Ethical and Legal Implications in Drug Prescription
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February 05, 2021
Ethical and Legal Implications in Drug Prescription
Medical errors are a common occurrence in health facilities globally. It is reported that medical errors are the second leading cause of death in the US, with an estimate of between 100,000 and 200 000 deaths annually (Tawfik et al., 2018). Other studies have indicated that medical errors are the leading cause of patient readmission, increased adverse drug reaction, and increased care costs. Prescription errors, be it in the actual coding or decoding of the medicine, are critical contributors to medical errors. Different interventions have been put forth in quality improvement, and laws and policies are among them. Other reporting systems have been put in place to reduce medical errors in prescription incidences (Tsigengagel et al., 2020). However, with the plans, you still find that mistakes still occur. In such instances, care practitioners often face the dilemma of disclosing or not disclosing the occurrences to the patients or close family members with fear of the legal actions taken against them, e.g., withdrawal of their practice licenses (Gates et al., 2019).
In instances of medical errors, legal and ethical implications often entail three key stakeholders, i.e., the prescriber, pharmacists, the patients, and the close family members of the patient. The moral implication involves the failure to accept responsibility for the error, while the pharmacist’s ethical significance is not disclosing sufficient and necessary information to the patient. The patient has a legal obligation of reporting any case that appears peculiar or unintended to give room for corrections to minimize errors or chances of their occurrence in the future. After an error has occurred, legal implications now come into play. Legal implications involve reporting the case to a legal justice system or the health facility administration. Every stakeholder needs to be aware of the ethical and legal consequences of a medical error. In this paper, a case study will be utilized to review ethical and legal implications that may result from the stated incidence. The case study involves a prescription error of drugs to a child with the dosage standards. In the case scenario, the critical stakeholders implicated include the prescriber, the pharmacist, and the patient’s family/parents.
Ethical and Legal Implications of the Relevant Stakeholders
Ethically, the prescriber is implicated by not reviewing the prescription to notice that the prescription standards do not match those of pediatrics. Furthermore, the error is considered legally unjustified. During data entry of information to a system or manual recording, the doctors feed the child’s age, and physical examination gives room for reminding the prescriber that the patient is a child. The prescription error puts the child at greater risk of a drug overdose, adverse drug reactions, or even toxicity, and all these expose the child to a legal suit. On the other hand, on receiving the prescription, the pharmacist is ethically required to review the data and identify the errors, thus preventing the mistake’s compounding. A pharmacist is never considered a retail shop attendant since he/she needs to show interest in the patient receiving the treatment. This is always led by the pharmacist’s engagement with the patient by getting the patient’s demographic features before dispensing. In this scenario, the pharmacists are ethically wrong to ignore the patient’s information review and are also subjected to a lawsuit. Since the patient and family members lack the professional expertise to notice the error and highly trust the care professionals, they are less subject to legal implications. However, they are ethically required to report any unusual occurrence to the facility that they encounter as the child takes the drugs. Similarly, after knowing the errors, they have a choice of deciding to take legal action or not. In Georgia, the legal actions against medical malpractices have different dimensions. According to Goguen (2019), the law through the Board allows for the specific nurse practitioners to be sued by the plaintiffs in case of health effects or damages. The law only provides for a lawsuit in a case that is not more than five years old since the occurrence of the error. A case reported after the period is automatically nullified. Also, in a case where the medication causes effects more than five years after medication, the nurse practitioners are not answerable. According to the nursing laws in Georgia, a nurse should be reported to the Board if the effects of the errors caused cannot be remediated. Minor errors are not reported.
Ethical and Legal Implications in Drug Prescription
Disclosure and Nondisclosure in Prescription Errors
All care professionals and associations, e.g., the American Nursing Association, recognize medical errors in healthcare practice. Different states have different procedures for preventing and reporting medical errors as well as the required response channels. These channels help in the identification of frequency of the errors, punishing of the involved people, and identification of quack practitioners. The legal implications help increase practitioners’ attention to detail and minimize the medical deaths or overall care costs.
In medical practice, honesty and integrity are considered vital principles that govern information disclosure in incidences of medical errors (Kennedy et al., 2019). Therefore, the prescriber or pharmacist needs to disclose the information by filling a report as per the existent ethical principles once one identifies the error. In practice, codes of conduct require that the stakeholder reports the error and fast-tracks the patient to manage the error. Such an action can also result in a waiver of the penalty or punishment if a legal suit is filed against one of the stakeholders. According to Georgia’s law on disclosure, disclosing an error does not reflect professional incompetence or misconduct of the physician or the nurse practitioner and should not be in a presumption that medical malpractice has already occurred. This protects the nurse practitioners from being sued for disclosure.
Nondisclosure is legally and ethically wrong, and it might cost the wellbeing or life of the patient and even promote the occurrence of similar incidences in the future. Nondisclosure also increases the degree of punishment from the legal system once one is proven guilty and might even result in license withdrawal as well as long-term jail sentencing. As an APRN, I should disclose errors in medication or prescription levels in helping the patient to discontinue the use of the wrongly prescribed medications. Additionally, it is important to take responsibility for the mistakes and errors to help strategize and correct the errors for better delivery of services. In a health facility or environment where the APRNs avoid taking responsibility for the medication errors, the process of correcting and tracing the root-cause is paralyzed, and thus, more errors are likely to follow.
Strategies
Two main strategies can be implemented in the healthcare system to reduce the health risks associated with medical errors in hospitals and other healthcare institutions. One of the strategies that can be included to reduce medical errors is barcodes to get the right drug for the right patient. According to the FDA (2019), rules require the use of barcodes on particular drugs or biological products to verify the right drugs and dosage. With barcodes, the practitioners can cross-check the medications and doses before being delivered or administered to the patients. The tables or other dosage forms should have different and legible imprinted codes, designs, and labels for cross-verification before being administered. The code established by the nurse practitioner will be used by the pharmacists and thus avoiding the error of wrong medication.
In reducing medication errors, all stakeholders should be fully involved, including the nursing practitioners, physicians, pharmacists, patients, or caregivers. Physicians should explain to the patient the need, strength, effectiveness, interactions, and contraindications to reduce poor dosage or medication cases. The records of age, disease, and prescriptions should be shared with the pharmacists to verify the effectiveness and strength of the particular medication on the patient. In some cases, a pharmacist will have to confirm from the physician in case the dosage is not suitable or may be risky for the patient and thus reduce the risks of medical errors. The cross-verification through different stakeholders screens out any factor of medication errors.
Generally speaking, to avoid errors, there is a need for multidisciplinary collaborations of all the stakeholders, focusing on the patient’s demographics and laboratory reports. These variables help guide the drug choice, dosage forms, and the type of drugs to be given to the patient. Similarly, all care practitioners should accept faults and take full responsibility by ensuring the reduction of adverse events and filling the error reports. Primarily, all care professionals need to increase attention to detail with a focus on delivering quality care.
Ethical and Legal Implications in Drug Prescription
References
FDA. (2019, August 23). Working to Reduce Medication Errors. US Food and Drug Administration. https://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reduce-medication-errors
Gates, P. J., Baysari, M. T., Gazarian, M., Raban, M. Z., Meyerson, S., & Westbrook, J. I. (2019). Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug safety, 42(11), 1329–1342. https://doi.org/10.1007/s40264-019-00850-1
Goguen, D. J. D. (2019). Georgia Medical Malpractice Laws. No. https://www.nolo.com/legal-encyclopedia/georgia-medical-malpractice-laws.html
Kennedy, A. B., Moraska, A., & Rich, G. (2017). What Did I Do? Practitioner Awareness of Ethical Issues in Scientific Publishing. International journal of therapeutic massage & bodywork, 10(3), 1–3. https://doi.org/10.3822/ijtmb.v10i3.374
Tawfik, D. S., Profit, J., Morgenthaler, T. I., Satele, D. V., Sinsky, C. A., Dyrbye, L. N., Tutty, M. A., West, C. P., & Shanafelt, T. D. (2018). Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clinic Proceedings, 93(11), 1571–1580. https://doi.org/10.1016/j.mayocp.2018.05.014
Tsigengagel, O., Glushkova, N., Samarova, U., Begimbetova, G., & Khismetova, Z. (2020). Georgian medical news, (308), 155–160.
Ethical and Legal Implications in Drug Prescription
Question
Scenario – 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.