The Ethics and Legalities of Medication Error Disclosure
MEDICAL ERRORS 2 Introduction: The occurrence of medical errors is an inevitable part of practice in health care systems.
As a result, they always get associated with compromising the safety and welfare of the patients.
Through forecasting, medical errors remain bound to continue to occur in the health care setting due to the associated flaws in clinical workflow processes, in the health care information systems, and among the healthcare providers.
According to the Institute of Medicine (IOM,
2004), a medical error got defined as a failure of a planned action ought to get completed as
intended; a mistake of execution or the use of a wrong plan to attain an aim; an error of planning.
In essence, it includes omitting or commissioning through an act. A healthcare practitioner ought
to consider both the ethical and legal implications of disclosing a medical error and how to go
about it even in those circumstances where it was not intentional, or it did not have adverse
effects.
Legal and Ethical Implications of Disclosure and Nondisclosure
Legal Implications
Generally, medical errors get associated with severe legal implications to health care
subscribers in holding them accountable for the outcomes. Such consequences often leave them
wallowed in dilemmas of whether to disclose or keep a low profile concerning the errors. The
prevailing legal penalties the prescribers face concerning medical errors include medical board
disciplines, civil actions, and criminal allegation (Sulivan, 2017). As clinicians, the APRNS get
demoralized when they get confronted with such situations and present with anxiety since they
get upset about failing to get competent and that they have compromised safety regarding the
healthcare standards. Subsequently, the Advanced Practice Registered Nurses ought to have full
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insight into the practice and prescribing laws specific to their state since the laws and regulations
are particular to each state.
The prescriptive authority also regarded as independent prescribing refers to the ability of
an APRN to prescribe, do legend prescription without limits, and have control on drugs, medical
devices, supplies, and equipment. According to the American Association of Nurse Practitioners
in the state of Florida, Advanced Registered Nurse Practitioners (ARNP), Certified Nurse
Midwives (CNM), and Certified Registered Nurse Anesthetists (CRNA) constitute the Nurse
practitioners who can prescribe. The prescribers ought to check the Prescription Drug
Monitoring Programs (PDMD) before giving prescriptions of controlled substances whereby
order gets done in the health care facilities and the outpatient settings by the aid of a controlled
substances formulary list of the substances authorized or excluded subjects to certain limits. The
limitations to prescribers include no prescription of psychotropic medications for children aged
below 18 years unless the APRN is a certified psychiatric specialist nurse. Besides, APRNs
cannot prescribe controlled substances in pain management clinics and that APRN prescribers of
controlled substances ought to have attained a master's or doctorate (Goolsby, & DuBois, 2017).
Ethical Implications
In the event of an Advanced Practice Registered Nurse (APRN) facing a dilemma,
challenges or concerns regarding their scope of nursing practice, they ought to revisit their state
laws and regulations, scope and standards of practice, institutional guidelines and policies,
liability and risk management worries. (Zittel, Moss, O'Sullivan, & Siek, 2016). As a result, the
prescribers always have to consider ethical entanglement related to opting to disclose or not
disclosing medical errors. An error ever compromises the quality of patient care and the resultant
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health outcome of an individual through harm, dismantle patient-clinician relationship reduce
trust with other stakeholders involved in the healthcare system, including relatives.
The harm caused by medication errors causes damage to more than just the patient in the
clinical setting but also to the family, the nurse, and the healthcare organization. Patients have
their wellness compromised physically, emotionally, and spiritually. They incur financial loses
as well. Increased costs, malpractice, poor professional relationships, mistrust, and harm or death
of patients are the overall ethical and legal implications of medical errors. For the prescriber, he
or she may suffer from moral dilemmas, lose their license of practice, undergo litigation, or face
legal disciplinary action as well the organization. (Zittel, Moss, O'Sullivan, & Siek, 2016). A
call for maintaining professional competence ought to get stressed to avoid the implications of
medical errors.
To Disclose or Not Disclose the Error
It remains an uncommon practice by health care providers to disclose medical errors in
the health care settings; statistics reveal that prescribes usually disclose them. According to
ethics, it remains critical to uncover mistakes in clinical practice. In cases where the APRNs do
not disclose the errors, they act to the best of their interests and put them above those of their
clients. In the end, they violate the ethics related to patient-centered care. Additionally, they
undermine their moral courage of professionalism, and such events lead to impaired care to
patients leading to harm as well as jeopardized relationships. Therefore, it remains a necessary
step for organizations to adopt guidelines and policies that foster a culture of moral courage in
disclosing medical errors, offering training on modes of revealing them and providing support
mechanisms to clinicians to reduce such incidences.
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Prescription Writing Process
Prescriptions are guidelines and forms of communications done in writing, making legal
documents that involve patients, pharmacists, and other clinicians. As a result, they must be
clearly outlined to avoid misinterpretation hence reduce errors. A variety of factors get
considered by a prescriber before writing them.
First, patient information regarding the current treatment regimen, allergies, and past
medical history get considered. Evaluating medication reconciliation lists is critical before
prescription to avoid duplication and avoid adverse drug interactions. It also includes the
patient's full details; biodata; the name of the substance, dosage regimen, dose, and route of
administration; signature of the prescriber, the license number, and the Drug Enforcement
Administration (DEA) if it is required. (Arcangelo & Peterson, 2013). In the state of Florida, for
example, the APRNs ought to get aware of the state laws regarding the prescription of controlled
substances. In the state, the APRNs may not prescribe controlled substances in a pain
management clinic. Prescribing of schedule II drugs gets limited to a 3-day supply, and
psychotropic meds should not be prescribed for children less than 18 years unless the nurse is a
psychiatric specialist.
Strategies to Minimize Medication Errors
Prescribers must get familiar with the symbols, table of abbreviations, and dose designs
outlined by the Institute for Safe Medication Practices that should never get used in
communicating medical details since they are bound to misinterpretation hence lead to medical
errors. Again, two identifiers ought to be present to confirm each prescription. Besides, the five
rights of medication administration should get considered including the right patient, right drug,
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right time, correct dosage, and right route. (Anderson, 2013). Other considerations that are
ethically acceptable are the inclusion of the right of the patient to refuse the substance, right
reason for medication, and the proper documentation. (Anderson, 2013). Promoting a culture of
safety in reducing medical errors and relying on technology by using tools get essential in the
reduction of medical errors.
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References
American Association of Nurse Practitioners [AANP]. (2016). State practice environment.
Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-
practice-environment
Anderson, P. (2013). Medication errors: Don't let them happen to you. American Nurse Today,
8(6), 23–28. Retrieved from https://americannursetoday.com/medication-errors-dont-let-
them-happen-to-you-2/
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice:
A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins
Goolsby, M. J., & DuBois, J. C. (2017). Professional organization membership: Advancing the
nurse practitioner role. Journal of the American Association of Nurse Practitioners, 29(8),
434-440.
Institute of Medicine. (2004). Patient safety: Achieving a new standard of care. Washington, DC:
National Academies Press.
Sullivan, W. (2017). Medical Legal. 2017 Syllabus, 65, 157.
Zittel, B., Moss, E., O'Sullivan, A., & Siek, T. (2016). Registered nurses as professionals:
Accountability for education and practice. OJIN: The Online Journal of Issues in
Nursing, 21(3).
