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:
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.
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 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.
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.
- 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.
Bird, S. (2018). The pitfalls of prescribing for family and friends. Australian prescriber, 39(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 Bioeth, 5(174), 2.
Haque, M. (2017). Potential of clinical pharmacology in developing rational prescribing. Acta Medica International, 4(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 Pharmacists, 75(11), 774-783.
Pollock, M., Bazaldua, O. V., & Dobbie, A. E. (2017). Appropriate prescribing of medications: an eight-step approach. Am Fam Physician, 75(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.
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