NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Sample Answer for NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing Included After Question

NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing 

Responsibilities are given to him on whom trust rests. Responsibility is always a sign of trust.
—James Cash Penney  

Nurses have been rated the most trusted professionals in the United States (CDC, 2012). With this trust comes a critical responsibility to maintain ethical and legal practices in order to preserve patient safety when treating patients and prescribing drugs. Since the scope of practice for advanced practice nurses is broadening, you will likely encounter new and complex ethical challenges in your clinical settings. 

This week, you explore ethical and legal implications of prescribing drugs including disclosure, nondisclosure, and prescriptive authority. You also examine the process of writing prescriptions to avoid prescription drug errors. 

Learning Objectives 

By the end of this week, students will: 

  • Evaluate ethical and legal implications related to prescribing drugs 
  • Analyze ethical and legal practices of prescribing drugs 
  • Evaluate ethical and legal implications of disclosure and nondisclosure 
  • Analyze the process of writing prescriptions to avoid medication errors 
  • Understand and apply key terms, concepts, and principles related to ethical and legal aspects of prescribing 

Photo Credit: erhui1979/DigitalVision Vectors/Getty Images 

NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing 
NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. 

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below. 

Required Readings 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

  • Chapter 1, “Issues for the Practitioner in Drug Therapy” (pp. 3–14)
    This chapter introduces issues relating to drug therapy such as adverse drug events and medication adherence. It also explores drug safety, the practitioner’s role and responsibilities in prescribing, and prescription writing.  

 

  • Chapter 59, “The Economics of Pharmacotherapeutics” (pp. 1009-1018)
    This chapter analyzes the costs of drug therapy to health care systems and society and explores practice guideline compliance and current issues in medical care.  

 

  • Chapter 60, “Integrative Approaches to Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
    This chapter examines issues in individual patient cases. It explores concepts relating to evaluation, drug selection, patient education, and alternative treatment options.  

Due to the importance of ethical and legal considerations in advanced practice nursing, several resources have been provided for your reference. 

Sabatino, J.A., Pruchnicki, M.C., Sevin, A.M., Barker, E., & Green, C.G. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students 

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator. 

Note: Retrieved from the Walden Library databases. 

 

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html 

 

This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses. 

 

Ladd, E., and Hoyt, A. (2016).Shedding Light on Nurse Practitioner Prescribing. The Journal For Nurse Practitioners. 12(3). 166-173.  

This article provides NP’s with information regarding state based laws for NP prescribing.  

Note: Retrieved from the Walden Library databases. 

 

Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html 

 

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule. 

 

Drug Enforcement Administration. (2006.). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html 

 

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs. 

 

Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf 

 

This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors. 

 

Optional Resources 

 

Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm 

 

Drug Enforcement Administration. (n.d.). Registration. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/Registration.html 

 

In addition, refer to the Optional Resources listed in Week 1. 

 

Discussion: Ethical and Legal Implications of Prescribing Drugs 

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? 

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 on a daily basis. 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. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond. 

Scenario 1: 

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. 

Scenario 2: 

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway. 

Scenario 3: 

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident. 

Scenario 4: 

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life. 

To prepare: 

  • Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Ladd and Hoyt (2016), the Drug Enforcement Administration, and Sabatino et al (2017). 
  • Select one of the four scenarios listed above. 
  • Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the 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. 

With these thoughts in mind: 

By Day 3 

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario. 

By Day 6 

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different scenario than you did, in one or more of the following ways: 

  • Suggest additional ethical and legal implications for all stakeholders in your colleagues’ scenarios. 
  • Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. 
  • Validate an idea with your own experience and additional research. 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Submission and Grading Information 

Grading Criteria  

 

To access your rubric: 

Discussion Rubric 

 

Submission 

Post by Day 3 and Respond by Day 6 

 

To participate in this Discussion: 

Week 2 Discussion 

 

 

Assignment:
The Ethics and Legalities of Medication Error Disclosure  

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error. 

Consider the following scenario: 

  • You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional. 

To prepare: 

  • Consider the ethical implications of disclosure and nondisclosure. 
  • Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic. 
  • Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. 
  • Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors. 

By Day 7 

Write a 2- to 3- page paper that addresses the following: 

  • Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state. 
  • Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale. 
  • Explain the process of writing prescriptions including strategies to minimize medication errors. 

 

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting. 

 

Submission and Grading Information 

To submit your completed Assignment for review and grading, do the following:  

  • Please save your Assignment using the naming convention “WK02Assgn+last name+first initial.(extension)” as the name.  
  • Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment. 
  • Click the Week 2 Assignment link. 
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK02Assgn+last name+first initial.(extension)” and click Open 
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. 
  • Click on the Submit button to complete your submission. 

Grading Criteria  

 

To access your rubric: 

Week 2 Assignment Rubric 

 

Check Your Assignment Draft for Authenticity 

 

To check your Assignment draft for authenticity: 

Submit your Week 2 Assignment draft, and review the originality report 

 

Submit Your Assignment by Day 7 

 

To submit your Assignment: 

Week 2 Assignment 

 

 

Week 2 Quiz 

This week’s Quiz covers the content you have explored this week. The Quiz may include the following topics: 

  • Cost effectiveness and utility of a drug as a first-line treatment from the perspective of the patient, provider, payer, and society 
  • Ethical and legal issues involved in prescribing drugs 
  • Federal and state laws relating to the purchasing, possessing, prescribing, administering, and disposing of pharmacologic and nonpharmacologic agents 
  • Prescriptive authority for nurse practitioners 

By Day 7 

You have 60 minutes to complete this 26-question Quiz. 

This quiz is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are expected to comply with Walden University’s Code of Conduct. 

Submission and Grading Information 

Submit Your Quiz by Day 7 

 

To submit your Quiz: 

Week 2 Quiz 

 

A Sample Answer For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Week In Review 

This week you evaluated and analyzed ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure and analyzed the process of writing prescriptions to avoid medication errors. 

Next week you will examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders and explore ways to improve drug therapy plans for these disorders. 

Next Week 

Brandy Barrett  

week 2 Initial Post  

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Week 2 Initial Post 

Nurs 6521N 

Scenario # 1: 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. 

            When prescribing medication for anyone it is important to check multiple times that the medication is prescribed correctly.  Prescribing for children can be complicated because their dosages are not usually standard doses.  Medication for children is usually prescribed based on the child’s weight in kilograms.  As the prescriber you have to be attentive and knowledgeable about the medication prescribed, “it is the prescriber’s responsibility to calculate the dose and write the correct dose, and not depend on the pharmacist to calculate the dose” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p.9).  The pharmacist should be looked at as an additional check who would hopefully catch any medication errors before a prescription is filled and given to the patient.  However, the liability with medication errors will fall back on the prescriber because they are first responsible for their patient.  The pharmacist can also make mistakes which would ultimately fall back on the prescriber if it has to be explained in a court of law. 

 If I made a medication error when prescribing medication to the five years old or any patient it is my ethical duty to make the parent or legal guardian (since the error was on a minor) aware of the medication error.  If the child has not yet taken the medication, I would need to contact the pharmacy to stop the medication from being filled and contact the parents to inform them of the mistake and stop them from giving the medication to the child.  In the instance that the child was already given the medication, I would need to instruct the person caring for the child on the proper instructions to prevent further harm which could be monitoring the child to seeking immediate treatment for the child.  

            Not only is it unethical to not inform the parents of the medication error it is a violation of the patient’s bill of rights to be notified of medication errors.  In Maryland, medication errors must be reported to the appropriate agency.  The six rights to medication administration must be followed (right person, right medication, right dose, right time, right method/route, right charting/documentation).  Not following any of these six rights could be considered a medication error. Patients want to know when a medical error has been made, “the patient’s bill of rights also demands to have full disclosure of an error” (Ghazal, Saleem, & Amlani, 2014, p.1).  When patient’s feel wronged they are more inclined to file lawsuits, “insufficient provider-patient communication after an error motivates patients to file lawsuits” (Hannawa & Shigemto, 2016,p.29).  

Strategies 

            As an APN it is important to maintain the trust of the population that we serve.  Not being honest about how we practice will reflect poorly on us and whoever we may work for.  The first strategy I would use is the triple check system when prescribing the medication.  I would want to make sure that the medication order is correct before it is given to the patient to avoid error.  In the case that an error was made I would provide full disclosure, “disclosure of error to the patient will enhance the trust in physician and prevent lawsuit on the hospital” (Ghazal, Saleem, & Amlani, 2014, p.1). After the error, I would follow up with the patient, assess the damage determine if the patient needs immediate attention or monitoring and prescribe the correct the error.  No one wants to make mistakes when prescribing medication being truthful about the incident will help maintain the respect of the provider.  

Reference: 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). 

Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Hannawa, A. F., Shigemoto, Y., & Little, T. D. (2016). Medical errors: Disclosure styles, 

interpersonal forgiveness, and outcomes. Social Science & Medicine, 156, 29–38. https://doi-org.ezp.waldenulibrary.org/10.1016/j.socscimed.2016.03.026 

Saleem, L. G. (2014). A Medical Error: To Disclose or Not to Disclose. Journal of Clinical  

Research & Bioethics,05(02). doi:10.4172/2155-9627.1000174 

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3 months ago  

Antoinette Joseph  

Main Post- Scenario 2  

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Main Post  

 

Scenario 

               Scenario two was chosen for this discussion. In this scenario, a friend calls and asks the APRN to prescribe a medication for her. The APRN has the autonomy; however, does not have the friend’s medical history. The prescription is written anyways. 

Legal and Ethical Implications 

               Legally, in the writer’s state of Florida, APRNs are required to have protocols that are written with an MD, DO, or dentists in order to diagnose, treat, order diagnostic tests, treat patients, and order physical and occupational therapies (Kaplan, 2016). Prescribing this medication can cause the writer to be outside of practice standards depending on the condition the friend is attempting to treat. The friend would not have knowledge of the standards established by the APRN and their supervising physician, placing the APRN in danger of not being legally compliant. 

               The ethical implication in this scenario is focused on the lack of patient information during the prescriptive process. Studies have shown high incidences of prescribing errors occurring at the primary care provider’s office and the occurrence is usually during the prescriptive process (Sabatino, et al., 2017). When prescribing a medication, it is imperative to have a clinical indication for the medication being prescribed (Arcangelo, Peterson, & Reinhold, 2017). Some medications are utilized for off-label use and some medications are used to treat multiple disorders. 

 One example of a medication used to treat multiple diagnoses is Bupropion also known as Wellbutrin. This medication can be used to treat depression and is utilized for smoking cessation (Connective Rx, 2018). There have been incidences in the writer’s practice where the medication list has been utilized to determine the past medical history, which can be an inaccurate guess in the case of Bupropion. The other ethical concern is the need to prescribe the appropriate medication based on the medical history or possible contraindications. The lack of information about the patient will increase the likelihood of the medication error during prescribing.  For example, the PDR indicates the need for dosage adjustment with the prescription of Bupropion with individuals with renal or hepatic insufficiency (Connective Rx, 2018). It is also contraindicated for patients with alcoholism, anorexia nervosa, brain tumor, bulimia nervosa, diabetes mellitus, hypoglycemia, hyponatremia, hypoxemia,  obesity treatment, seizure disorder, seizures, stroke, substance abuse (Connective Rx, 2018) to name a few. At this juncture, patient safety and appropriate clinical indication becomes a problem. 

Two Strategies for Decision-Making 

               The two strategies that would be utilized to navigate the interaction with the friend and help with the decision-making process would be to educate the patient safety concern and the need to ensure it is the appropriate drug and dosage for the friend. The education provided to the friend would be to explain the possible food and drug interactions (and drug-drug) that can occur with the medication in question. Explanation of the possible adverse effects that can occur due to the lack of information on the health history would help the friend understand the processes that have been put into place to ensure his/her safety. The other strategy would be to determine if the drug is really appropriate for the friend based on an assessment. Without a health history, it would not be possible to determine if it is truly the correct medication for the indicated condition. 

Conclusion 

               In conclusion, the above-mentioned scenario requires exploration of legal and ethical considerations when making a decision. Legally, in Florida, there are certain standards that have been established with APRNs that have to be followed. Ethically, there are a lot of patient safety concerns that can potentially cost the friend her life or result in an inaccurate diagnosis. Education about dangers of prescribing without the appropriate indications would be one strategy. The second one would be to assess the patient to determine the appropriate treatment for the condition in question. 

 

References 

Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins. 

Connective Rx. (2018). Wellbutrin. Retrieved from PDR: https://www.pdr.net/drug-summary/Wellbutrin-bupropion-hydrochloride-237.5886 

Kaplan, L. (2016). Florida NPs advocate for controlled substance prescriptive authority. The Nurse Practitioner, 14-16. 

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C., & Porter, K. (2017). Improving prescribing practives: A pharmacist-led educational intervention for nurse practitioner students. Journal of the American Association of NPs, 248-254. 

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3 months ago  

christie haase  

Scenario #2  

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Scenario: Your sister’s friend, and your acquaintance, Elena calls you Monday afternoon stating that she tweaked her knee over the weekend, and while  

she can put weight on it, she is in tremendous pain despite around the clock acetaminophen, elevation, and icing. She has an appointment scheduled with  

her primary care provider on Friday for an evaluation, but they are unable to get her in any sooner. She is sure that she took ketorolac for a previous injury 

and that it worked miracles for her; Elena asks for a prescription to hold her over until she can see her primary care provider. You ask her a few questions  

to include allergies, history of asthma, and stomach ulcers.  These answers are negative, she is young and appears healthy, and you reluctantly issue her a  

5- day prescription for ketorolac. 

     Antibiotics, antihistamines, and contraception are the most commonly prescribed medications to provider family, friends, and self (Cowgill, 2015),  

though it is easy to see how the scenario described could occur. Practitioners prescribing for friends or families may neglect to address sensitive portions of  

the medical history (Bird, 2016). Because a thorough medical history was not obtained, which is a common cause of prescribing errors (Arcangelo,  

Peterson, Wilbur, & Reinhold, 2017), you are unaware of Elena’s lithium use for diagnosed bipolar disorder.  

     Lithium remains the mainstay of pharmacological treatment of bipolar disorder because of its effectiveness in reducing suicide during the depressive  

cycle. Lithium’s “narrow therapeutic window” necessitates frequent monitoring to prevent toxicity (Ayano, 2016, para. 4). There are many theories as to  

the biochemical mechanism of lithium that stabilizes mood to include alteration of metabolism of catecholamines and serotonin and that its similarities to  

sodium, potassium, calcium, and magnesium can alter ion pumps in cell membranes (Ayano, 2016). Ayano also states that lithium is wholly absorbed, not  

protein bound (which means available) and excreted primarily by the kidneys with a 70-80% reabsorption rate in the proximal tubule. Small changes in  

reabsorption or excretion of lithium by the kidney can quickly alter the serum levels leading to potential toxicity. 

     Ketorolac is a non-steroidal anti-inflammatory (NSAID) indicated for short-term acute pain and is contraindicated for those with asthma, concurring  

NSAID use, history of GI bleed or ulceration, decreased renal function, and suspected or known cerebrovascular bleeding; bioavailability is 100 percent, is 

highly bound to serum proteins and is believed to relieve pain by inhibition of prostaglandin synthesis (Roche, n.d.). Ketorolac is metabolized by the liver, 

but like lithium, it is primarily excreted by the kidneys (Ayano, 2016 & Roche, n.d.). The concern with the simultaneous use of these two drugs is that  

ketorolac, like most NSAIDs, can reduce the amount of lithium cleared, or excreted, by the kidneys increasing serum lithium levels leading to potential  

toxicity (Ayano, 2016 & Roche, n.d.). 

 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical approach  

     (4th ed.). Philadelphia, PA: Wolters Kluwer. 

Ayano, G. (2016). Bipolar disorders and lithium: Pharmacokinetics, pharmacodynamics, therapeutic effects and indications of Lithium: Review of articles. 

     Austin Journal of Psychiatry and Behavioral Sciences, 3(2), 1-8. Retrieved from http://austinpublishinggroup.com/psychiatry-behavioral- 

     sciences/download.php?file=fulltext/ajpbs-v3-id1053.pdf 

Bird, S. (2016). The pitfalls of prescribing for family and friends. Australian Prescriber, 2016(39), 11-13. https://doi.org/10.18773/austprescr.2016.002 

Cowgill, C. (2015). Ethical obligations and self-regulation: APRN perspective. Retrieved from  

     epubs.democraticprinting.com/article/ETHICAL_OBLIGATIONS-AND-SELF-REGULATION%3A-APRN- 

     ERSPECTIVE/2271998/2732831article.html 

Roche. (n.d.). Toradol. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019645s019lbl.pdf 

 

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Sonya Howald  

RE: Week 2- Main question post (Scenario 3)  

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Week 2 Main Question Post 

NURS-6521 Pharmacology 

Sonya Howald 

 

Scenario 3: 

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident. 

 

 

Ethical and Legal Implications for the Prescriber 

 

            In scenario 3 of this week, there are several ethical and legal implications for all involved, therefore, the ethical thing to do in this case is to report what happened. The Iowa Board of Nursing is the regulatory agency for licensed practical nurses, registered nurses, and nurse practitioner’s (NPs) in the state of Iowa. Disciplinary actions the Board may impose upon the prescriber in this scenario include but are not limited to citation and warning, 

civil penalty/fine, continuing education, probation with conditions, suspension, and revocation (Iowa Board of Nursing, n.d.a). For one to have their license reinstated, a submission of an application for reinstatement of licensure and a written letter stating “why the circumstances that led to your encumbered license have been resolved, evidence to support that, and why it would be in the best interest of the Board to reinstate your license,” must be completed (Iowa Board of Nursing, n.d.a, para 2). If these items are deemed complete, the prescriber may have to appear in person at a Board meeting hearing. 

 

Pharmacist 

The Iowa Prescription Monitoring Program (PMP) allows pharmacists and other prescribers access to information regarding their patients’ use of Schedule II, III, and IV controlled substances (Iowa Board of Nursing, n.d.b.). If the patient goes to the same pharmacy for this prescribed narcotic, it would not be unreasonable for the pharmacist to request the patient’s use of Scheduled drugs from the electronic database. This database may reveal the number of prescriptions filled each year and signs of excessive pharmacy-shopping or doctor-shopping for controlled substances. If the pharmacist notices a pattern of excess prescription for the narcotic for this patient or that he has been to several other pharmacies for the same prescription, he has an ethical duty to report it to the Iowa Board of Pharmacy. According to Chapter 124.509: Education and research- The board and the department, subject to approval and direction of the governor, shall carry out educational programs designed to prevent and deter misuse and abuse of controlled substances…Determine patterns of misuse and abuse of controlled substances and the social effects thereof (Iowa Board of Pharmacy, n.d.a., p. 45). If a pharmacist violates any provision of the controlled substances Act or rules relating to that Act, it is grounds for licensure discipline (Iowa Board of Pharmacy, n.d.b.) 

 

Patient             

The consequence for the patient may be that their care at that office or by the providers of the practice may be terminated. There are several reasons an NP may decide to terminate a patient’s care, for example, inappropriate or disruptive behavior from the patient such as physically or verbally assaulting a provider or staff member. A practice may also terminate care when the patient’s provider leaves the practice, and the current providers are at capacity and unable to accommodate the patient. Another reason may be repeated failure to show up for scheduled appointments or paying their medical bills, although some states may prohibit the termination of care due to lack of payment. Another common reason to terminate care is a breach in a patient-provider agreement surrounding controlled substances or failure to follow recommended treatment plans. While there are many reasons to terminate a patient’s care, there are also unacceptable reasons for care termination such as those based on age, gender, race, religious beliefs, or sexual orientation (Wright, 2017). 
 

Strategies for Decision Making 

            The strategies I would use to guide my decision making in this scenario is the American Nurses Association (ANA) Code of Ethics for nurses, the Iowa Board of Nurses, and the Iowa Legislature laws. The ANA Code of Ethics (2015), Provision 2.2 discusses the conflict of interest for nurses. “Nurses address such conflicts in ways that ensure patient safety and that promote the patient’s best interest while preserving the professional integrity of the nurse and supporting interprofessional collaboration… Nurses in all roles must identify, and whenever possible, avoid conflicts of interest” (p. 5). The prescribing NP did not avoid conflicts of interest by prescribing her husband, who is not a patient of hers, narcotics. It is also my duty as well as it was the prescribers to preserve the professional integrity of our profession. Furthermore, the Code of Ethics states in Provision 3.5 that a “nurse must be alert to and take all appropriate action in all instances of incompetent, unethical, illegal or impaired practice or actions that place the rights or best interest of the patient in jeopardy” (ANA, 2015, p. 12).  

            Another key point to consider is the prescribing NPs specialty. If the prescribing NP works in an ophthalmology clinic, it would not be appropriate for the prescription of narcotics. According to the Iowa Board of Nursing (2018), registration as a practitioner with the Federal Drug Enforcement Administration and the Board of Pharmacy Examiners permits the Advanced Registered Nurse Practitioner to prescribe controlled substances within the practitioner’s recognized specialty, in which this scenario does not. And lastly, for an advanced registered nurse practitioner, prescribing, dispensing, administering or distributing drugs to individuals who are not patients or are outside the licensee’s specialty area is prohibited (The Iowa Legislature, n.d.). 

 

 

 

References 

American Nurses Association. (2015). Code of ethics for nurses: With interpreted statements. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ 

Iowa Board of Nursing. (2018). Advanced registered nurse practitioner: Role and scope. Retrieved from https://nursing.iowa.gov/practice/advanced-registered-nurse-practitioner-role-scope 

Iowa Board of Nursing. (n.d.a). Enforcement FAQs. Retrieved from https://nursing.iowa.gov/enforcement/enforcement-faqs 

Iowa Board of Nursing. (n.d.b). Iowa Prescription Monitoring Program (PMP). Retrieved from https://nursing.iowa.gov/practice/arnp-role-scope/iowa-prescription-monitoring-program-pmp 

Iowa Board of Pharmacy. (n.d.a). Rules/Laws. Chapter 124. Retrieved from https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.124.pdf 

Iowa Board of Pharmacy. (n.d.b). Rules/Laws. Chapter 155A. Retrieved from https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.155a.pdf 

The Iowa Legislature. (n.d.). Grounds for discipline. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/01-06-2016.655.4.6.pdf 

Wright, W. (2017). Terminating a patient from care. Nurse Practitioner, 42(11), 53-55. Retrieved from the Walden Library database. 

 

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3 months ago  

William Ledesma  

Main post, scenario 1  

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Hello professor and class 

As prescribing practitioners, we have a responsibility to abide by the legal and ethical aspects of prescribing medications. The practitioner has the responsibility of formulating one or more diagnosis and treatment plans after a detailed history is obtained and a physical examination is performed (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In the scenario number one, the provider appeared to diagnose correctly the child’s pathology, but failed to appropriately prescribe the correct dose for the patient’s age. This case scenario is describing a medical error and actions must be taken as soon as the provider discovered the mistake. 

The Provider 

Ethical issues regarding medical errors according to Bonnie (2014), as cited by Sorrell (2017), can be grouped according to four principles: 

1-      Autonomy and Right to self Determination: the patients’ right to make their own choices and to act based in their own beliefs, personal views, and perceived benefits. Also, established the providers obligation to report the medical error. In this case the 5 years old child may have not been informed, but his legal guardians, in this case the patient’s parents, were supposed to be notified in spite of any consequences the provider may have faced. 

2-      Beneficence and Non-Maleficence: This principle guided providers to do what is right to his patients and to avoid harm. The ordering provider should have taken the necessary steps co correct the error as soon as he became aware of the mistake. 

3-      Disclosure and Right to Know: This principle describes the provider’s obligation to disclose information the patients need to make informed decision making. In this case, informing the parents about the mistake may have de creased the damages caused by and overdose. 

4-      Veracity: This principle calls for all medical providers to always be honest and disclose accurate information. This helps build trust with patients and families. 

Disclosure of a medical error is still an ethical dilemma. One of the reasons they may not report the mistake is because of fear of being sued by the patient or the patient’s family. Many physicians do not disclose errors because they are afraid of being held liable. They fear than an apology be taken as an admission of guilt or liability. But, according to Guilloid (2013) many injured patients merely seek an explanation and hope for an apology rather than strive for financial compensation. 

The Pharmacist 

Multiple ethical and legal aspects surround this medical professional as well. Some of these ethical principles are similar to the ones for Medical Doctors and Nurse practitioners. Non-Maleficence, Beneficence, Honesty, Justice, Empathy and Excellence, Cooperation, and Respect for Patient’s Dignity and Autonomy are some of the principles that guide this profession (Salari, et al., 2013). The pharmacist should have noticed the medication error when he reviewed the prescription. Based on the principles of his profession he should have notified the patient of the adverse reactions, warnings, contraindications and storage (Salari, et al., 2013). The pharmacist should also notify the ordering provider of the error and should have tried to correct the problem before the patient obtained the filled prescription. 

The Patient and the family 

In the case of the patient in the case study, a 5 years old child, it must have been very difficult for the ordering provider to explain a mistake and the consequences of this error, but an effort should have been made to contact the family members to report the mistake and to stop the administration of this medication immediately. Also, based on the type of medication the patient may need additional tests to ensure no organ damages were caused by the excessive medication dose administration. The provider in this scenario omitted the patient right: correct dosages. Many patients seek legal recourse when a medical error has occurred. Edwin (2009), said that majority of patients only want an honest explanation of what happened and an appology, but also pointed out that disclosure of the mistake may not decrease malpractice claims. He also stated that about a third of the families were told the mistake caused their child injuries and 39% of patients, after full disclosure, would still seek legal advice. “Failure to disclose is certainly associated with an increased desire to sue” (Edwin, 2009). 

Strategies 

As a nurse practitioner I would use the ethical principles of autonomy and right to self-determination, beneficence and non-maleficence, as well as Veracity to guide my decision making, as discussed earlier, for the scenario. “The World Health Organization suggests a multi-step approach to prescribing that may help providers better focus the intent for the treatment. The guidelines were established in 2007 and are still applicable today. 

  1. Evaluate and define the patient’s problem.  
  1. Determine the therapeutic objective of the drug therapy.  
  1. Select an appropriate medication.  
  1. Provide patients with information, warnings and instructions.  
  1. Monitor the patient regularly.  
  1. Consider drug costs when prescribing.  
  1. Use appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors” (Duquesne University School of Nursing, 2018).  

Also, the authors stated that the importance of always reporting the errors and the validation of honesty from the nurse practitioner to always come forward in situations like the one discussed in the scenario.  There are questions we can ask ourselves before ordering medications in order to avoid mistakes. These questions are: 

  • “Is this drug needed to treat the presenting problem?  
  • Is this the best drug for the problem?  
  • Are there any contraindications to this drug with this patient?  
  • Is the dosage correct?  
  • Does the patient have allergies or sensitivities to the drug?  
  • What drug treatment does the patient currently use, and will the potential new drug interact with the patient’s other drugs or treatments?  
  • Is there a problem with storage of the drug?  
  • Does the dosage regimen interfere with the patient’s lifestyle?  
  • Is the route of administration the most appropriate one?  
  • Is the proposed duration of treatment too short or too long?” (Duquesne University School of Nursing, 2018).  

Mistakes are going to happen, but the way we face them will determine the way we will be seeing and validated.   

 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice A Practical Approach. Philadelphia: Wolters Kluwer. 

Duquesne University School of Nursing. (2018, December 4). The APRN’s Role and Responsibility in Ethical Prescribing. Retrieved from Duquesne University School of Nursing: https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/ 

Edwin, A. K. (2009). Non-Disclosure of Medical Errors an Egregious Violation of Ethical Principles. U.S. National Library of Medicine, 34-39. 

Guillod, O. (2013, December 1). Medical Error Disclosure and Patient Safety: Legal Aspects. Retrieved from US National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147746/ 

Salari, P., Namazi, H., Abdollahi, M., Khansari, F., Nikfar, S., Larijani, B., & Araminia, B. (2013). Code of ethics for the national pharmaceutical system: Codifying and compilation. US National Library of Medicine , 442-448. 

Sorrell, J. M. (2017, March 7). Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. The Online Journal of Issues in Nursing. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Ethical-Issues-with-Medical-Errors.html 

 

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3 months ago  

Collette Dillon  

week two- Ethical and legal scenarios -Case two  

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NURS 6521-Advanced Pharmacology 

INITIAL POST 

 

Nurse practitioners (NP’s) and other healthcare providers who are given legal authority to be prescribers of medications must follow ethical guidelines to ensure the safety of those they are entrusted to provide care too. Prior to prescribing any medication, a nurse practitioner (NP) should have a complete list of the patient’s medication to prevent drugs interaction with can cause adverse reactions which can be fatal (Mitchell and Oliphant, 2016). In addition, the medical history of the patient.  

Scenario  

In scenario two the nurse practitioner was asked by a friend to prescribe a medication without having access to his or her medical record. In the scenario, it is very tricky as a friend the nurse practitioner would like to provide support to her friend but there are legal ramifications if the nurse practitioner when ahead and prescribed the medication. The nurse practitioner should be aware of what are the rules that are governing the state that he or she is practicing in regarding prescribing medications to friends. According to (Arcangelo & Peterson, 2013) while some practitioners prescribe for friend and family, in general, it is not a good idea because laws and regulations differ by each state. Some states expressly forbid nurse practitioners to treat and write medication prescriptions for friends and family, while others just simple advise against it (Arcangelo & Peterson, 2013). It believes that due to the nurse practitioner’s close relationship with friends that it can cause an impairment ins judgment and decision making fatal (Mitchell and Oliphant, 2016). A nurse practitioner can encounter legal ramifications if he or she prescribed medication for a friend outside of the setting that he or she is permitted to practice within. This holds true for even nurse practitioners who have authority to prescribed medication but is required in certain states to still have a collaborative relationship with a physician (Mitchell and Oliphant, 2016). Even in states where the NP’s are permitted to practice and prescribed independently, the major complication would be what is best for the patient and whether local ethical boards having an opinion on the matter (Mitchell and Oliphant, 2016). The nurse practitioner not only puts himself or herself risk by prescribing the medication, but they’re also at risk are the patient, pharmacist, and the loved ones of the patient. The NP could face disciplinary actions for prescribing the medication to a friend without having the medication history which can put the patient at risk for adverse reactions from the prescribed medication and for not practicing within the scope of practice for the state which he or she resides. The pharmacist who is filling the medication in good faith can also face disciplinary action from the governing board or even get sued by the patient’s family. The implications for the patient’s family is that they might lose a loved one if the patient dies from adverse reactions from the medication that was prescribed. Through an assessment of a patient’s medical history which includes medication list must be done prior to prescribing any medication to make the best pharmacology treatment for the patient. 

Strategies to Guide Ethical and Legal Decision in Scenario 

            A major component of ethical prescribing is an examination of each patient’s distinct needs and situation. Therefore, the first strategy that the student would utilize to make an ethical and legal decision in scenario two, is one that was developed by the World Health Organization. Which is to; evaluate and define the patient’s problem, determine the therapeutic objective of the drug therapy, choose an appropriate medication for a given clinical situation, taking individual patient factors into account such as allergies, provide patients with information, warnings, and instructions, monitor the patient regularly (World Health Organization, 2018). The second strategy that the student would use is prescriptive and descriptive of the model of decision making. The student would choose this model because it consists of; specifying the problem, identifying all factors, weighting factors, identifying all alternatives, rating alternatives on each factor and choosing the optimal alternative, (Divekar, Bangal, Sumangala, 2012). These two strategies can be pivotal in decision making both legally and ethically.  

References  

Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams and Wilkins. 

 Divekar, A., Bangal, S., and Sumangala, D (2012). The study of prescriptive and  

descriptive models of decision making. Retrieved from http://thesai.org/Downloads/IJARAI/Volume1No1/Paper12-The_Study_Of_Prescriptive_And_Descriptive_Models_Of_Decision_Making.pdf 

Mitchell, A. and Oliphant, M.C, (2016). Responsibility for ethical prescribing. The Journal for  

Nurse Practitioners, 12 (3) A20. doi: 10.1016/j.nurpra.2016.01.008 

World Health Organization (2018). Improving medication safety. Retrieved from  

http://www.who.int/patientsafety/education/curriculum/who_mc_topic-11.pdf 

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3 months ago  

Kristin Pullins  

Week 2 intial discussion post  

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Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs 

The ability to prescribe medications and treatments also comes with great responsibility that directly affects the patient.  Ethical and legal issues may also arise and need to always be taken into consideration before a prescription is written.  The purpose of this post is to discuss the ethical and legal implications of a chosen scenario on all stakeholders involved and strategies that I would use to guide my decision making in this scenario.   

Scenario 

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life. 

Ethical and Legal Implications 

Nurse practitioners (NP) must follow an ethical code of conduct that includes justice (respect of the patient), beneficence (doing good), nonmaleficence (doing no harm), accountability (admitting fault), fidelity (being faithful/ loyal), and veracity (being truthful) just as we all do in practice as a registered nurse (American Nurses Association, 2001).  In this situation all these values are being strained.  “Patients and physicians have a joint ethical responsibility to discuss medical costs and to avoid financial harms for patients and society at large” (Gupta, Tsay, and Fogerty, 2015, p.1073).  It would be respectful of the NP to have included the patient in the decision of deciding if a prescription was affordable.  Obtaining information, such sociocultural factors (insurance information and income level), are part of writing a prescription (Arcangelo, Peterson Wilbur, & Reinhold, 2017). If the provider was aware of financial difficulties prior to prescribing the medication, as well as knowing that the prescription was rather pricy, the choice was made rather thoughtlessly.  Prescribing a medication that is financially straining to a patient is not exactly “doing good” and their financial situation may be in harm if they struggle to afford a pricy prescription ever month.  Feeling like they might not have any other options can be emotionally straining as well.  They are already dealing with physical ailments, they do not need another burden in the form of costly medications to add stress. The NP needs to be loyal and truthful to his/her patient and make sure all options are presented and allow them to be part of the process.  Admitting that a prescription was written perhaps too hastily should be done as soon as possible so other options can be explored if need be. The pharmacist has no ethical implications in this situation as they probably do not know the patient as well and most likely have no idea of their financial struggles unless it was directly mentioned.  They probably assume the provider has made the best decision for this particular case and are simply fulfilling their role of the filling and delivery of the drug. The patient and their family are not bound to any ethics other than in a personal case in this situation and could be free to change providers, ask for a second opinion, or simply stop the medication that was prescribed at any time.  This situation is mainly ethical in nature and legal implications are most likely not going to occur as long the medication was prescribed correctly and no major adverse effects are experienced.   

Strategies 

While cost would not be the first factor you would consider before writing a prescription (I would consider allergies and contraindications first and foremost), it is very important if you know the drug comes with a large price tag.  “The selection of treatment options must include consideration of the cost, because if patients cannot afford the treatment, they will not follow the plan” (Arcangelo, Peterson Wilbur, & Reinhold, 2017, p.1301).  A prescriber cannot assume that what may be ‘affordable’ is in fact practical for each patient without asking.  Managed care organizations (MCO’s) use formalities to keep the cost of most medications down (Arcangelo, Peterson Wilbur, & Reinhold, 2017).  Programs such as generic substitutions therapeutic interchange, prior authorization, step therapy, medical necessity and dispensing limitations are some examples (Arcangelo, Peterson Wilbur, & Reinhold, 2017).  While a brand name medication could be medically necessary that is most likely not the case for this scenario.    

As a provider, I will familiarize myself with low cost options, such as the $4 list from Walmart, that can be used for most common prescriptions.  When I am prescribing a drug that is unfamiliar, I will remember to consider that cost is a very relevant factor in compliance and discuss anything that could be considered even remotely expensive with the patient prior to writing a prescription.  Being financially transparent is part of providing patient centered care.  I will also ensure that I discuss financial concerns with each and every patient, regardless of their physical appearance and put aside any stereotypes that I may have had in the past.  Since the drug has already been prescribed in this situation, I would want to contact this individual myself and suggest they come in for a checkup.  If the individual is unable to schedule another appointment it might be worth having a conversation over the phone to address.  I would also want to ensure I had done my research prior to seeing and speaking with the patient to explore all options to ensure the new prescription would be as successful, present the same or lesser risk of adverse effects and was more affordable.   

In a study conducted by Kang, Lobo, Kim and Sohn (2018), found that 16.5% of individuals with diabetes reports noncompliance with a prescribed medication regimen because of costs.  Indvidual’s without diabetes only reported a 9.9% noncompliance due to costs (Kang, Lobo, Kim and Sohn, 2018).  Going forward this is an alarming statistic to remember because diabetics will make up a large percentage of my patient population.  These individuals also often have other comorbidities that need to be considered when estimating their medication costs as well.    

 

 

 

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html 

 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).   

Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.  

Gupta, R., Tsay, C., and Fogerty, R.L. (2015, November). Promoting Cost Transparency to   

Reduce Financial Harm to Patients. AMA Journal of Ethics, 17(11), 1073-1078.   

Doi:10.1001/journalofethics.2015.17.11.mhst1-1511.   

Kang, H., Lobo, J.M., Kim, S., Sohn, M. (2018, September). Cost-Related Mediation Non-  

Adherence among U.S. Adults with Diabetes. Diabetes Research and Clinical Practice, 143, 24-33. https://doi.org/10.1016/j.diabres.2018.06.016 

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3 months ago  

Lindsay Ramirez  

Week 2 Discussion – Initial Post  

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NURS 6521 

Week 2 

Ethical and Legal Aspects of Prescribing 

            Medication errors continue to happen in all types of patient care areas despite safety measures, protocols, and best intentions.  As a nursing student, one of the first things we are taught are the five rights to medication administration; right patient, right medication, right route, right dose, and right time.  This seems quite simple and straightforward, yet I have seen multiple medication errors from nurses, physicians, mid-level providers, and pharmacists.  Several factors are involved in safe medication prescribing.  This includes the process of determining the proper prescription for the patient, writing prescriptions to avoid errors, prescribing medications in an ethical and legal manner, and disclosing medication or prescribing errors despite the legal implications.   

Scenario 2 

            The scenario I chose for this discussion is scenario 2 involving a friend calling and asking me to prescribe a medication for her.  In this scenario, I do not know her medical history, but I write the prescription anyway.  I chose this scenario because I have already run into this with friends and family who ask, “so will you be able to write us prescriptions when you are a nurse practitioner?”.  This is a situation that even though we may possess the ability and power to do this, it doesn’t mean it is safe, legal, or ethical.   

            Since I have chosen to write the prescription for my friend I would have to determine what medication is appropriate for her based on her symptoms and presumed condition and consider an appropriate dose, potential side effects, drug allergies, and possible drug interactions (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 11).  I would also need to consider the age of my friend and any other medical problems such as kidney, liver, or cardiac issues that may affect the pharmacokinetics and pharmacodynamics of this medication.  For example, if my friend wanted a prescription for ondansetron (Zofran) for the indication of nausea and vomiting, I would ask her what her symptoms are, what medications she is taking currently, if she has any drug allergies, and consider potential contraindications such as liver disease, long QT syndrome, or phenylketonuria (PKU) (drugs.com, 2018). I would provide my friend with education about the medication, potential side effects such as confusion, dizziness, fast heartbeat, fever, headache, shortness of breath, and weakness (drugs.com, 2018).  I would also stress the importance of following the directions as written, and adherence to the prescription regimen.   

Ethical and Legal Implications of the Scenario 

Ethical and legal implications may exist for me as the prescriber as this is not a patient that I currently have a documented provider-patient relationship with.  One major concern in this scenario is that I do not know the medical history of this person.  I do not have access to her medical chart to know if she has any allergies, other medications or supplements she may be on, or what current or previous medical problems she has that may be affected by prescribing certain medications.  “Before prescribing therapy, the practitioner has a responsibility to gather data by taking a thorough history and performing a physical examination” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 7).  Considering ethical and practical issues “one overriding issue may be the lack of a clinical indication for using a medication” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 7).  I would want to ensure that my friend truly needed this medication and that she would be using it herself, for the intended purpose.   

“To be accountable, nurses follow a code of ethical conduct that includes moral principles such as fidelity, loyalty, veracity, beneficence, and respect for the dignity, worth, and self-determination of patients, as well as adhering to the scope and standards of nursing practice” (American Nurses Association, 2001).  Ethical principles of nursing include beneficence of doing good, and non-maleficence to do no harm (Marquis & Huston, 2017, p. 88).  I may be compromising the well-being of this person by prescribing a medication that may not do her any good or may potentially cause harm.   

In terms of legal implications, “problems with prescribing medications could negatively impact an NP’s professional license, with punishment decisions made by the Boards of Registered Nursing (or medical boards in some states) ranging from an administrative penalty and decree of censure to probation, suspension, or revocation of license” (Balestra, 2013, p. 18).  This article also states that disciplinary action in one state will affect an NP’s license in another, and additionally, civil and criminal problems could result (Balestra, 2013, p. 18).  This article lists three high-risk prescription areas for nurse practitioners involving opioids and other controlled substances, psychiatric medications, and prescribing for family and friends.  Depending on the state, the Board of Registered Nursing could require that a nurse practitioner has a documented medical history and physical exam before any medication can be prescribed (Balestra, 2013, p. 19).  This article also states that at the Federal level, laws for written prescriptions are limited to controlled substances and require that a prescriber has a patient-physician relationship with written record of it (Balestra, 2013, p. 19).  I am currently a registered nurse in Minnesota, and this is where I plan to practice as an advanced nurse practitioner.  Based on this scenario, I do not know what type of medication this friend is asking me to prescribe to her.  According to Minnesota statute 151.37, a prescription drug order for certain medications is not valid unless it can be established that this prescription was based on a documented patient evaluation, including an examination that was adequate to determine a diagnosis (Minnesota Statutes, 2018).  This includes controlled substances, muscle relaxants, centrally acting analgesics, drugs containing butalbital, and phosphodiesterase type 5 inhibitors (Minnesota Statutes, 2018).  In the state of Minnesota, nurse practitioners have full independent prescriptive authority.  “Full practice authority has no requirements for mandatory physician collaboration or supervision” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 8).  

The pharmacist processing and dispensing this prescription is an unknowing stakeholder in this scenario, although pharmacists are subject to legal and ethical principles of prescription monitoring and dispensing.  Pharmacists may act as a “medical gatekeeper” in that they trust the provider to appropriately diagnose and prescribe medications, but they also monitor the provider by identifying potential errors and drug interactions (Chiarello, 2013, p. 322).  The pharmacist would act as a “legal gatekeeper” if they would identify this client passing a fraudulent and altered prescription, purchasing a prescription to make illegal drugs, using intravenous drugs, or diverting drugs for illegal use (Chiarello, 2013, p. 322).  If the pharmacist filling this prescription receives a prescription written by me, the pharmacist would determine that this is a legitimate prescription and ensure that the prescription includes the patient information, my prescriber information including my signature, NPI number, and DEA number, the name of the medication, dose, route, quantity, and administration instructions. The pharmacist should check for any medication allergies for the patient as well as drug interactions with any other current medications that this patient is actively taking.  In this case, I assume the pharmacist does not know that I have written this prescription for a friend.  I do not believe that the pharmacist could be held responsible for any adverse outcome if they have received a legitimate prescription from a licensed provider for this patient.  

The patient absorbs legal and ethical responsibilities as well if she accepts and fills a prescription that she has asked for, that was not prescribed by her doctor.  This is the choice of my friend and I would consider the ethical principle of autonomy. Autonomy is the freedom of choice or accepting the responsibility for one’s choice and the right to self-determination (Marquis & Huston, 2017, p. 87).  Another concern with writing this prescription is that the patient or her family may seek legal action against me if there is an adverse outcome as a result of her taking this medication.  

Two Strategies to Guide Decision-making 

One strategy I would use to guide my decision-making in an ethical and legal manner would be to become familiar with and adhere to the Nurse Practice Act in the state of Minnesota and be familiar with the advanced practice registered nurse (APRN) practice standards for my state.  I would refer to the Board of Registered Nursing and familiarize myself with the scope of practice laws for Minnesota.  I would also use the nursing Code of Ethics to ensure that I am adhering to the provisions of care.  Another strategy I would take in guiding my decision-making would be to determine whether or not writing this prescription is medically necessary.  I would determine if my friend needs this prescription urgently or if she has access to her primary care provider to address her issue. I would recommend emergency care for my friend if needed, otherwise refer her to her doctor or urgent care if I felt that writing this prescription for her was unethical or illegal.  I would explain to my friend that I am legally responsible for safe prescribing practices and do not want to compromise my license if something were to go wrong.   

References 

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from https://www.nursingworld.org/coe-view-only 

Arcangelo, V.P., Peterson, A.M., Wilbur, V., & Reinhold, J.A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach(4thed.). Ambler, PA: Lippincott Williams & Wilkins. 

Balestra, M. L. (2013). Minimizing legal risks when prescribing. The Nurse Practitioner, 38(8), 18-20. doi:10.1097/01.npr.0000431184.17924.52 

Chiarello, E. (2013). How organizational context affects bioethical decision-making: Pharmacists management of gatekeeping processes in retail and hospital settings. Social Science & Medicine, 98, 319-329. doi:10.1016/j.socscimed.2012.11.041 

Drugs.com. (2012). Retrieved December 4, 2018, from https://www.drugs.com/ondansetron.html 

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Lippincott Williams & Wilkins. 

Minnesota Statutes. (2018). Retrieved December 4, 2018, from https://www.revisor.mn.gov/ 

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Week 2 Discussion: Ethical and Legal Implications of Prescribing Drugs  

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Ethical and Legal Implications of Prescribing Drugs  

Kaitlan Middlemas 

Nurs 6521: Advanced Pharmacology 

Walden University 

December 3, 18 

Scenario 

The scenario that I chose for this discussion was scenario 4. In scenario 4 I read a journal article on pharmacoeconomics. I thought of a couple of patients who mentioned their financial difficulties. I wondered if the expensive drugs that I have prescribed are managing their conditions and improving their quality of life. 

Ethical and legal implications 

One issue when it comes to prescribing medications that a patient can’t afford may be that there is a lack of clinical indication for using a medication (Arcangelo et al., 2017). Patients may be prescribed medications that may not be needed or may be prescribed a brand name medication instead of a generic medication that could cost them a lot less. Patients have to pay for medications that aren’t covered through their insurance because of their medical providers best judgment. Providers may enhance or alter the patient’s diagnosis to make sure that the medication is covered by insurance. “Aside from the legality of proffering potentially fraudulent statements to obtain prescription coverage, there are important ethical issues such as the morality and ethics of lying for a patient, breach of trust and contract with the insurer, the professional integrity of the involved physician, and the potential impact of this likely fraudulent behavior on the health-care system as a whole” (Weston et al., 2016). 

If a specific treatment isn’t covered by the patients insurance, the patient has to make a decision to pay high out-of-pocket costs to proceed with their treatment, delay their treatment, or abandon treatment altogether (Weston et al., 2016). “Much of the attention has been about high-priced branded drugs entering the market. Most people can’t afford them, and so it’s limiting access to very important drugs” (Anderson, 2017). 

“A study in the US confirmed that realization of pharmacist’s role in providing drug information results in lowering the cost of treatment” (Salari, et al., 2013). Patient consultation is one of the most important ethical issues in pharmacy practice to help better treat patients with lower costs. Counseling patients takes time and it may not be possible (Salari et al., 2013). 

Two Strategies 

One strategy that I would use to guide my decision making in this scenario would be to call the patient and make an appointment to sit down and visit with them. During this appointment I would talk to them about the costs of their medications. I would talk to them about whether they are able to afford these medications or if they are unable to afford them and therefore aren’t taking the medications. I would discuss with them a reasonable amount of money that they are willing to spend on their medications each month. By talking with my patients, I would be able to determine which medications would be best for these patients. 

A second strategy that I would use to guide my decision making in this scenario would be to look at the generic medications versus the brand name medications that these patients are taking. Take the medication lists from these patients and determine if brand name medications could be changed to generic medications. Changing medications could decrease the amount of money these patients spend monthly. 

Reference: 

Anderson, G. (2017). Examining the rising costs of prescription drugs in the U.S., and possible alternatives. Retrieved from https://hub.jhu.edu/2017/04/03/drug-pricing-health-policy-expert-gerard-anderson/ 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Salari, P., Namazi, H., Abdollahi, M., Khansari, F., Nikfar, S., Larijani, B., & Araminia, B. (2013). Code of ethics for the national pharmaceutical system: Codifying and compilation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810583/ 

Weston, G., Rothe, M., Kels, B., & Grant-Kels, J. (2016). The good, the bad, and the ugly of medication coverage: Is altering a diagnosis to ensure medication coverage ethical? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412101/ 

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