Ethical and Legal Implications of Prescribing Drugs

Ethical and Legal Implications of Prescribing Drugs

Introduction

Advanced Practice Registered Nurse (APRN) are Registered nurses with obtained further education and specialization. They play a vital role in the healthcare system; with prescription authority, they can assess, diagnose, treat, and manage patients’ conditions. Like many other healthcare professions, this level of responsibility comes with its legal and ethical standards of practice that must be upheld by every licensed APRN. The legal standards and code of ethics for APRNs may vary from state to state. However, they are all in place to ensure the safety of patients and APRNs. Providing care and prescribing medications may sometimes have some conflicting legal and ethical implications. Therefore, APRNs need to know the state and federal regulations governing all aspects of their practice and specialty (American Association of Nurse Practitioners, 2015). This paper aims to discuss the ethical and legal implications of an APRN prescribing narcotics for a family member who is not a patient; the paper will also discuss the process of writing prescriptions and strategies to minimize medication errors.

Ethical and Legal Implications of an APRN Prescribing Narcotics for a Family Member

APRNs in the united states have been granted various prescriptive authority levels for medications, procedures, and services. APRNs need to understand the prescriptive authority in their state and federal and state legal and ethical guidelines. Prescribing medication like most healthcare services provided by healthcare professionals first requires an assessment, a review of patients’ history, diagnosis, education, and follow up (American Association of Nurse Practitioners, 2015); this guideline is in line with the nursing ethical responsibility to do no harm (ANA, n.d.).

Many state laws prohibit or restrict the prescription of medication or provision of medical services to family members for safety purposes and to avoid legal and ethical dilemmas, (Conde, 2017). For example, Texas does not prohibit treating family members if a medical record with appropriate assessment and diagnosis is maintained; however, prescription of controlled substances to self, family members, or friends is prohibited unless in the case of emergency (Conde, 2017). The legal implication in this scenario could be the APRN breaking the state law. Ethical implications implied in this scenario could be responsive to the APRN’s duty to do no harm, which may have prompted a narcotic prescription if this was a case of emergency. It could also be a violation of the duty to do no harm if the APRNs are supporting her spouse’s case of substance abuse by prescribing narcotics to them. However, this case scenario will need to be further reviewed to determine whether this was done in good faith.

Strategies to Address Disclosure and Nondisclosure of Medication Error

A medication error can occur from the point of prescription to the point of administration; for APRNs, the risk of medication error is substantial when prescribing. Medication errors are capable of causing serious harm to patients, including death; hence, state and federal laws are put in place to help protect patients against such errors. It is the APRN’s responsibility and any healthcare professional who witnesses a mishap to report when errors or abuse occurs. (Westrick & Jacob, 2016). Making the decision for disclosure or nondisclosure of medication error can be challenging; however, understanding state and federal laws about reporting medication errors and the facility policy can make the process a little less daunting. Therefore, it is important for every APRN to be educated on state, federal, and institutional policies on medication errors and reporting them (Sorrell, 2017)

Medical errors can occur in healthcare at any point during treatment; one of such error includes medication error. When medical errors occur, it is important for patients affected to be informed; this can potentially prevent further errors from occurring and allow the patient to make decisions about their care moving forward. There is the possible legal implication for the spouse as a stakeholder in this scenario if there is a chance that the narcotics prescribed are being abused. According to section 74.106 of the Texas civil law, nondisclosure of medical error or potential harm to a patient is considered a violation of state laws in Texas that could lead to criminal charges for negligence and suspension revocation of license (Texas.gov, n.d.).

Two Strategies an Advanced Practice Nurse Would use to Guide Decision Making in this Scenario

Nurses and all healthcare professionals have a responsibility to do no harm, and patients have a right to full disclosure when receiving medical care; therefore, when a nurse witnesses potential harm to patients occurring, it is their responsibility to address the situation. APRNs must be diligent in making controversial decisions about ethical dilemmas; patient safety must be of the utmost importance when making this decision (Rosenthal & Burchum, 2018). In this scenario, as a nurse witnessing another APRN prescribing medications for a spouse who is not a patient, the first strategy would be to consult with the organizational policy and follow the guidelines for reporting the incident. Another strategy would be to address the said APRN in a professional manner to gather more details and determine if a legal or ethical code is being violated.

Process of Writing Prescriptions

The process of writing a prescription is complex and sensitive due to the potential for life-threatening errors; therefore, every provider, including the APRN, must be familiarized with this process. There are important things that must be included in a prescription, whether electronic or written, although they may differ with state and organizational policies, certain elements are standard and should be included in all prescriptions; these include the provider’s name and information (including signature and DEA/NPI number), the patient’s name and a second identifier (for example, date of birth), drug name, drug strength, route, and frequency (Rosenthal & Burchum, 2018)

Strategies to Minimize Medication Errors

Prescription writing is an important aspect of managing a patient’s care, errors made when writing prescriptions can cause harm, including death to patients (Dyasanoor & Urooge, 2016). Therefore, APRNs and organizations must pay special attention and continually strive to improve the process of writing a prescription. The use of EMAR has been instrumental in improving the process of writing prescriptions and preventing medication errors. The use of EMAR decreases the chances of misinterpreting some elements of a written prescription. For example, an abbreviation or illegible word on a written order has the potential to cause a medication error, whereas, on an EMAR, the probability to misinterpret an abbreviation is greatly decreased.

Another strategy to help prevent medication errors from prescription writing is avoiding the use of verbal orders (American Academy of Ophthalmology, 2015). Verbal orders have the potential to cause medication errors due to being misinterpreted. Another strategy is to utilize a double verification system for prescribed medication before administering it. For example, the pharmacy. Healthcare organizations need to ensure staff are educated and feel comfortable reporting errors to prevent future recurrences; this can be done by providing a safe and non-judgmental environment to promote reporting (Moffatt-Bruce et al., 2016).

 

Conclusion

Providing medical services, including medication prescription, has the potential to cause harm. Therefore, APRNs with prescriptive authority need to know state laws, federal laws, and ethical guidelines that govern the prescription of medications. In addition to ethical guidelines and state laws, APRNs need to follow organizational policies and evidence-based guidelines when prescribing medications to avoid medical errors.

 

References

American Academy of Ophthalmology. (2015). Minimizing Medication Errors: Communication about Drug Orders – 2015. https://www.aao.org/patient-safety-statement/minimizing-medication-errors-communication-about-d#top

American Association of Nurse Practitioners. (2015). Standards of practice for nurse practitioners. Retrieved from https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners

ANA. (n.d.). Ethics and Human Rights. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics

Conde, C. (2017). Treating your own. Retrieved from https://www.texmed.org/template.aspx?id=22563

Dyasanoor & Urooge (2016). Insight into the quality of prescription writing – An Institutional study. Journal of Clinical and Diagnostic Research: 10(3) ZC16-ZC64. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843389/

Moffatt-Bruce, S. D., Ferdinand, F. D., & Fann, J. I. (2016). Patient Safety: Disclosure of Medical Errors and Risk Mitigation. https://www.sts.org/sites/default/files/documents/patient_safety/DisclosureofMedicalErrors.pdf

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St Louis, MO: Elsevier.

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

Texas.gov. (n.d.). Civil practice and remedies code. https://statutes.capitol.texas.gov/Docs/CP/htm/CP.74.htm#74.104

Westrick, S. J., & Jacob, N. (2016). Disclosure of Errors and Apology: Law and Ethics. The Journal for Nurse Practitioners, 12(2), 120-126. https://doi.org/10.1016/j.nurpra.2015.10.007

Assignment: 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? 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.

Photo Credit: Getty Images/Caiaimage

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.

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). All papers submitted must use this formatting.

Excellent Good Fair Poor
Explain 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.
23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

20 (20%) – 22 (22%)
The response explains the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

18 (18%) – 19 (19%)
The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved.

The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

(0%) – 17 (17%)
The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing.

The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.

Describe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state.
18 (18%) – 20 (20%)
An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes specific, detailed, and accurate reference to state laws related to the scenario.

16 (16%) – 17 (17%)
An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes accurate reference to state laws related to the scenario.

14 (14%) – 15 (15%)
A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes inaccurate or vague reference to state laws related to the scenario.

(0%) – 13 (13%)
A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing.

The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.

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.
18 (18%) – 20 (20%)
The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.

16 (16%) – 17 (17%)
The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.

14 (14%) – 15 (15%)
The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy.

The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.

(0%) – 13 (13%)
The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing.

The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.

Explain the process of writing prescriptions including strategies to minimize medication errors.
18 (18%) – 20 (20%)
The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.
16 (16%) – 17 (17%)
The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.
14 (14%) – 15 (15%)
The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.
(0%) – 13 (13%)
The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
(5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
(4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
(5%) – 5 (5%)
Uses correct APA format with no errors
(4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
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