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The practice of an advanced nurse practitioner involves complex ethical and legal challenges, which should be properly addressed. The statistics reveal that 7,000 to 9,000 Americans die each year from the consequences of medication errors (Tariq et al., 2021). The following paper will review the selected scenario to identify ethical and legal implications, relevant approaches to disclosure and nondisclosure, and appropriate decision-making strategies. The process of writing prescriptions and minimizing medication errors will also be discussed in the essay.
Safe and competent advanced nursing practice should be based on the awareness of ethical and legal implications. Prescriptive authority refers to the legal right defined by state law that requires the practitioner to properly choose, prescribe, and manage prescription drugs (Rosenthal & Burchum, 2021). In the scenario, ethical implications for the prescriber are the breach of the non-maleficence principle, the decrease in the quality of patient care, and the erosion of trust.
Legal implications may involve license withdrawal or lawsuits initiated by the family. The main consequence for the patient is the potential adverse drug event (morbidity, mortality) from the mistakenly prescribed medication (Tariq et al., 2021). The family may experience psychological issues following the event compromising the child’s welfare and initiate a lawsuit against the hospital or the practitioner. Ethical and legal implications for the pharmacist would only occur if there was a dispensing error. However, the scenario suggests that the wrong dosage was prescribed by the practitioner, and the pharmacist is not ethically/legally responsible for the mistake.
Healthcare practitioners may be reluctant to disclose medication errors due to possible malpractice lawsuits. However, the Agency for Healthcare Research and Quality (AHRQ) (2019) recommends that all potentially harmful errors should be disclosed and explained to patients. Furthermore, the New York State Senate (n.d.) informs that Bill S2533 excludes a practitioner’s apology statement as a liability admission, which means that it cannot be used in medical malpractice lawsuits. Thus, a non-disclosure strategy is inappropriate in the scenario because it would decrease the patient’s or family’s satisfaction with the treatment and increase the risk of harm due to an unidentified dosage error.
The first strategy I would employ is full disclosure of the medication error in a timely manner to prevent an overdose in the pediatric patient. As a practitioner, I would communicate with the patient/family to apologize for the error and express readiness to accept appropriate disciplinary action (letter of reprimand, suspension from work). Disclosure will allow the provider to investigate the error’s causes, such as unclear labeling or poor patient-practitioner communication, and develop effective preventive measures. The second strategy would involve the determination of the correct dose to proceed with the patient’s treatment.
The child’s weight should be used to calculate an appropriate dosage. (Rosenthal & Burchum, 2021). The understanding of dose-response relationships is a basic consideration for effective pharmacological therapy helping the nurse providing proper treatment to the patient.
The process of responsible prescription writing should be supported by the knowledge of drugs combined with the records of provider-patient relationship containing the information on medical history, performed physical exams, and a drug monitoring plan. Medication errors due to inappropriate communication, prescribing practices, or oversight, need to be prevented or minimized because they undermine drug safety and increase morbidity and mortality.
Rosenthal and Burchum (2021) provide two recommendations for reducing medication errors. First, patients and families should be active and informed participants of the healthcare team. Second, care providers should possess adequate access to the tools (e.g., computerized systems) and practices (e.g., medication reconciliation) for safe prescription and administration of drugs.
To sum up, ethical and legal implications, including state laws, should be considered by advanced practice nurses to resolve the incidents involving medication errors. Disclosure strategy and the issue of correct dosage to the scenario’s patient may help identify the causes of the error, improve communication, and reduce the risk of an overdose. Finally, the process of responsible prescription writing and the recommendations for error reduction should be examined.
References
AHRQ. (2019). Disclosure of errors. PSNet. Web.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
Tariq, R. A., Vashisht, R., Sihha, A., & Sherbak, Y. (2021). Medication dispensing errors and prevention. StarPearls Publishing.
The New York State Senate. (n.d.). Senate Bill S2533. NY State. Web.
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