Assignment: Ethical and Legal Implications of Prescribing Medications

Assignment: Ethical and Legal Implications of Prescribing Medications

Assignment: Ethical and Legal Implications of Prescribing Medications

Ethical and Legal Implications of Prescribing Medications

These are some of the questions you might consider when selecting a treatment plan for a patient.

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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.

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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.
• Conclusion.

Resources
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
• Chapter 1, “Prescriptive Authority” (pp. 1–3)
• Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
• Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
• Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
• Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
• Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

https://content.waldenu.edu/cc74d598cd0208b6fb67b6926bd717f9.pdf
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=1300
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=1300
http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
https://www.deadiversion.usdoj.gov/drugreg/index.html
https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1021763&site=eds-live&scope=site&authtype=shib&custid=s6527200
https://search.proquest.com/docview/1773198542?accountid=14872
https://openathens.ovid.com/OAKeystone/deeplink?idpselect=https://idp.waldenu.edu/openathens&entityID=https://idp.waldenu.edu/openathens&T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01741002-201705000-00005&LSLINK=80&D=ovft

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Ethical and Legal Implications of Prescribing Medications

Advanced practice registered nurses or APRNs as a rule do have prescriptive authority that means they are allowed and trained to prescribe medications to patients. However, in doing this they must follow the law and the ethical principles that accompany that responsibility. The Drug Enforcement Administration in the United States is the body mandated to control the prescription and use of dangerous controlled medications that are prone to be abused. They issue a DEA number to all prescribers and it is this number that identifies the clinician that prescribed any medication for each patient (Androus, 2019). This way, they can be held accountable at a later date if it is found that they have abused their prescriptive authority. In the state of California, reporting (disclosure) of errors to patients is covered by the Health and Safety Code (California Legislative Information, n.d.). This paper uses a scenario to illustrate the ethical and legal implications inherent in drug prescribing.

Implications of the Scenario on Stakeholders

In the chosen scenario, the advanced practice nurse finds themselves caring for an 85 year-old female with cognitive deficiency and other comorbidities in long-term care facility. The patient is also on blood thinners due to a valve replacement done years earlier and requires frequent monitoring of the INR. She feels a lot of pain and cries every time she is pricked to draw blood for the test. Her primary care physician has declared her condition terminal due to the congestive heart failure and chronic kidney disease (CKD) that she has. All stakeholders in this scenario are affected by this action. For the prescriber, the action ordering frequent monitoring of the INR that requires pricking at every time is unethical since it violates the principle of nonmaleficence or “to do no harm” (Haswell, 2019). By the fact that the patient is terminally ill and faces the prospect of medical futility, it would be better if she was given comfort during her last days.

According to Duquesne University (n.d.), because of this the DEA may question the wisdom in continuing with the blood thinners under these circumstances due also to the risk of bleeding. The implication on the pharmacist is that it is their responsibility to determine the age and status of the patient before dispensing the blood thinners and then consult the prescriber for a collective decision in favor of the patient. The patient and their family are also impacted in that she suffers physically and emotionally and her family also suffers emotionally.

Disclosure and Non-Disclosure

In the state of California, the scenario described above qualifies as an incident or incidents that are reportable. This obligation for disclosure is covered by the law referred to in the Health and Safety Code (California Legislative Information, n.d.). Any occurrences that are detrimental to patient safety and comfort pursuant to the administration of medications or the carrying out of procedures qualify as reportable incidents (to be disclosed within 5 days or 24 hours if acute and life-threatening), according to the Health and Safety Code (HSC) of the state of California.

Guiding Decision Making Within the Case Scenario Framework

There are two strategies that may inform the decision making in the scenario considered. Both are helpful in complying with the legal and ethical requirements that accompany prescriptive authority. The first strategy would be to stop the frequent checking of the INR or reduce the frequency to once in a month. This would ensure the patient remains comfortable and free of pain. The other strategy would be to completely stop the administration of the blood thinners since the risks (of pain and bleeding) in a terminally ill patient outweigh the benefits. These actions would conform to the requirements imposed by the ethical principles of beneficence and nonmaleficence as well as California’s Health and Safety Code.

Making Prescriptions and Minimizing Medication Errors

In order to minimize medication and other errors, the process of medication prescription must be followed to the letter. According to Pollok et al. (2007), this should start by a thorough evaluation of the patient by taking both subjective and objective data. A physical examination is also required to follow after which a diagnosis or the underlying problem can be identified. The prescriber then sets a treatment objective to inform what they will prescribe. Based on the diagnosis and the treatment objective, the prescriber then identifies the most appropriate medication and orders the prescription only on one condition. This condition is that they now have in their possession enough details about the patient. The next steps will entail educating the patient on the medication prescribed. This will include factors such as possible side effects, adverse reactions, or allergies. The dose and frequency will also be clearly stated at this juncture. Lastly, the clinician and prescriber will then need to give a follow up date to the patient. This will enable them to gauge the progress of the patient and see if the prescribed medication would have had the effect that was hoped it would have.

Conclusion

Prescriptive authority is a very necessary privilege that all APRNs must have. It allows them the legal authority to prescribe for their patients medications including those that are controlled. Being human, however; there are instances that one finds that they have violated the ethical and legal requirements that must be followed with anyone that is a prescriber. There are checks and balances but if an error is committed as illustrated by the scenario in this case, disclosure should be done from an individual and professional perspective as well as from a legal standpoint.

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/

California Legislative Information (n.d.). Health and Safety Code – HSC. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1279.1.&lawCode=HSC

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

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