[ANSWERED 2023] A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history

Written By: Dan Palmer, RN

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway

You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs.  As advanced practice nurses, almost every clinical decision you make will have ethical or legal implications.  Your ethical and legal knowledge is fundamental to your ability to resolve the multitude of challenging issues encountered in practice.  This week you have an assignment to write a paper – you will explore the ethical and legal implications of the following scenario, and consider how to appropriately respond:

Scenario options

Scenario 1:

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Scenario 2:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Scenario 3:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Scenario 4:

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.

Please refer to the Course Schedule for specific assignments and due dates for this week.

Have a wonderful week!

Assignment: Ethical and Legal Implications of Prescribing Drugs

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.

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.

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history

A friend calls and asks you to prescribe a medication for her. You have this autonomy

 

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.

Expert Answer and Explanation

Ethical Issues in Drug Prescriptions

Ethical and Legal Implications of the Scenario

The given scenario highlights ethical issues that are involved when prescribing drugs to patients, especially if the patients are either family members or friends. The first ethical consideration falls under the ethical principle of beneficence and non-malfeasance. When prescribing drugs to family members or friends without being objective, it will be difficult for the prescriber to ascertain whether the drug will be of help or detrimental to the patient’s health which may not adhere to the ethical principles of beneficence and non-malfeasance (Ghazal, Saleem & Amlani, 2018).

Following due procedure when prescribing drugs for any patient is vital in reducing the chances of prescription errors. The legal implications of the decision to prescribe will arise when harm has been done to the patient, and proper disclosure and prescription procedures were not adhered to.

Strategies to Address Disclosure and Nondisclosure

According to Ghazal, Saleem, and Amlani (2018), one of the biggest ethical dilemmas encountered by most healthcare practitioners is whether to disclose or not to disclose medical errors. However, according to the statutory bill of rights, regarding patients’ rights, a healthcare provider is requested to disclose any incident of a medical error to the patient.

One of the strategies to address disclosure and non-disclosure in my state is by encouraging honesty in practice whereby both the patient and the prescriber ought to understand that errors in healthcare, at times, happen, and finding a solution to the errors committed is what is important. Encouraging the use of ethical decision-making is also essential since it will help the health provider be in a better position to explain the error, thereby encouraging disclosure.

Strategies in Decision-making and Disclosure of the Error

The first strategy is to retain objectivity when giving out the prescription. Objectivity allows one to prescribe medication with the right intention without allowing personal feelings to compromise the standards of practice. Objectivity also reduces the instance of prescription errors, which may come as a result of giving the wrong prescription, without first taking the patient’s history (Bird, 2016). The next strategy is to request for a complete analysis of the patient.

This will allow the nurse to prescribe the correct drugs after fully understanding the condition faced by the patient. In such a scenario, as described by Wittich, Burkle, and Lanier (2018), disclosure is done so that the patient can better understand the situation, even when there is no harm done as a result of the error. Disclosure also allows the prevention of similar situations from arising by understanding the repercussions of the error made. For these reasons, I will have to disclose the error.

The Process of Writing Prescriptions

The following is a detailed process of writing prescriptions and strategies to reduce prescription errors, as described by Pollock, Bazaldua, and Dobbie, (2017). The first step to the process is to properly define a patient’s health issue, which requires a drug prescription. This step is important in that it will allow a nurse to prescribe medication which will have the best impact with minimal side effects or any other negative implications on the patient the second step in the process is to establish a therapeutic objective of the prescription.

Different medications have different therapeutic objectives and depending on the patient’s hierarchy of health needs based on the diagnosis, and intended outcomes, the medication regimen may vary,

The third step in the process is to select the ideal drug therapy to assist the patient using the results obtained in the previous steps. When prescribing drugs, the healthcare provider in charge is advised to prescribe drugs that are tolerable to the patient, safe to use, if possible, not pricey, and effective in dealing with the patient’s problem (Haque, 2017).

The next step is to initiate the selected drug therapy to the patient. One of the considerations to take during this stage is that the prescription given should be written in a simple manner which the patient can easily understand. The prescription should clearly indicate the duration of the drug therapy, and if possible, additional instructions should be accompanied if complex drugs are used in the therapy.

The fifth step involves giving the patient instructions and warnings involved when under the drug therapy selected. Some of the instructions which should be emphasized include potential side effects, any product which the patient needs to avoid while under medication, and at times the activities to avoid after using the medications.

The final step is to follow-up with the patient to ascertain the effectiveness of the therapy (Kron et al., 2018). If the therapy is seen not to accomplish its intended objectives, then underlying reasons why it is not working needs to be assessed and a change of therapy may at times e required.

In order to minimize prescription errors, there are various strategies that can be employed. One of them is by using technology to counter the problem. Information stored about a patient by use of technology tools, like electronic health records, can be of great help in prescribing effective, safe, and correct prescriptions.

References

Bird, S. (2018). The pitfalls of prescribing for family and friends. Australian prescriber39(1), 11–13. doi:10.18773/austprescr.2016.002

Ghazal, L., Saleem, Z., &Amlani, G. (2018). A medical error: To disclose or not to disclose. J Clin Res Bioeth5(174), 2.

Haque, M. (2017). Potential of clinical pharmacology in developing rational prescribing. Acta Medica International4(2), 2-2.

Kron, K., Myers, S., Volk, L., Nathan, A., Neri, P., Salazar, A., … & Seoane-Vazquez, E. (2018). Incorporating medication indications into the prescribing process. The Bulletin of the American Society of Hospital Pharmacists75(11), 774-783.

Pollock, M., Bazaldua, O. V., & Dobbie, A. E. (2017). Appropriate prescribing of medications: an eight-step approach. Am Fam Physician75(2), 231-6.

Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2018). Medication errors: an overview for clinicians. In Mayo Clinic Proceedings (Vol. 89, No. 8, pp. 1116-1125). Elsevier.

Ethical and Legal Implications of Prescribing Drugs for Nurse Practitioners

Introduction

Nurse practitioners (NPs) are healthcare professionals who play a critical role in modern healthcare delivery. With their advanced education and clinical training, NPs are able to provide a wide range of healthcare services, including primary care, specialty care, and clinical leadership. However, the issue of drug prescribing authority for NPs has been a subject of debate and controversy in the healthcare industry.

In this article, we will explore the ethical and legal implications of drug prescribing for nurse practitioners and provide insights into best practices and solutions for safe and effective prescribing.

Ethical Implications of Drug Prescribing for NPs

One of the most important ethical considerations in drug prescribing for NPs is the potential harm that can be caused to patients if the drugs are not prescribed appropriately. The NP must always prioritize the safety and well-being of their patients when making prescribing decisions. This means ensuring that the drug is necessary, effective, and safe for the patient’s specific condition and medical history.

Another ethical consideration is the potential for conflicts of interest in drug prescribing. NPs may have relationships with pharmaceutical companies or be incentivized to prescribe certain drugs. It is important for NPs to remain objective and unbiased in their prescribing decisions, putting the needs of the patient first.

In addition, NPs must adhere to ethical guidelines and professional standards when prescribing drugs. This includes following relevant laws and regulations, practicing within their scope of competence, and maintaining appropriate documentation and communication with other healthcare providers.

Overall, ethical considerations play a crucial role in drug prescribing for NPs, and it is essential that NPs prioritize patient safety and adhere to professional standards when making prescribing decisions.

Legal Implications of Drug Prescribing for NPs

NPs must also be aware of the legal implications of drug prescribing, which can vary by state and country. In many jurisdictions, NPs are authorized to prescribe drugs as long as they have completed the necessary education and training and are practicing within their scope of competence. However, there may be restrictions on the types of drugs that NPs can prescribe or the conditions for which they can prescribe them.

NPs must also be aware of the potential legal consequences of inappropriate prescribing, such as malpractice lawsuits or disciplinary action from licensing boards. To mitigate these risks, NPs must ensure that they are prescribing drugs in accordance with relevant laws and regulations, and that they are documenting their prescribing decisions appropriately.

In addition, NPs must be aware of the potential for drug diversion or misuse, which can have serious legal and ethical implications. NPs should take appropriate measures to prevent drug diversion, such as maintaining appropriate security and documentation of controlled substances.

Overall, NPs must be aware of the legal implications of drug prescribing and ensure that they are prescribing drugs in accordance with relevant laws and regulations to mitigate legal risks and protect patient safety.

Challenges and Controversies Surrounding NP Prescribing

Despite the many benefits of drug prescribing for nurse practitioners, there are also several challenges and controversies surrounding this practice.

One of the biggest challenges is the lack of standardization in NP prescribing authority across states and countries. This can lead to confusion and inconsistency in prescribing practices, and can make it difficult for NPs to provide consistent care to patients who may move between jurisdictions.

Another challenge is the potential for conflicts with other healthcare providers, particularly physicians. Some physicians may view NP prescribing as a threat to their own authority or may be skeptical of the training and competence of NPs in prescribing drugs. This can lead to tension and resistance to NP prescribing, particularly in collaborative care settings.

There are also controversies surrounding specific drugs and drug classes that NPs may prescribe, such as opioids or psychotropic medications. These drugs carry significant risks for patient harm and addiction, and there may be disagreements over the appropriate prescribing practices and protocols for these drugs.

Best Practices and Solutions for Ethical and Legal Drug Prescribing for NPs

To ensure safe and effective drug prescribing practices, there are several best practices and solutions that nurse practitioners can implement. These include:

  1. Cultivating professional relationships with supervising physicians: NPs should work collaboratively with their supervising physicians and other healthcare providers to ensure that drug prescribing is conducted safely and effectively. This includes seeking consultation when necessary and communicating effectively about prescribing decisions.
  2. Maintaining up-to-date knowledge and skills: NPs must stay current with the latest evidence-based practices and guidelines for drug prescribing. This includes ongoing education and training to ensure that they are competent and confident in their prescribing decisions.
  3. Communicating effectively with patients and their families: NPs must communicate clearly and effectively with patients and their families about drug prescribing decisions, including the risks and benefits of different medications, potential side effects, and instructions for use. This can help to ensure that patients are informed and engaged in their own care.
  4. Using technology and electronic health records: NPs can use technology and electronic health records to help facilitate safe and effective drug prescribing practices. This includes using e-prescribing systems to reduce errors and improve documentation, and utilizing decision support tools to assist with prescribing decisions.
  5. Advocating for NP prescribing authority and policy changes: NPs can advocate for changes in policy and regulation to promote safe and effective drug prescribing practices. This includes advocating for standardized prescribing authority across jurisdictions, promoting interprofessional collaboration and communication, and addressing controversies surrounding specific drug classes.

Conclusion

In conclusion, ethical and legal considerations are critical components of drug prescribing for nurse practitioners. NPs must be aware of the potential risks and benefits of different medications and ensure that they are prescribing in a safe, effective, and legal manner. By following best practices and solutions, such as cultivating professional relationships with supervising physicians, maintaining up-to-date knowledge and skills, communicating effectively with patients and their families, using technology and electronic health records, and advocating for NP prescribing authority and policy changes, NPs can help to ensure that drug prescribing is conducted safely and ethically.

Nurse practitioners are valuable members of the healthcare team, providing high-quality, patient-centered care to individuals and communities across the country. As the healthcare landscape continues to evolve, there are many opportunities for nurse practitioners to take on leadership roles and drive innovation in the field of drug prescribing and beyond.

What are the 9 code of ethics for nurses?

Nursing is a noble profession that requires dedication, compassion, and a commitment to ethical principles. The nursing profession has its own set of ethical standards that are meant to guide nurses in their daily practice. In this article, we will discuss the nine code of ethics for nurses that help them provide safe, ethical, and compassionate care to their patients.

Respect for Autonomy

Respect for autonomy means respecting the patient’s right to make decisions about their healthcare. Nurses must respect the patient’s right to make decisions, even if they disagree with them. This code of ethics also includes obtaining informed consent, ensuring patient privacy, and protecting the confidentiality of medical information.

Beneficence

Beneficence means promoting the patient’s well-being and doing what is in their best interest. Nurses should act in the patient’s best interest, provide the necessary care, and strive to prevent harm.

Non-Maleficence

Non-maleficence means avoiding causing harm to the patient. Nurses should avoid causing harm to their patients and must be aware of the risks and benefits of the treatments and procedures they perform.

Justice

Justice means treating all patients fairly and equitably, regardless of their race, gender, ethnicity, religion, or social status. Nurses must provide equal care to all patients and ensure that healthcare resources are distributed fairly.

Fidelity

Fidelity means being faithful to the patient and maintaining trust. Nurses must be honest with their patients, maintain confidentiality, and respect their wishes.

Veracity

Veracity means telling the truth. Nurses should be honest and truthful with their patients, even if it means delivering bad news or uncomfortable information.

Accountability

Accountability means taking responsibility for one’s actions. Nurses must be accountable for their actions and decisions, and they must be willing to accept the consequences of their actions.

Confidentiality

Confidentiality means protecting the patient’s privacy and keeping medical information confidential. Nurses must maintain the confidentiality of their patient’s medical information, and they must ensure that this information is only shared with authorized individuals.

Professionalism

Professionalism means conducting oneself in a professional manner. Nurses must maintain a high level of professionalism, and they must act in a manner that is consistent with the ethical standards of their profession.

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