Ethics and Legalities of Medication Error Disclosure

Consider the following scenario:

You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

To prepare:

Consider the ethical implications of disclosure and nondisclosure.

Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.

Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.

Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.

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Write a 2- to 3- page paper that addresses the following:

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.

Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale Ethics and Legalities of Medication Error Disclosure.

Explain the process of writing prescriptions including strategies to minimize medication errors.

Lately, it has become widely acknowledged that medical errors and adverse events are frequent occurrences in all healthcare settings. The position is supported by multifarious reports including the famous To Err is Human, which revealed that adverse events, including medication errors, happen in around 3% of hospitalization cases (“Medicine I.O”, 2000). This report reveals that medical practitioners are susceptible to making errors including medication errors. Although the existence of medication errors will remain a healthcare issue as long as physicians and advanced nurses remain fallible humans, the phenomenon ought not to be acknowledged as a fact. However, even as such errors occur, the next step undertaken by the advanced nurse becomes imperative. The response provided by these advanced nurses need to be consistent with existing federal and state laws as well as ethical frameworks that have been established in the nursing profession.

One of the most fundamental questions that advanced nurses ask themselves upon realization of the occurrence of a medical error is whether disclosure or non-disclosure best serves the patient. However, the appropriate response, which is directly related to the advanced nurses’ attitude, has been facilitated by the present cultural change in medical behavior that has ditched the paternalistic approach of refusing to upset the patient and embraced the open-discussion approach that requires an advanced nurse practitioner to disclose the truth to the patient given that deception in medicine has become unacceptable (Arcangelo et al., 2017). The cultural change has received the backing of medical associations’ codes of ethics, which address the issue of disclosure and non-disclosure regarding medication errors. According to the American Nurse Association Code of Ethics, nurses are required to have the moral courage, moral resilience, and moral distress to speak out and make a decision that is right for the patient (Fowler, 2008). Thus, an advanced nurse is needed to admit their medication errors to the patient. The above ethical requirements are supported by both consequentialist and deontological perspectives. To this end, by considering the ethical currency of the medication error alone as well as the possible consequences of the same, it is obvious that disclosure is the correct decision to undertake whenever a medication error happens.

The issue of disclosure and non-disclosure has also been legislated upon at both federal and state levels. According to these legislations, the commission of medication error attracts consequences for both the hospital and the advanced nurse practitioner in varied ways. At the federal level, efforts have been made to establish a law that would address the issue of medication errors as committed by medical practitioners (Philipsen & Soeken, 2011). In the year 2005, Senators Hillary Clinton and Barack Obama introduced to the Senate what they termed as The National Medical Error Disclosure and Compensation Act (MEDiC), which was an amendment to the Public Health Service Act. In this Act, hospitals were required to disclose their personnel errors to patients and commit to offering significant financial compensations where necessary (“United States”, 2007). In addition to the compensations, the law also sought to protect any statements and apologies for errors that providers, including their personnel make, from being utilized in a future malpractice action Ethics and Legalities of Medication Error Disclosure.

As mentioned, various state jurisdictions have also formulated laws on the issue of disclosure. A quintessential example of these state laws is California’s apology statute, which requires hospitals to offer an apology to patients after the occurrence of a medical event. The purpose of such an apology is to encourage open discussions with the patient regarding the adverse results. During the apology, a healthcare professional may express regret, compassion and sympathy. Consequently, such an apology is barred from being presented to a jury should there be a jury. However, California’s Evidence Code 1160 (a), which according to Snape (n.d ) posits that the only inadmissible portion of the apology against a treating medical practitioner is “the portions of statements or benevolent gestures expressing sympathy” (p. 67). Therefore, the Californian law on medication error disclosures could have negative ramifications for both the hospital and the advanced nurse practitioner.

As a medical nurse practitioner in the aforementioned scenario, I would disclose the medication error information to the client. The morality of the matter requires that an advanced nurse makes a disclosure to the patient as that will no longer be a business-inspired decision. Commitment to full-disclosure by the author stems from the fact that it is the right moral decision to take. According to my take, the patient and even their family retain the right to known about the medication error. In addition, by disclosing the mishap to the patient, trust between myself as the provider and the patient will be promoted making patient care to remain the rudimentary focus of our clinician-patient relationship (“Medication Errors”, n.d.). Lastly, by openly discussing the issue with the patient, I could indirectly promote patient safety as I would be encouraged to seek system improvements that would probably deter the recurrence of the issue.

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The prevention of medication errors could be significantly reduced at the prescription stage. During the prescription process, an advanced nurse needs to express undivided attention and caution when prescribing the drug. It has been established that advanced nurses could also be distracted by patient questions as they write the medication (Crigger & Holcomb, 2008). According to professionals, one is advised to delay the patients’ distractions though verbal and non-verbal cues. Further, errors that result from distortions could be eliminated through limiting each prescription to a single medication. Further, an advanced nurse could be required to confirm the dosage information of a drug before prescribing it. Also, the provision of concise and specific directions regarding the utilization of the drug could significantly reduce instances of medication errors (“Practitioner’s Manual”, n.d). Other measures include adding the patient’s weight, elimination of drug administrations, and specifying the therapeutic durations Ethics and Legalities of Medication Error Disclosure.

Therefore, medication errors will continue since the infallibility of humans is a phenomenon that cannot be cured easily. However, the shifting cultural practices in medicine and nursing provides that a more open discussion ensures whenever such an issue arises during care giving. The moralistic and legalistic bases of the issue demand that patients become aware of the errors though the advanced nurse responsible for committing it. Otherwise, there will be both ethical and legal consequences for the guilty parties should a jury ensue. However, even as this occurs, advanced nurses need to adopt strategies that will minimize the existence of such errors.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.

Fowler, M. D. M., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association.

Medication errors: Best Practices – American Nurse Today. (n.d.). Retrieved from https://www.americannursetoday.com/medication-errors-best-practices/

Medicine, I. O. (2000). To Err Is Human: Building a Safer Health System. , : National Academies Press.

Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.

Practitioner’s Manual. (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/pubs/manuals/pract/

Snape, J. (n.d.). California Evidence Code 2017. , : Lulu.Com.

United States. (2007). Medical Liability: New Ideas for Making The System Work Better for Patients, S. Hrg. 109-710, June 22, 2006, 109-2 Hearing, *. Place of publication not identified: publisher not identified Ethics and Legalities of Medication Error Disclosure.

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