ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521

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How to Research and Prepare for ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521                     

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After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

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The introduction for the Walden University ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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After the introduction, move into the main part of the ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

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After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

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The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521

ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521

In the case scenario, a friend requests me to prescribe her medication. Although I have autonomy, I do not have the friend’s medical history. However, I still write the prescription. This paper explores this scenario’s ethical and legal implications, approaches to address disclosure and nondisclosure, and the procedure of writing prescriptions.

Ethical and Legal Implications Of The Scenario On All Stakeholders Involved

Prescribing or giving medications to family members and friends, except for an emergency, is considered unprofessional conduct and can call for disciplinary measures. The ethical problem is that the relationship with a friend or relative can cloud a practitioner’s judgment (Sorrell, 2017). Based on the state, the prescriber in this scenario can face legal consequences for prescribing to their friend.

Writing a drug prescription for friends in a social setting can prompt legal action. Since the prescriber has the autonomy to prescribe, the ethical and legal consequences would center on what is best for the person prescribed and whether local ethics boards have an outlook on the matter (Sorrell, 2017). The prescribed medication may result in an adverse drug event since no assessment was conducted, which fails to uphold the ethical principles of beneficence and nonmaleficence.

The ethical and legal implications of the act would not only fall on the prescriber but also on the dispensing pharmacist. Ethical implications for pharmacists include failing to uphold beneficence and nonmaleficence. The pharmacist should have reviewed the patient’s diagnosis before dispensing to ensure the medication is appropriate for the patient’s medical condition (Sorrell, 2017).

Failing to review the medical information puts the patient at risk of adverse drug effects if the drug is inappropriate.  Furthermore, the patient may face legal implications for getting a prescription without being assessed and diagnosed by a healthcare provider.

Strategies to Address Disclosure and Nondisclosure As Identified In the Scenario

Disclosure of medical error refers to the communication between a health provider and a client, family member, or a client’s proxy whereby the provider admits that a medical error occurred. North Carolina has a statute that protects reports made by a health provider apologizing for an adverse treatment outcome.

The statute on disclosure states that health providers should offer to implement remedial or corrective treatment interventions, as well as voluntary acts, to assist the affected patient (North Carolina Medical Board, 2017). However, the North Carolina statute does not protect any confessions of fault or a provider’s acknowledgment of responsibility.

If the medication has an adverse event on the prescriber’s friend or the prescriber realizes they prescribed the wrong medication, the prescribing clinician should inform the patient (Eniola & Gambino, 2019). The clinician should explain how the error occurred and the actions to be taken to correct the error and its effects.

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Strategies That You, As an Advanced Practice Nurse, Would Use To Guide Your Decision-Making In This Scenario

My decisions would be based on North Carolina laws and ethical principles in this scenario. I would reveal the medication error to the patient by explaining how it occurred as stated by the state law to avoid legal action and implications such as revoking my APN license (Eniola & Gambino, 2019).

In addition, I would employ beneficence and nonmaleficence in making decisions to promote ethical practice. Beneficence is the moral duty to promote good, while nonmaleficence is the duty to cause no harm. In this regard, I would take the duty to do good and prevent harm to the patient by informing them of the error and taking prompt interventions to mitigate potential harm from the medication error (Sorrell, 2017).

Besides, I would explain to the patient the steps the provider and the hospital are implementing to prevent errors in the future. This would help maintain the client’s trust in the clinician and the hospital.

Process of Writing Prescriptions and Strategies to Minimize Medication Errors

The prescribing clinician should fill in the patient’s data, including name, age, sex, and medical diagnosis. The next step is to write the prescribed medication, including the name, dose, frequency, and route of administration (de Araújo et al., 2019).

Besides, the clinician should indicate the frequency of refills, particularly for patients with chronic illness. The last step should be to write the clinician’s name, address, National Provider Identifier number, and DEA number. Medication errors can be reduced by taking a detailed history of the patient’s drug allergies and current medications (de Araújo et al., 2019).

Organizations can adopt technology systems such as E-prescribing software, which generates prescriptions electronically and send them directly to the pharmacy. The software minimizes errors cause by illegible paper prescriptions.   Drug interaction checkers can also help evaluate potential drug interactions, thus reducing adverse drug outcomes.

Conclusion

The prescribing clinician and dispensing pharmacist face ethical implications for not upholding beneficence and nonmaleficence by prescribing medication without a patient assessment and medical diagnosis.  The North Carolina statute states that the clinician should inform the client of the medical error and the corrective treatments to be implemented. Medication errors can be avoided by taking a patient history of drug allergies and current treatments and using IT systems.

References

• de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. D. A., & Toma, T. S. (2019). How to prevent or reduce prescribing errors: an evidence brief for policy. Frontiers in pharmacology, 10, 439. https://doi.org/10.3389/fphar.2019.00439
• Eniola, K., & Gambino, C. (2019). Taking the Fear Out of Error Disclosure. Family practice management, 26(6), 36-36.
• North Carolina Medical Board. (2017). Position Statements North Carolina Medical Board. https://www.ncmedboard.org/images/uploads/other
• Sorrell, J. M. (2017). Ethics: Ethical issues with medical errors: Shaping a culture of safety in healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2). de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. D. A., & Toma, T. S. (2019). How to prevent or reduce prescribing errors: an evidence brief for policy. Frontiers in pharmacology, 10, 439. https://doi.org/10.3389/fphar.2019.00439

In the United States, advanced practice nurse practitioners have varying degrees of prescriptive authority, over certain medications and medical devices. They must thus display a comprehensive understanding of the legal implications associated with prescribing drugs, in addition to their ethical obligations (Billstein-Leber et al., 2018). Clinical practice ethical guidelines recommend all clinicians with prescriptive privileges, ensure that their patients are protected from harm. The provided case study however demonstrates a situation where a nurse practitioner prescribed an adult dose of a drug to a 5-year-old. The purpose of this paper is to elaborate on the ethical and legal implications associated with this scenario, and effective mitigating strategies to prevent such occurrences in the future.

Ethical and Legal Implications

In this scenario, the medication error displayed poses substantial ethical implications for the prescriber, pharmacist, patients, and the patient’s family. The nurse practitioner as the prescriber is required to uphold ethical principles governing patient safety. It was thus an act of unprofessionalism to make such a mistake of giving a child an adult dose, knowing very well the harm that the drug could cause. Ethically, the nurse is required to ensure beneficence in the process of care provision, which was violated by the incidence of medication error (Tigard, 2019). Consequently, clinicians are required to uphold justice in practice, which required the nurse to follow the necessary process required to address the medication error, rather than neglecting the patient. With this act, the nurse exposes the patient to the possibility of a legal lawsuit.

The pharmacist on the other hand is required to counter-check the prescription once received. In case of a medical error, the pharmacist must contact the prescriber and discuss the identified error before taking the necessary actions required to address the issue (Robertson & Long, 2018). However, if the pharmacist fails to identify the medical error, then he or she will also bear the ethical and legal burden associated with posing harm to the patient due to the medication error made by the nurse practitioner.

The patient, on the other hand, is a minor, who will suffer substantial harm from a drug overdose. The parents, who bear the legal responsibility of taking part in making healthcare decisions for their child, can sue both the prescriber and the pharmacist for the medication error (Varkey, 2021). Consequently, the patient’s parents have a legal right to information concerning the medication prescribed to their child, and how to take it, which should have been provided by the pharmacist.       

Strategies to Address Disclosure and Nondisclosure

            Disclosing medication error is an ethical act thus must be exhibited by all authorized prescribers in case they are faced with such a situation. In South Carolina, provisions for medication errors reporting are organized according to the South Carolina Code of Regulations. Medication errors are recognized in this state as one of the most crucial treatment-caused risks to the patient. As such, the South Carolina Department of Disabilities and Special Needs demands clinicians to report every medication error that may occur in the course of care provision (Billstein-Leber et al., 2018). As such, clinicians must apply appropriate decision-making skills concerning disclosure and non-disclosure of medication errors such as assessing the severity level of the error and conducting both reactive and proactive analysis to reduce the medication errors.  [E-USER1] 

Strategies for Appropriate Decision Making

When faced with such a situation as an advanced practice nurse, I will always decide on disclosing the information to the patient. Medication safety is a crucial aspect in safeguarding patients from harm during the care delivery process. As such, in case of an error, the nurse needs to come forward to avoid legal penalties associated with non-disclosure(Varkey,2021). I will utilize two main strategies to decide on how to disclose the matter to the patient. First, I will explain to the patient how the medication error occurred to regain trust essential for a healthy patient-provider relationship. I will then expound on how the harmful impact of the error can be ameliorated and provide appropriate steps which will be taken to ensure that such an error will never happen again. This will help regain the patient’s confidence in the care plan hence promoting positive care outcomes.

Writing Prescriptions to Minimize Medication Errors

The process of writing a prescription mainly involves six steps. First, the prescriber must evaluate the patient’s problem, then specify the therapeutic objective (Mullen et al., 2018). After which the prescriber will select the most effective drug therapy, and initiate the therapy, with appropriate consideration of the dosage, frequency, and duration of drug use. The prescriber will then give information and instructions to the patient and evaluate therapy regularly. To minimize incidences of medication errors, the prescriber must consider several factors before prescribing any medication. Such factors include whether the medication is the best choice in the management of the patient’s condition, whether there are any contraindications, whether the dosage is correct, whether the patient is allergic to any of the drug components, and appropriate storage for the drug among others.

Conclusion

Several ethical considerations have been outlined to promote appropriate prescriptive practices upholding patient safety and preventing harm. As such, in case of medication error like in the provided case study, the nurse is required to disclose the matter to the patient and implement appropriate strategies to address the issue.

References

Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP guidelines on preventing medication errors in hospitals. American Journal of Health-System Pharmacy, 75(19), 1493-1517. https://doi.org/10.2146/ajhp170811

Mullen, R. J., Duhig, J., Russell, A., Scarazzini, L., Lievano, F., & Wolf, M. S. (2018). Bestpractices for the design and development of prescription medication information: A systematic review. Patient education and counseling, 101(8), 1351-1367. https://doi.org/10.1016/j.pec.2018.03.012

Robertson, J. J., & Long, B. (2018). Suffering in silence: medical error and its impact on health care providers. The Journal of emergency medicine, 54(4), 402-409. https://doi.org/10.1016/j.jemermed.2017.12.001

Tigard, D. W. (2019). Taking the blame: appropriate responses to medical error. Journal of Medical Ethics, 45(2), 101-105. http://dx.doi.org/10.1136/medethics-2017-104687

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119

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 [E-USER1]The instructions say “Be sure to reference laws specific to the state of South Carolina

”. No reference to any law let alone laws has been made. Make reference to at least 2 laws.

Ethical and Legal Implications of Prescribing Drugs

            Nurses care for patients with different health conditions in their practice. In doing so, they ensure the adoption of ethical interventions that optimize care outcomes. Nurses also embrace evidence-based practices to minimize the potential of patient harm while ensuring safety, quality, and efficiency. Advanced practice nurses often engage in prescribing medications for their patients. They utilize their knowledge on patient factors that may affect treatment effectiveness in their decision-making. They also utilize the recommended prescription practices to minimize errors (Buka, 2020). Therefore, this paper explores ethical and legal implications of caring the assigned patient, strategies to address nondisclosure, and decision-making.

Ethical and Legal Implications

            The assigned case scenario is MA, an 85-year-old female living in a long-term care facility. She has significant cognitive decline and her physician has said that her death is near with other health issues such as heart failure and renal failure. The care MA is associated with significant ethical and legal implications for healthcare providers and her family. First, healthcare providers including advanced registered nurses, physicians, and pharmacists have to collaborate in developing her needed plan of care.

The collaboration should aim at minimizing any potential harm to the patient and continuity of care despite the declining health status of the patient. The scenario also demands that healthcare providers take measures to ensure the protection of MA’s data confidentiality and privacy. Healthcare providers should only share the patient’s information with those involved in her care (Buka, 2020; Kohlen & McCarthy, 2021). MA retains her right to informed consent before sharing her information despite her being chronically ill.

Healthcare providers, including advanced registered nurses involved in MA’s care should also obtain comprehensive history about the patient before prescribing any medication. MA has a long history of using blood thinners due to valve replacement 20 years ago. Her age is also associated with a decline in functioning of major organs such as liver and kidneys, which are involved in drug metabolism and elimination (Buka, 2020). Therefore, advanced registered nurses should consider these factors to minimize toxicities and interaction between different drugs prescribed for her.

Strategies to Address Disclosure and Nondisclosure

All patients irrespective of their backgrounds or disease status have a right to confidentiality and privacy of their protected health information. Healthcare providers have to ensure that patient’s data is not shared with other parties without seeking informed consent from the patients. The right to access information is only limited to the healthcare providers involved in the provision of direct care to the patient. Advanced registered nurses should seek MA’s consent before sharing any information with her family concerning her treatment and prognosis (De Brasi et al., 2021).

Advanced registered nurses must adhere to disclosure and nondisclosure laws set by the state of New York, which is my state. New York state requires that nurses embrace strategies that uphold the highest possible protection of data integrity in healthcare. Nurses and other healthcare providers must sign an agreement with their employers not to disclose any sensitive information that relate to or affects the performance or competitiveness in their markets.

Strategies to Guide Decision Making

            One of the strategies that I would adopt to guide in my decision-making is adhering to the set procedures and guidelines in the organization. I will adopt the models of decision-making n my workplace to determine the best decision when caring for MA. The second strategy I will adopt when making a decision is considering the implications of the action, I will take on other stakeholders. This approach will enable me to make an informed and ethical decision on the best approach to address the situation. I will not disclose the error to the family. Instead, I will utilize the procedures that have been developed in the organization for disclosing medication errors (Rainer et al., 2018). This will enable the investigation of the issue and implementation of measures to eliminate it in the future.

Process of Writing Prescriptions and Strategies to Minimize Medication Errors

The process of writing a prescription begins with patient identification using name or any other identifiers. It is followed by providing comprehensive information about the medication. This includes providing information such as the name of the medication, strength, route of administration, duration to be taken, and frequency. The prescription should also specify the quantity of drugs that the pharmacists should dispense and any refills if required. The last process of the prescription is the name and signature of the prescribing service provider such as the advanced practice nurse or physician. Several interventions can be adopted to minimize medication errors. They include training healthcare providers on safe prescription practices, undertaking medication reconciliation, using health technologies such as barcode systems, and educating patients about the correct medication use (Rodziewicz et al., 2022; Rutten et al., 2020).

Conclusion

Overall, MA’s care is associated with significant legal and ethical implications for healthcare providers and her family. State and organization’s laws guide disclosure and nondisclosure of MA’s protected health information. Organizational policies and regulations will guide my decisions in the case scenario. Advanced registered nurses should utilize best prescription practices to ensure safety of patient care.

References

Buka, P. (2020). Essential Law and Ethics in Nursing: Patients, Rights and Decision-Making. Taylor & Francis Group.

De Brasi, E. L., Giannetta, N., Ercolani, S., Gandini, E. L. M., Moranda, D., Villa, G., & Manara, D. F. (2021). Nurses’ moral distress in end-of-life care: A qualitative study. Nursing Ethics, 28(5), 614–627. https://doi.org/10.1177/0969733020964859

Kohlen, H., & McCarthy, J. (2021). Nursing Ethics: Feminist Perspectives. Springer International Publishing.

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19–20), 3446–3461. https://doi.org/10.1111/jocn.14542

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2022). Medical Error Reduction and Prevention. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK499956/

Rutten, J. J. S., van Buul, L. W., Smalbrugge, M., Geerlings, S. E., Gerritsen, D. L., Natsch, S., Sloane, P. D., Veenhuizen, R. B., van der Wouden, J. C., & Hertogh, C. M. P. M. (2020). Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): Study protocol for a cluster randomized controlled trial. BMC Geriatrics, 20(1), 341. https://doi.org/10.1186/s12877-020-01662-0

 For this week’s discussion, we are to post about a patient case from our experiences, observations, and/or clinical practice from the last 5 years.  We are then to describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient that is identified.  We are then to explain details of the personalized plan of care that would be developed based on influencing factors and patient history.

     The first case that comes to mind is that of a current patient whom I will refer to as Mr. X, who is a resident at the long-term care facility where I work.  He is a an 85 year old gentlemen, who has diagnoses of PTSD, depression, hypertension, and dementia.  His medications include Depakote, Quetiapine Fumerate, Sertraline, Donepezil, Amantadine, Nifedipine, and Lithium.  

     According to Mangoni and Jackson (2004), there are pharmacodynamic changes a person of advanced age undergoes, including a reduction in renal and hepatic clearance and increases in the volume of distribution of lipid soluble drugs.  This results in an increased sensitivity to particular drugs such as anticoagulants, cardiovascular and psychotropic drugs as clearance of these drugs is longer than most.  Mr. X is on cardiovascular and psychotropic drugs. 

     Recently, he had a change in Quetiapine due to an increase in hallucinations.  This drug is an atypical antipsychotic that is indicated for hallucinations, depression, and anxiety disorders (Duncan et. al).  His doses of this drug are 25 mg in the morning, and 300 mg at bedtime.  This drug was increased slowly with an effectiveness measure of decreased (or no) hallucinations.  Lithium is given as a dose of 300 mg at bedtime.  Again, this drug was increased slowly with a measured effectiveness of no hallucinations, as well as decreases in behaviors such as angry outbursts.  Nifedipine extended release is 90 mg in the morning.  The effectiveness of Nifedipine was a decrease in blood pressure.

     Mr. X has his blood levels of Lithium checked monthly at this time after it was checked every 7 days for a month, which I believe is appropriate given the alterations in clearance of this drug.  He is also checked monthly by psychiatry in my facility.  I also agree with this.  His blood pressure is monitored before administration of his cardiovascular drug.  I believe it is also pertinent to check his Lithium levels if he begins to hallucinate as this is a side effect of Lithium.  Furthermore, his sodium is 140, potassium is 4.1, BUN is 18, Creatinine is 1.0.  These are within normal limits. 

      For his care plan, he will be free from medication side effects, he will be able to verbalize feelings of safety within the building, he will receive the least dosage of the prescribed psychotropic drug to achieve maximum functional ability both mentally and physically. Additionally, there will be a decrease in behaviors and Mr. X will be able to verbalize his feelings.  Finally, he will also have a blood pressure with a systolic no greater than 140, and a diastolic no greater than 80 for two readings or more.

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

           Pharmacokinetics and pharmacodynamics are the process of what happens to drugs on entrance to the body and what the body does to the drug. Pharmacokinetics the study of drug movement throughout the body by four processes. These processes are absorption – a drugs movement from its site of administration into the blood, and distribution- the movement of a drug from the blood to interstitial space of tissues and then into the cells. The next two are: metabolism- the enzymatically mediated alteration of a drugs structure and excretion- move of drugs and their metabolites out of the body. Pharmacodynamics relates to what happens to the body with the entrance to a drug. (Rosenthal & Burchum, 2021)

           It is important to have as best a possible a clear picture of a patient’s history and medication usage. A 72-year man was admitted to the unit post fall at home. He has a history of Alzheimer’s/dementia, hypertension, chronic kidney disease and diabetes. He is diagnosed with a urinary tract infection (UTI) and increased agitation. On assessment the patient is very agitated, he is attempting to get out of bed by himself, pulling on his lines and hitting staff. He was given haldol times three and Ativan in the ED prior to arrival on the unit.

            Rosenthal & Burchum, states most medication are excreted through the liver or kidneys. Studies on use of antipsychotics in the elderly state that “Because the pharmacokinetic characteristics among older individuals differ from those in other age groups, selecting antipsychotics for delirium should be cautiously considered” (Jenraumjit et al, 2021). The study also refers to finding the unlaying cause for the change, in this case it would be the UTI. For this patient his four processes in relation to his age and disease process may causing the delay in action of the medications given. A current medication review for any medication which may interact and therefore cause this reaction could be beneficial.

          As a plan of care for this patient – I would trial one to one sitter to, testing should be ordered for renal, kidney status – prior to the addition of any new medications unless it becomes urgently needed.

Reference

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Jenraumjit, R., Somboon, J., Chainan, S., Chuenchom, P., Wongpakaran, N., & Wongpakaran, T. (2021). Drug‐related problems of antipsychotics in treating delirium among elderly patients: A real‐world observational study. Journal of Clinical Pharmacy & Therapeutics, 46(5), 1274–1280. https://doi.org/10.1111/jcpt.13423