Assignment: Ethical and Legal Responsibilities of Prescribing for the Advanced Practice Nurse

SCENARIO FOR THIS ASSIGNMENT; TF is an 18-month-old boy who was admitted to your hospital for failure to thrive and losing 6 lbs. You have found that he has extreme blockage throughout his GI system with severe impaction throughout. He is in a great deal of pain and is screaming. His parents are adamant that they do not want treatments due to religious beliefs. They have stated that they boy’s grandfather, an elder in their church, is on his way to pray over the boy and heal him.

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Ethical and Legal Responsibilities of Prescribing for the Advanced Practice Nurse

The advanced practice nurse (APN) is a clinician who has been educated and trained to prescribe medications. For those that have autonomous practice in full practice authority states, this prescriptive authority is absolute (Dillon & Gary, 2017). That means the APN has the sole responsibility to ethically and legally prescribe according to what the law and practice guidelines say. This paper looks at this responsibility of the APN in line with the ethical and legal requirements with special reference to the state of Maryland.

Ethical and Legal Implications of the Chosen Scenario on Stakeholders

The APN has specific ethical responsibilities when prescribing (Mitchell & Oliphant, 2016). These touch on the five bioethical principles of autonomy, beneficence, nonmaleficence, justice, and fidelity (Haswell, 2019). The scenario presented involves an 18-month old boy whose parents are negligent and are refusing treatment despite the fact that he is very sick, malnourished, and requires urgent medical attention due to gastrointestinal impaction.

Ethical Implications of the Scenario on Stakeholders

Prescriber

The APN is the prescriber in this case. Ethically, they are supposed to seek informed consent in this case from the parents before any intervention since the patient is still a minor. In other words, they cannot forcefully treat the child if the parents do not give consent. This is the whole essence of autonomy. Second, the APN is bound to do everything to bring the child some good as dictated by beneficence. This means treating the child for the impaction and alleviating their pain. Third, the APN should not do anything that will bring harm to the child as dictated by the ethical principle of nonmaleficence. Fourth, the child should be treated fairly with everything at the disposal of the APN without holding back as the principle of justice requires. Lastly, the APN needs to be honest with the child’s parents about his condition but at the same time should maintain confidentiality. This is what the principle of fidelity requires.

Pharmacist

The pharmacist has the ethical obligation to avail medications that have been prescribed without fail. They are also bound by the five bioethical principles as discussed above for the prescriber.

Patient

In this scenario, the patent is a minor and a child and so they are not bound by any ethical considerations as they do not know what is going on.

Patient’s Family

A lot of ethical responsibilities fall on the parents of this 18-month boy. It is incumbent upon them to make decisions that have the best interests of their child at heart. This includes seeking prompt medical attention for the child when they are sick. Clearly, they are not doing this at the moment and letting the child suffer as they wait for him to be prayed for.

Legal Implications of the Scenario on Stakeholders

Prescriber

It is the APN that has the DEA (Drug Enforcement Administration) number that authorises them to prescribe medications (Androus, 2019). By law, it is them that are supposed to make the decision as to what medications to prescribe for the child’s pain and impaction. The Prescription Drug Monitoring Program, or PDMP, in Maryland also aids in the prevention of legal and ethical infractions by prescribers having prescriptive authority. The prescriber is also legally obliged to do mandatory reporting on any case of child abuse they come across such as this one.

Pharmacist

By law, it is the pharmacist that is authorised to dispense medications and they are supposed to verify the credentials of the prescriber before doing this. This includes verifying whether the DEA number is valid and authentic.

Patient

The patient in this case is a minor and therefore there is no legal responsibility on his part.

Patient’s Family

The patient’s family will be legally held responsible for negligence and child abuse. As a matter of fact, the child would be taken away and placed under foster care by the state. The parents would then be charged with this gross violation of the child’s rights and absconding of parental responsibility.

Strategies to Address Disclosure and Nondisclosure in Maryland

Disclosing medical errors and disparities is both an ethical and legal requirement in Maryland, as it is in many other jurisdictions. This is because taking such action could save lives that would otherwise be lost due to drug misuse or bad drug reactions. According to the Maryland Department of Health (DoH, n.d.-b), there is a statute known as COMAR 10.07.06 that was passed in 2004. It requires clinicians to self-report cases of medical prescription errors and anomalies that could hurt the patient or cause them to become addicted. Furthermore, the PDMP requirements hold prescribers accountable for providing background information on the people to whom they have issued a prescription. In the given scenario, the APN is expected to disclose to the PDMP any instance of a prescription error that they may make when prescribing for this boy medications for his impaction and pain.

Two Strategies to Guide Decision in the Scenario

As the APN, one of the strategies I would use to guide decision making in this scenario is to involve the department of children’s services so that the parents can be compelled to give the child medical attention. Another strategy I would use is to do my duty of mandatory reporting of child abuse to the authorities so that the child can get help. I would also involve the hospital chaplain to try and convince the parents to also consider medical treatment on top of prayers. As an APN, I would indeed disclose my error if I committed one in this case. The justification is that the law in Maryland requires me to do so and it is also the best thing to do ethically.

The Process of Writing Medications and Strategies to Minimize Errors

APRNs must follow the World Health Organization’s six-step paradigm to reduce the risk of prescription mistakes. These are also the steps in the process of prescribing medications (Pollok et al., 2007):

Identifying and characterizing the patient’s issue
Formulation of a therapeutic goal
Selecting the most appropriate medication
Begin therapy only when you’ve gathered adequate information about the patient. Non-drug interventions should be considered.
Educate, inform, and caution the patient
Check to see if the treatment is working on a regular basis.

References

Androus, A.B. (2019). What is a DEA number and how can a nurse practitioner obtain one? https://www.registerednursing.org/answers/dea-number-how-nurse-practitioner-obtain-one/

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

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

Maryland Department of Health [DoH] (n.d.-b). Patient safety. https://health.maryland.gov/ohcq/Pages/PatientSafety.aspx

Mitchell, A., & Oliphant, C.M. (2016). Responsibility for ethical prescribing. JNP, The Journal for Nurse Practitioners, 12(3), A20. https://doi.org/10.1016/j.nurpra.2016.01.008