Assignment: Ethical and Legal Implications of Prescribing Drugs

The case depicts AC, a 72-year-old man admitted to the ICU following a massive stroke that has made him unresponsive and impaired his communication. The patient is now on a ventilator. The stroke has been attributed to a medication error. The patient’s wife reports that they do not have any advanced directives, but she is certain the patient would not wish to continue being in that condition. However, AC’s daughter insists that her father would wish to be kept alive if there is a possibility of getting better. The purpose of this paper is to explore the related ethical and legal implications and approaches to dealing with disclosure and nondisclosure.

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Ethical and Legal Implications

The case raises ethical issues since a medical error led to a severe adverse effect on the patient. The prescriber is at risk of legal consequences for prescribing the wrong medication that led to the patient’s stroke. If the patient’s family is informed of the medication error, they may pursue a lawsuit against the prescriber, pharmacist, and the hospital for negligence (Sorrell, 2018). Consequently, the prescriber and pharmacist licenses risk being revoked, which can hinder their career advancement. Besides, the hospital may be required to pay a hefty sum to the patient’s family, and the hospital’s image may be negatively impacted. Furthermore, ethical implications may surface since the prescriber and pharmacist did not uphold the medical ethics of beneficence and nonmaleficence (Sorrell, 2018). This is because they are required to implement interventions that will promote better patient outcomes and prevent any harm from coming to the patient. The contradicting views between the patient’s wife and daughter on euthanasia create an ethical dilemma. In this case, the healthcare team has to make a moral decision based on what is right for the patient.

Strategies to Address Disclosure and Nondisclosure

Disclosure of medical error entails communication between a healthcare provider and a patient or patient’s family members whereby the provider admits the incident, explains what transpired, and the connection between the error and outcomes in a meaningful way to the patient (Mashayekhi et al., 2021). Disclosure addresses the care recipient’s needs and is usually conveyed by the attending physician and chief nurse executive. It can take the approach of a formal verbal apology or writing by patient safety officers. Usually, the providers involved in the error apologize. California has a new law requiring hospitals to make timely reports to the state health department when severe medical errors occur. The health department must then investigate the incident within 48 hours. The new law also significantly increased fines for medical errors that jeopardizes the health or safety of a patient from $25,000 to $100,000 per incident.

Strategies to Use to Guide Decision-Making In This Scenario

The decision to disclose is usually complex and relies on how the error is defined and if it is recognized or detected. In this scenario, the decision to disclose the medical error to the patient’s family would be guided by the organization’s and state’s policy on disclosure (Mansour et al., 2020). Thus, if the policies demand that all medical errors be disclosed to patients, I would adhere to the policy. My professional responsibility as an advanced practice nurse (APN) would also guide my decision on disclosure. APNs have an ethical, legal, and professional responsibility to disclose harm that occurs in patient care delivery.

Process of Writing Prescriptions

The first step in writing a prescription is noting the prescriber’s information, including name, address, and phone number. The second step is writing the patient information, including first and last name, sex, and age. The prescribe should then write the medical diagnosis and medication details, including name and strength, drug quantity in textual and numeric formats, directions for use, and date prescribed (Mieiro et al., 2019). Lastly, the prescribing practitioner should sign the prescription on the day issued and include qualifications.

Medication errors can be minimized by following the five rights of medication administration: right patient, right drug, right dose, right route, and the right time. Hospitals can also implement health technologies to reduce medication errors. Mieiro et al. (2019) explain that prescribing and determining drug doses using computerized systems significantly lowers incidents of medication errors. Bar codes also lower errors that occur in medication administration. Besides, the implementation of electronic prescriptions, with compulsory field fillers and suggested doses can minimize errors.

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Conclusion

In the case scenario, the prescriber, pharmacist, and the hospital risk facing lawsuits against them if the patient’s family knows that a medication error led to a massive stroke. The prescriber and pharmacist risk losing their licenses, while the hospital can pay heavy fines. Disclosure decisions would be based on the hospital and state policies on disclosure. Medication errors can be reduced by following the five rights of drug administration and using technologies like computerized systems, barcode, and electronic prescribers.

References

Mansour, R., Ammar, K., Al-Tabba, A., Arawi, T., Mansour, A., & Al-Hussaini, M. (2020). Disclosure of medical errors: physicians’ knowledge, attitudes and practices (KAP) in an oncology center. BMC medical ethics, 21(1), 1-8. https://doi.org/10.1186/s12910-020-00513-2

Mashayekhi, J., Forouzandeh, M., & Saeedi Tehrani, S. (2021). Error Disclosure Algorithms: How to Disclose Colleague’s Medical Error at Individual and Organizational Levels. Medical journal of the Islamic Republic of Iran, 35, 163. https://doi.org/10.47176/mjiri.35.163

Mieiro, D. B., Oliveira, É. B. C. D., Fonseca, R. E. P. D., Mininel, V. A., Zem-Mascarenhas, S. H., & Machado, R. C. (2019). Strategies to minimize medication errors in emergency units: an integrative review. Revista Brasileira de Enfermagem, 72, 307-314. : http://dx.doi.org/10.1590/0034-7167-2017-0658

Sorrell, J. M. (2018). Ethics: ethical issues with medical errors: shaping a culture of safety in healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2). https://doi.org/10.3912/OJIN.Vol22No02EthCol01