ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
Sample Answer for ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521 Included After Question
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632 Links to an external site.). All papers submitted must use this formatting.
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A Sample Answer For the Assignment: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
Title: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
In the case scenario, a friend calls and requests me to prescribe her medication. Although I have the autonomy, I do not have the friend’s medical history. However, I still write the prescription. This paper explores the ethical and legal implications of this scenario, 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 regarded as unprofessional conduct and can call for disciplinary measures. The ethical problem surrounds the fact 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 ethic 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 ethical principles of beneficence and nonmaleficence.
The ethical and legal implications of the act would not only fall on the prescriber but also the dispensing pharmacist. Ethical implications for the pharmacists would include the failure to uphold beneficence and nonmaleficence. The pharmacist ought to have reviewed the diagnosis for the patient 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 not appropriate for the patient. 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 making an apology 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. In the case that 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.
Strategies That You, As an Advanced Practice Nurse, Would Use To Guide Your Decision Making In This Scenario
In this scenario, my decisions would be based on the North Carolina laws and ethical principles. 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 having my APN license revoked (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 on 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 that 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.
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Process of Writing Prescriptions and Strategies to Minimize Medication Errors
The prescribing clinician should first 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 the 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 be used to 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, 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
A Sample Answer 2 For the Assignment: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
Title: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
Across the United States, nurse practitioners have some extent of prescriptive authority over drugs, controlled substances, medical services, and medical devices (de Araújo et al., 2019). NPs and other healthcare professionals with legal authority to prescribe medication are required to observe legal and ethical guidelines to safeguard the patient from harm. However, the regulations governing prescriptive practice among NPs vary across different states. For this discussion, the ethical and legal implications of the provided case scenario will be illustrated based on the New Jersey NP’s scope of practice.
Ethical and Legal Implications
The provided case study demonstrates an ethical dilemma of whether or not to report an NP who prescribes narcotic medication to her
husband. The laws and regulations regarding prescribing medication to a family member or a friend differ by state as it is forbidden in other states, whereas in some states, it is only advised against. In New Jersey, NPs are required to collaborate with physicians to enjoy prescriptive authority privileges (Ellenbogen & Segal, 2019). When prescribing controlled drugs such as narcotics, the NP is required to consult with the supervisory physician and complete must have completed education in the pharmacology of drugs listed under controlled substances. Consequently in New Jersey, prescribing controlled substances to self, family member, or friend is prohibited.
The prescriber, which in this case is the NP, violated all the regulations for prescribing controlled substances as required by the New Jersey state laws. For instance, she failed to consult the supervisory physician before prescribing the narcotic medication to her husband, which is also against the law. Prescribing medication to a family member undermines the professional objectivity of the prescriber in addition to compromised professional medical judgment (Phillips, 2020). Legally, the prescriber can end up losing their prescriptive authority or even the practice license. The pharmacist, on the other hand, must ensure that the prescription from the NP has met all the requirements as per the prescriptive practice protocol before dispensing the medication to the patient. Failure to do so, the pharmacist can also face legal charges.
Finally, the patient in this scenario may fail to disclose all the required information to promote the safe use of controlled substances, to her wife, who is the prescriber. Due to patient privacy and confidentiality, most couples fail to share their full medical history, especially the ones that they consider embarrassing such as addiction. Failure to disclose such information may promote the risks of adverse events and negative treatment outcomes (Squellati et al., 2022).
Disclosure and Nondisclosure
The nurse who witnessed her colleague violating the prescriptive authority of state laws and regulations was faced with an ethical dilemma of disclosure and nondisclosure of the incident. According to the Patient Safety Act, N.J.S.A. 26:2H-12.23, healthcare professionals are required to report any form of medical malpractice including prescription malpractice, to the department head and the patient (Ellenbogen & Segal, 2019). Doing so will help prevent such issues from taking place in the future. However, failing to disclose the matter can lead to legal implications, in addition to being unethical primarily to the patient. As such, in the provided case study, it would have been necessary for the nurse to approach the prescribing nurse, and inform her about the implications associated with her actions in addition to the adverse outcomes associated with the use of narcotics. The prescribing nurse should also be advised against failing to adhere to the outlined prescriptive practice protocols to promote patient safety and positive treatment outcome. If the prescribing nurse ignores these concerns, she should then be reported to the departmental head, for legal action to be taken.
Decision Making
As an advanced practice nurse, critical thinking is crucial in promoting appropriate decision-making in situations like the one described above. Considering the patient as the center of care is a crucial strategy that must be utilized among all healthcare professionals when deciding on whether or not to disclose a medical error (Grecu & Spector, 2019). The second strategy should be based on upholding the patients’ rights, such as the right to information concerning their health. With these two strategies, I would disclose the error to the patient, and adopt appropriate mitigating interventions to ensure the patient’s safety and prevent harm. Failing to disclose the information to the patient, is unethical, and puts the patient at risk of adverse events and negative outcomes associated with the use of controlled substances such as narcotics.
Process of Writing a Prescription
A high level of professionalism is required in prescribing medication to promote patient safety and avoid medication errors. The prescriber must meet all the information requirements when writing the prescription. The following steps are crucial when writing a prescription. The first step is collecting patient information, including demographics and diagnosis (de Araújo et al., 2019). The second step is providing your information as the prescriber. The third step is to identify the drug name, form, strength and frequency to be administered. It is also important to write the exact quantity of the drug that has been prescribed. The fourth step is giving the direction of use and the number of refills. Finally, the prescriber must append his or her signature.
Conclusion
With the increasing prescriptive privileges among nurses, it is crucial to consider legal and ethical guidelines to promote patient safety. Consequently, each state has specific regulations governing prescriptive practice among RNs. Violation of such regulation is unethical to the patient and can also lead to legal implications for the prescriber, just like in the discussed case study.
References
de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. de A., & Toma, T. S. (2019). How to Prevent or Reduce Prescribing Errors: An Evidence Brief for Policy. Frontiers in Pharmacology, 10. https://doi.org/10.3389/fphar.2019.00439
Ellenbogen, M. I., & Segal, J. B. (2019). Differences in Opioid Prescribing Among Generalist Physicians, Nurse Practitioners, and Physician Assistants. Pain Medicine. https://doi.org/10.1093/pm/pnz005
Grecu, A. M., & Spector, L. C. (2019). Nurse practitioners’ independent prescriptive authority and opioids abuse. Health Economics, 28(10), 1220–1225. https://doi.org/10.1002/hec.3922
Phillips, S. J. (2020). 32nd Annual APRN Legislative Update. The Nurse Practitioner, 45(1), 28–55. https://doi.org/10.1097/01.npr.0000615560.11798.5f
Squellati, R., McCants, K. M., Hadden, T. A., & Mitchell, C. V. (2022, January 1). 9 – Health policy for NPs: health literacy, cultural competence, and communication (D. Seibert, B. Malone, & P. DeLeon, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780323999939000068
A Sample Answer 3 For the Assignment: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
Title: ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS NURS 6521
When a patient enters the health center, medication is very likely to be administered. A health history and a patient’s medical evaluation are important things to examine when administering medication. A nurse or doctor should administer the care of the condition and be informed of the standard a condition should be offered depending on a background of health and physical inspection (Rosenthal & Burchum, 2020). In this discussion, the essay focuses on Scenario 2 to clarify the ethical and legal ramifications of patient family, prescriber, pharmacist and patient to all parties concerned. The discussion continues by explaining the methods I will use to drive decision-making for an experienced clinical nurse in the selected scenario.
Selected scenario
A colleague calls and demands for drugs to be taken for her. You are self-sufficient, but do not have the medical experience of your mate. Anyway, you write the drug. The ethical, as well as legal implications of the scenario on all stakeholders such as the prescriber, pharmacist, patient, and patient’s family, discuss as follow:
Nurse Practitioner: A nurse who uses medications without performing the requisite testing, evaluation and legal consequences such as absence, as needed by the medical code of ethics, such as the Colorado “Medical Practice Act,” breaches the code and is unprofessional (Sabatino & Pruchnicki, 2017). The NP who prescribes medication for a friend without a medical background fears jeopardizing his permit since adverse reactions can turn fatal. A nurse has the ethical obligation to prescribe the best medication, but only after a medical exam and evaluation.
Pharmacist: In mediation, a pharmacy dealer who carries out a prescription does not presume that the prescriber has made an examination, nor that the practitioner is ethically and legitimately liable for the background before the order is submitted. Thus, loading the Rx with the pharmacist’s chance of losing the license while knowing his clinical background.
Patient and family: Prescribing drugs to a patient is morally and technically permissible whether a patient may not have an awareness of his or her background, evaluation and allergies. Therefore the patient and the relatives will bring court charges against the nurse and pharmacy firm should any incident take place.
Strategies to Guide Decision making
The first strategy is to call the patient before prescribing medication and to make an appropriate date for a medical evaluation to reach the condition. Medical testing and an assessment may lead to the patient’s medical condition and, therefore, to the required medication (Musellim & Borekci, 2017). In medical and personal interactions, faulty and incorrect prescribe inaccurate medications, less frequent usage for preventive treatment, loss of medical satisfactions, and escalated aggressive incidents against healthcare providers, maybe the result of a patient’s evaluation over a short duration of time. The patient assessment period could have been influenced too gradually or too rapidly.
The second strategy is to do the clinical examination before administering medication to assess the condition of the patient. Clinical trials are study experiments in which patients actively undergo experimental therapeutic techniques, techniques or measures in order to avoid, diagnose, cure or control various conditions or diseases (Rosenthal & Burchum, 2020). Some studies consider how people react to a new procedure and what side effects may be created. The third method is to implement a prescriptive decision-making process by looking at the patient’s family members and their prior fitness. The prescriptive method of educated judgment aid approaches describes a variety of strategies to enable citizens to think differently about a decision.
Process of Writing Prescriptions
There are important things that physicians should consider before writing medications. Relevant elements must also be considered. Again, it is necessary to remember that there are norms in various countries. The criteria specify that the details on medications are provided. Both medications usually tend to use a vocabulary the consumer can understand such that they can learn quickly how to take medicine. Secondly, it is important to write clearly in writing while writing the medication (Solanki & Shah, 2015). Third, it is necessary to determine the duration of usage of the medication and the days the patient is supposed to take. Additional detail used is subject to local drug laws. With the exponential advancement of technology, electronic prescribing will continue to reduce the cost-effectiveness of drug mistakes. Electronic prescribing is an efficient means of eliminating medication errors. The continuous dependency on handwriting writing is one of the factors that have made medication mistakes inevitable (Nickless & Davies, 2016). Handwritten prescriptions might be negligible. Problems like this can be overcome by technology-based prescribing, as this will help to reduce drug mistakes.
References
Musellim, B., & Borekci, S. (2017). What should be the appropriate minimal duration for patient examination and evaluation in pulmonary outpatient clinics? Annals of Thoracic Medicine, 12(3), 177–182. doi:10.4103/atm.ATM_396_16
Nickless, G., & Davies, R. (2016). How to take an accurate and detailed medication history. The Pharmaceutical Journal.
Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier – Health Sciences Division.
Sabatino, J. A., & Pruchnicki, M. C. (2017). Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248-254. doi:10.1002/2327-6924.12446
Solanki, N. D., & Shah, C. (2015). Prescription audit in outpatient department of multispecialty hospital in western India: an observational study. International Journal of Clinical Trials, 14-19.
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