Scenario

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.

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.

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Solution

Ethical and Legal Implications of Prescribing Drugs

            Legal and ethical measures guide nurse practitioners during care delivery. Legal and ethical guidelines prevent medication errors, thus preventing adverse drug reactions to promote patient safety. This discussion presents an incident of a prescription error, including all stakeholders involved in ethical and legal implications, measures for addressing disclosure and nondisclosure based on Maryland law, strategies that guide an advanced practice nurse in making decisions, and the process for writing a prescription.

Ethical and Legal Implications associated with the Presented Case and involved Stakeholders

The provided case study involves medication errors that occurred during drug prescription. A dose suitable for an adult was prescribed to a 5-year-old patient. Thus, the presented scenario is attributed to some ethical and legal implications. The first ethical and legal implication applies to the nurse practitioner who, in this case, prescribed an adult dosage to a five years old boy, thus exposing him to an adverse drug reaction. Consequently, legal action should be taken against the prescriber. Secondly, ethical and legal implications apply to the pharmacist who provided the adult dosage to the five years old client. The pharmacist should have rectified the prescription error made by the prescriber rather than compounding it. For this reason, legal action should be taken against the pharmacist. Additionally, the pharmacist and the prescriber acted against the ethical principle of beneficence and nonmaleficence. Beneficence advocates for doing good to the patient while nonmaleficence prevents healthcare providers from exposing patients to any form of harm knowingly. Nonetheless, no ethical or legal implication applies to the patient and his family members. They only trusted the nurse practitioner for quality and safe care, but they did not reduce prescription errors.

Measures for Addressing Disclosure and Nondisclosure Based on Maryland Law

Every state in the United States has a set of regulations and policies that guide nurse practitioners during drug prescription to prevent prescription errors. Additionally, states have laws regulating the medication error disclosure process. Healthcare regulations aim at promoting the quality and safety of patient care (El-Jardali, & Fadlallah, 2017). Similarly, the state of Maryland has enacted laws and regulatory measures to guide nurse practitioners in the event of a medication error. In Maryland, medical professionals should adhere to health care standards approved in the health care system (ARFAA Law Group, 2017). Thus, the failure of the medical practitioners to comply with the set guidelines results in medical malpractice. Additionally, the health care provider is liable for patient harm caused by deviation from the established care standard. Maryland law also permits medication error victims to hold the healthcare practitioner accountable for the adverse drug reaction and should compensate for the caused harm (Lebowitz & Mzhen, 2021). Finally, the prescriber should report the error the relevant authorities as a requirement by Maryland law.

Strategies that Guide an Advanced Practice Nurse in Making Decision

The most effective strategy in this case is disclosure. The nurse should inform the patient about the harm and potential harm. Professional standards guide advanced nurse practitioners in making all clinical decisions. Nursing professional standards prioritize quality care for all patients (WHO, 2021). Thus, a nurse practitioner should make decisions to promote patient care quality to achieve a positive patient experience and health outcomes. Additionally, practitioners should be guided by morals, thus making morally right decisions. Moral decisions consider the outcomes of a particular action. Hence, nurses will consider actions that lead to better health outcomes (Bryant-Lukosius et al., 2017).

The process of writing a Prescription

Nurse practitioners should consider various factors when writing a prescription. First, they should consider patients’ demographics, particularly age, to ensure they are prescribed the right dosage based on their age. A practitioner should also consider a patient’s drug-related allergies to avoid prescribing drugs that cause allergic drug reactions. Additionally, the prescriber should consider other aspects, including medication name, medication indication, strength, medication frequency, dose, number of pills to dispense, refills number, prescriber name, contact information, license number, and the DEA number during prescription.

Medication errors are associated with legal and ethical implications that apply to the parties involved in the error. In this case, the prescriber and the pharmacist are responsible for the medication error. According to the state of Maryland law, the prescriber is liable for the error, and legal action should be taken against him or her by the patient’s family.

References

ARFAA Law Group. (2017). Medication Errors on the Rise in Maryland and Elsewhere. Baltimore Medical Malpractice Lawyer. https://www.baltimoremedicalmalpracticelawyer.net/medication-errors-rise-maryland-elsewhere/

Bryant-Lukosius, D., Valaitis, R., Martin-Misener, R., Donald, F., Peña, L. M., & Brousseau, L. (2017). Advanced practice nursing: a strategy for achieving universal health coverage and universal access to health. Revista latino-americana de enfermagem, 25.

El-Jardali, F., & Fadlallah, R. (2017). A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan. BMC health services research, 17(1), 1-13.

Lebowitz, M & Mzhen, A. (2021). Maryland Medication Error Lawsuits. https://www.pharmacyerrorinjurylawyer.com/maryland-medication-error-lawsuits/

World Health Organization (WHO). (2021). Delivering quality health services: A global imperative for universal health coverage. WHO. http://apps.who.int/iris/bitstream/handle/10665/272465/9789241513906-eng.pdf