NURS 6521 Week 1 Assignment 1: Ethical and Legal Implications of Prescribing Drugs (Pharmacology)

NURS 6521 Week 1 Assignment 1: Ethical and Legal Implications of Prescribing Drugs (Pharmacology)

NURS 6521 Week 1 Assignment 1: Ethical and Legal Implications of Prescribing Drugs (Pharmacology)

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.

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.

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• 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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Ethical and Legal Implications of Prescribing Drugs (Pharmacology)

The responsibility for prescribing medications is not granted to anyone in the healthcare field and it is heavily regulated. Only clinicians that have been extensively trained and taught about drugs, pharmacokinetics, pharmacodynamics, habituation, addiction and the social impact of the same are granted the opportunity to prescribe. This authority is referred to as prescriptive authority and it is not absolute. This means that it can be withdrawn at any time if the clinician abuses the responsibility or acts unethically and unlawfully. A good number of medications are classified as controlled drugs because of the great potential that they have for abuse. The body responsible for this regulation in the United States is the Drug Enforcement Administration or DEA (Androus, 2019). For every clinician with prescriptive authority, the DEA issues them with a DEA number that they must indicate on every prescription that they make for ease of tracing and accountability. Advanced practice registered nurses (APRNs) such as nurse practitioners (NPs) are included amongst those clinicians that have prescriptive authority. This is especially obvious and clear in states that have the provision for full practice authority (FPA); otherwise referred to as autonomous practice without supervision (Dillon & Gary, 2017). The purpose of this paper is to look at the ethical and legal implications of prescribing medications within the context of a scenario involving an error in the state of Maryland.

Implications of the Prescriptive error to Stakeholders

The prescriptive error in the scenario provided involves the prescription of an adult dose of a drug to a 5 year-old child. This error will possibly lead to a violation of the bioethical principle of nonmaleficence which requires practitioners not to cause harm to the patient (Haswell, 2019). The high dose may cause serious side effects to the child and may potentially poison them. For the prescriber, they have ethically violated nonmaleficence and legally are supposed to disclose this error to the Prescription Drug Monitoring Program or PDMP (Maryland Department of Health, n.d.). A further implication is that their practice license may be revoked (Duquesne University, n.d.). The pharmacist is ethically responsible for confirming the dose and will violate nonmaleficence if they do not. Legally, they are also required to report the error to the PDMP. The patient in this case is a minor and so no legal or ethical implication is addressed to them. The patient’s family has the ethical advantage of possessing autonomy (authority to ask about what is done to their child). Legally, they can also sue for the tort of professional negligence (Buppert, 2021) if the child is harmed by the high dose.

Legal Disclosure and Non-Disclosure

The error described in the scenario merits disclosure according to the legislation in the state of Maryland. A specific law that addresses this is the COMAR 10.07.06 (Maryland Department of Health, n.d.). Both the APRN and the pharmacist should report the error once discovered to the PDMP.

Strategies that Would Inform Decision Making in the Scenario

To inform decision making in the above scenario after the error has occurred, two strategies would be helpful. The first one would be to initiate contact with the child’s parents so that they can come back for the dose to be corrected. However, this will only be possible if the error is discovered immediately. The second strategy will be to inform the pharmacist and the PDMP of the error so that they can take action at their levels. In both cases, I would disclose the error since that is what is mandated by the law.

How to Write Prescriptions and Minimize Errors

The correct process for prescribing involves examining the patient, making a valid diagnosis, formulating a treatment objective, prescribing he correct medication, educating the patient or parent/ guardian about the actions and side effects of the medication, and finally setting a follow up date to assess progress (Pollok et al., 2007). Minimizing medication and prescription errors may require the installation of an integrated computerized clinical decision support system or CCDSS into the electronic health record or EHR system (Olakotan & Yusof, 2021). This will alert the prescriber when they are about to prescribe a wrong dose.

Conclusion

The authority to prescribe comes with responsibility for maintaining ethical and legal obligations. If an error is committed by the prescriber, there are checks and balances to identify it. However, the law also mandates them to disclose such an error to the relevant bodies.

References

Androus, A.B. (2019). What is a DEA number and how can a nurse practitioner obtain one? https://www.registerednursing.org/answers/dea-number-how-nurse-practitioner-obtain-one/

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide, 7^th ed. Jones & Bartlett Learning.

Dillon, D. & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93. https://doi.org/10.1097/naq.0000000000000210

Duquesne University (n.d.). The APRN’s role and responsibility in ethical prescribing. https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Maryland Department of Health [DoH] (n.d.). Prescription drug monitoring program (PDMP). https://bha.health.maryland.gov/pdmp/Pages/Home.aspx

Olakotan, O.O., & Yusof, M.M. (2021). The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review. Health Informatics Journal, 27(2), 1-22. https://doi.org/10.1177/14604582211007536 

Pollok, M., Bazaldua, O.V., & Dobbie, A.E. (2007). Appropriate prescribing of medications: An eight-step approach. American Family Physician, 75(2), 231-236. https://www.aafp.org/afp/2007/0115/p231.html#:~:text=This%20six%2Dstep%20approach%20to,%3B%20(5)%20give%20information%2C