to medical malpractice. On the other hand, the pharmacist has an ethical and legal obligation to provide education to patient on the right use of the any prescribed medication and their possible side effects before issuing the patient with the medication. Therefore, failure to do this may attract legal actions. The patient and the patient’s family on their side had a responsibility to report any adverse reaction to medication to the NP for proper action including change or discontinuation of medication. Besides, they are allowed to initiate legal action against NP for negligence.
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Strategies to Address Disclosure and Nondisclosure
In the present scenario, it is appropriate to report to the matter to the physician and consult on the best way forward. Essentially, in Texas, the NP is required to collaborate with physicians to form a relationship that fosters consultation and referral. However, many NPs do not trust this strategy for fear of possible loss of job since reporting such cases equal accepting committing illegal activities. Alternatively, the NP may rely on the statutory citation rule 413, which is a state apology law. This rule enables the NP to ask for pardon for contravening the standards rules of practice with a surety that such apology cannot be used against him or her in the court of law (Westrick & Jacob, 2016). In Texas, the statutory citation rule 413 is applicable as Tex. Civil Practice & Remedies Code Ann. §18.06. This rule is essential in enabling a better opportunity for the NP to indicate remorse and ask for forgiveness. Moreover, the NP stands a chance of legal action because this act is deemed as out of court settlement.
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Strategies to Guide Decision Making
In this scenario, the NP made a mistake by failing to consider medical history of patient and prescribing controlled substance without being mindful of the potential occurrence of adverse effects. Therefore, if I was the advanced practice nurse, I would have conducted a detailed patient examination and consider the patient history to guide my action while prescribing the medication. Besides, the other strategy is to strictly rely on the Texas laws and regulations on prescription of controlled substance to guide decision making. For instance, I would work in collaboration with physician since NPs in Texas operates under restricted practice where they are required to form an agreement with supervising physician to be able to prescribe controlled substances (Lyapustina et al., 2016).
The Process of Writing Prescriptions Including Strategies to Minimize Medication Errors
Before writing prescription, it is advisable for the advanced nurse practitioner to first perform patient evaluation, diagnosis to identify the correct medical condition and the best medication for the condition. Consequently, according to Volpe, Melo, Aguiar, Pinho and Stival (2016), while providing hand written prescription, vital information such as date, patient’s name, address, and date of birth should be indicated. On the other hand, the prescriber’s name, contacts, and address should also be captured. Importantly, the medication name and associated details such as mechanisms of administration and dosages should be clearly stated.
References
Lyapustina, T., Rutkow, L., Chang, H. Y., Daubresse, M., Ramji, A. F., Faul, M., & Alexander, G. C. (2016). Effect of a “pill mill” law on opioid prescribing and utilization: the case of Texas. Drug and alcohol dependence, 159, 190-197.
Rossi, P. H., Lipsey, M. W., & Henry, G. T. (2018). Evaluation: A systematic approach. Thousand Oaks, CA: Sage Publications.
Volpe, C. R. G., Melo, E. M. M. D., Aguiar, L. B. D., Pinho, D. L. M., & Stival, M. M. (2016). Risk factors for medication errors in the electronic and manual prescription. Revista latino-americana de enfermagem, 24.
Westrick, S. J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126.
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.
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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Ethical and Legal Implications of Prescribing Drugs
The patient in this case scenario is an elderly 85-year-old lady with significant cognitive decline at her end-of-life phase. She has renal failure, and heart failure, and has been on prophylactic anticoagulants. She is currently in immense pain and can barely tolerate procedures. The purpose of this paper is to explore the ethical and legal implications of prescribing drugs in this scenario. The aspects that will be addressed include the ethical and legal implications on all stakeholders, strategies to address disclosure and nondisclosure, the prescription writing process, and the minimization of medical errors.
Ethical and Legal Implications for All Stakeholders
The prescriber is ethically and legally obligated to prescribe medications that are safe and effective in attaining the therapeutic objective. This may necessitate the prescription of restricted medications such as opioids since the patient is in agony for adequate end-of-life care. The pharmacist is obligated to dispense the correct medication in appropriate doses. Both the prescriber and pharmacist should take responsibility and accountability for any medical errors. The patient and their families should disclose any information that may contribute to adverse outcomes such as comorbidities and current medications. The patient should also follow recommendations for the best therapeutic outcomes and seek clarification for any concerns about their management.
Strategies to Address Disclosure and Nondisclosure
Disclosure and nondisclosure of medical errors are complex issues within the healthcare setting. Strategies for effective disclosure include avoidance of blame and speculation, sincere apology, reassurance of mitigation of resultant effects, strategies to prevent a recurrence, and training of healthcare professionals (Kalra et al., 2019). In Canada, policies dictate that healthcare professionals are obligated to fully disclose harmful, near-harm, and near-miss incidents to patients (Advice to the profession: Disclosure of harm. CPSO, n.d.). This will allow for the adoption of measures to mitigate resultant adverse outcomes, prevent future recurrence, and promote patient autonomy in making informed decisions.
Strategies to Guide Decision-Making
The patient in this scenario has significant cognitive decline which may necessitate the use of advanced directives, the patient’s family, and care teams in decision-making regarding treatment interventions. The decisions will be guided by the ethical principles of beneficence, nonmaleficence, autonomy, and justice (Varkey, 2020). The benefits and harms of each intervention should be weighed to avoid any harm to the patient. There should not be any coercion to therapeutic interventions. In case of medical errors, integrity should be upheld by promptly informing the patient and their family which prioritizes the patient’s interest.
Prescription Writing Process and Strategies to Minimize Medication Errors
Prescription writing errors significantly contribute to medical errors with implications on quality of care, patient safety, legal, and economic sequelae. The prescription writing process follows a set standard that includes certain elements in prescriptions. These include the date of prescription, patient identifiers such as name, age, and gender, prescriber identifiers such as name, registration number, and contacts, and treatment description that meets the therapeutic objective (Nkera-Gutabara et al., 2020). The treatment should include the full drug name, dose, frequency, and duration of the regimen. Generic names, use of standard abbreviations, and legibility should be ensured to minimize medication errors (Nkera-Gutabara et al., 2020). The patient should also be educated on appropriate and correct drug use.
Conclusion
Drug prescription is an integral component of patient care that sometimes result in unexpected medical errors. These errors can have implications on patient safety, quality of care, and legal issues. In the event of harmful, near-harm, and near-miss incidents, healthcare professionals are legally and ethically obligated to disclose such events to patients and their families. This provides room for mitigation measures against resultant adverse outcomes, prevention of recurrence, and promotion of informed decisions by the patient.
References
Advice to the profession: Disclosure of harm. CPSO. (n.d.). Retrieved December 13, 2022, from https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Disclosure-of-Harm/Advice-to-the-Profession-Disclosure-of-Harm#:~:text=Physicians%20have%20a%20legal%20duty,valid%20consent%20for%20subsequent%20treatment.
Kalra, J. (J., Campos-Baniak, M. G., Saxena, A., & Rafid-Hamed, Z. (2019). Medical error disclosure – A Canadian perspective in improving quality of health care. Advances in Intelligent Systems and Computing, 26–34. https://doi.org/10.1007/978-3-030-20451-8_3
Nkera-Gutabara, J. G., & Ragaven, L. B. (2020). Adherence to prescription-writing guidelines for outpatients in Southern Gauteng District hospitals. African Journal of Primary Health Care & Family Medicine, 12(1). https://doi.org/10.4102/phcfm.v12i1.2263
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
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