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According to the chosen scenario, I am an advanced practice nurse who works at a community health clinic. I have made an error when prescribing a drug to a patient. The mistake was not intentional. It is possible that the patient is not aware of what has happened. Therefore, it is necessary to evaluate various ethical and legal issues and clarify what I can do in this situation to avoid complications or different concerns that may arise under the law of New Jersey.
Although it is an ordinary thing for people to make mistakes, when medication errors happen in nursing practice, a number of ethical consequences and concerns are inevitable. Medication mistakes are hard to avoid or prevent; therefore, specialists should be ready to solve them (Arcangelo & Wilbur, 2017; Arcangelo, Peterson, Reinhold, & Wilbur, 2017). That is why I have to choose the most effective way of resolving the situation at minimal costs. For this purpose, the ethical consequences of disclosure and non-disclosure have to be analyzed.
If the problem is not disclosed, the major ethical issue that may arise as a result of my error is harm done to the patient. Since he is totally unaware of the effects of the prescribed medication, the dosage may be exceeded, which is fraught with detrimental consequences for his health. Moreover, his real condition will remain unaddressed and may get aggravated.
In the event of disclosure, these negative effects can be avoided. However, another concern arises. If the patient learns about the mistake, his trust in the healthcare system may be undermined. In the United States, more than 3 billion prescriptions are made annually, and 34% of these prescriptions are defined as unnecessary (Crigger & Holcomb, 2008). As a nurse, I realize that each prescription should be justified in order to avoid further medication errors. Yet, if the mistake has already occurred, learning about it may make the patient believe that such cases are common and prevent him from seeking medical aid in the future.
Despite this, my major ethical obligation is to do no harm to the patient (Sorrell, 2017). That is why disclosure is still more preferable than non-disclosure. However, before making a decision, I must also investigate the legal consequences of my error.
Legal Implications and Laws
Regarding the existing laws and regulations in the state of New Jersey, hospitals have to report all unstipulated and poorly-defined medical events to the Department of Health and Senior Services (“New Jersey: Public and private policy,” 2017). In this state, there was also a medical liability reform at the beginning of the 2000s. As a result of this reform, the Patient Safety Act was introduced in 2004, according to which a new reporting system was developed. At the present moment, there are Patient Safety Committees that take responsibility for all doubtful and provocative situations in health facilities, to which the given case may be referred.
Error Disclosure and Nondisclosure in New Jersey
According to New Jersey’s Patient Safety Act, mandatory disclosure of the events to patients or their families is an obligation that has to stay confidential. For the clinic and me, it implies that administrative or even criminal liability may be imposed in case of nondisclosure. However, in some facilities, medical employees support special programs and conditions according to which some space may be left for an error (Mistry, Santaniello, & Spooner, 2017). Thus, the presence of alleviating circumstances may help mitigate the penalty if the issue is disclosed.
Despite my unwillingness to admit this mistake, I fully realize that, from the legal and ethical points of view, the patient’s bill of rights supports the idea of full disclosure of a medical error (Sorrell, 2017). Thus, in order to solve this dilemma, I would rely on the level-of-harm principle used by many nurses and physicians when they have to decide whether to disclose or not to disclose their medical errors (Chamberlain, Koniaris, Wu, & Pawlik, 2012).
In order to solve the dilemma of disclosure or nondisclosure of this mistake, I must assess the impact of this medication. Although the outcomes of this mistake have been discussed, it is still challenging to estimate the level of harm done to the patient as he has not been even informed about the error. As an advanced practice nurse, in this scenario, I would take the following steps:
- Inform a physician or a leading nurse about the mistake;
- Agree to talk to the patient if the leader allows;
- Choose a supportive tone of the conversation to explain all points;
- Improve my knowledge to make sure that I can avoid similar mistakes in the future.
Prescription Writing Process
One of the possible ways to cope with the outcome of the mistake and to learn from this scenario is to visit official websites of credible organizations and to make sure I do not miss anything. To write a prescription successfully, it is necessary to give clear information about the prescriber and the patient as well as about the drug that has to be prescribed. For example, the Institute for Safe Medication Practices (2016) suggests nurses and other medical staff follow specific oral dosage forms while prescribing drugs. In addition, the attention to real date and superscription should be paid to avoid complications and misunderstandings with time.
Strategies to Avoid Errors
To avoid or minimize medication errors, several strategies can be offered. First, it is necessary to update and have a complete drug list at hand. Second, much attention should be paid to patients and their medical histories. Finally, if a new medicine name or dosage appears in the prescription, it is suggested to clarify all points with the doctor before following it. These steps may help avoid serious errors.
Arcangelo, V.P., & Wilbur, V. (2017). Issues for the practitioner in drug therapy. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4th ed.) (pp. 3-14). Ambler, PA: Lippincott Williams & Wilkins.
Arcangelo, V.P., Peterson, A.M., Reinhold, V., & Wilbur, V. (2017). Integrative approaches to pharmacotherapy – A look at complex studies. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4th ed.) (pp. 1021-1036). Ambler, PA: Lippincott Williams & Wilkins.
Chamberlain, C.J., Koniaris, L.G., Wu, A.W., & Pawlik, T.M. (2012). Disclosure of ‘nonharmful’ medical errors and other events: Duty to disclose. Archives of Surgery, 147(3), 282-286.
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Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120-125.
Institute for Safe Medication Practices. (2016). Oral dosage forms that should not be crushed. Web.
Mistry, S.K., Santaniello, B.I., & Spooner, J.J. (2017). The economics of pharmacotherapeutics. In V.P. Arcangelo, A.M. Peterson, V. Wilbur, & J.A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4th ed.) (pp. 1009-1018). Ambler, PA: Lippincott Williams & Wilkins.
New Jersey: Public and private policy: Medical errors and patient safety. (2017). Web.
Sorrell, J.M. (2017). Ethics: Ethical issues with medical errors: Shaping a culture of safety in healthcare. The Online Journal of Issues in Nursing, 22(2). Web.