Running head: MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES Medication errors disclosure and ethics /legalities
Sharon Williams
Walden University
Advanced Pharmacology
Nurs 6521 N-1
Dr. Anay Mosus
June 10, 2016 1 MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES 2 Medication errors disclosure and ethics /legalities
Medication errors occur when health care workers inappropriately prescribed, dispensed, or
administered drugs. Medication errors are a multifaceted problem which may arise in any health
care setting. According to Arcangelo and Peterson (2013), many outpatient prescriptions have
mistakes that can be prevented. The purpose of this paper is to explain the ethical and legal
implications of medication errors disclosure and nondisclosure; specific state laws and different
strategies used to minimize medication errors
Ethical and Legal Implications of Disclosure / Nondisclosure
As healthcare providers, we are obligated to protect our patients from harm and not reporting
a medication error is illegal unethical and harmful to the patient. Sometimes clinicians are afraid
to report errors for fear of losing their jobs, reputation, and licenses. However, disclosing errors
can prevent an adverse outcome for the patient. According to the code of ethics found in the
American Nurses Association (2015), clinicians must report all medication errors to the proper
authority to ensure patients safety and quality of care. Healthcare providers must maintain an
open, honest working relationship with their patients. That may include disclosing medication
errors. It is our duty to uphold honesty with our clients regardless of the consequence (Ehsani et
al., 2013). Our patients may have confidence in us if we are honest and attempt to repair the
problem. Nondisclosure can cause great harm to a patient and can lead to complete lack of trust
in the provider. Disclosure of error is not only illegal but unethical and unprofessional. When an
error occurs, patients and family need to know (Brandom, Callahan & Micalizzi,2011)
Federal and State about Disclosure MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES 3 Disclosure is informing the patient and or family that a mistake or error has occurred and
explaining the situation. Some states have disclosure laws while others have apology laws. The
state of Texas has an apology law which is an expression of sympathy (Mastroianni, Mello,
Sommer, Hardy, Gallagher, 2010). Full apology includes acceptance of responsibility providing
an explanation and making amends. Admission of guilt can lead to malpractice lawsuit and some
states give health care workers legal protections when they apologized to patients for medical
mistakes. The U.S Department of Health and Human Services (HHS) sponsored pilot studies
which introduced medical liability reforms including programs that provide for disclosure and
apology as well as offers for compensation (Mastroianni, Mello, Sommer, Hardy, Gallagher,
2010). Practitioners must prescribe according to federal law, and the state guidelines, that makes
is challenging for advanced practice register nurses (Arcangelo & Peterson, 2013). The Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001 institutes the first
national requirement for patient’s adverse events disclosure which instruct clinicans to inform
patients about unexpected outcome (Brown, Lehman, Truog, Browning & Gallagher, 2012.
My Reaction to the Scenario
In this scenario, the advanced practice nurse (APRN) made an error when prescribing a
drug to a patient and therefore is responsible for reporting this mistake immediately to avoid
further negative impact. A prescription is a legal document that communicates from the
prescriber to the pharmacy (Arcangelo & Peterson, 2013). APRNs may face consequences of
mistrust, civil and criminal charges as well as license revocation after a medication error
(Wittich, Burkle, & Lanier, 2014). I will inform my patient about the medication error. According
to Wittich, Burkle, & Lanier (2014), keeping a healthy relationship and promote trust with
clients, will encourage clinician and patient to have a healthy relationship post medication errors. MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES 4 It would be difficult, but I will meet with my patient and immediate family to inform them of the
error, apologize and make amends.
Strategies to Minimize Medication Errors and prescription writing
Medication errors, occur in the U.S occur frequently. The Institute for Safe Medication
Practices (2012), issues a list of abbreviations that can lead to the misinterpretation of
prescriptions and therefore leads to medication error. I will utilize this list to prevent
prescription writing mistakes. Drug checking software reduces medication errors by
checking the drug dose, allergies and other medications the patient is currently taking
(Arcangelo & Peterson, 2013). Electronic health record (EHR) can prevent medication errors
and enhance patient safety, especially in pediatric patients by automatically calculate the
weight based dosage. Arcangelo and Peterson (2013) , emphasized the importance of taking a
thorough history and performing a physical examination before prescribing medication to
anyone. Health history may include current medications, height and weight (pediatric
patients) and known allergies. The risk for medication errors decreases when clinicians
follow the rules of prescribing medications.
Summary
Medication error is a serious problem in the U.S and clinician must exercise caution
when prescribing, making sure they follow all the laws about prescribing in their states. As
APRNs, we have an ethical, professional and legal obligation to protect our patients from
preventable harm. Our patients trust us and expect us to protect them from harm. We must do
all that lies in our power to maintain that confidence and keep our patients safe from
unnecessary harm. MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES 5 References
American Nurses Association. (2001). Code of ethics for nurses with interpretive
statements. Nursing World. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Code of
EthicsforNurses/Code-of-Ethics-For-Nurses.html
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced
practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Brandom, B. W., Callahan, P., & Micalizzi, D. A. (2011). What happens when things go wrong?.
Pediatric Anesthesia, 21(7), 730-736.
Brown, S. D., Lehman, C. D., Truog, R. D., Browning, D. M., & Gallagher, T. H. (2012).
Stepping out further from the shadows: disclosure of harmful radiologic errors to patients.
Radiology, 262(2), 381-386.
Ehsani, S. R., Cheraghi, M. A., Nejati, A., Salari, A., Esmaeilpoor, A. H., & Nejad, E. M.
(2013). Medication errors of nurses in the emergency department. J Med Ethics Hist Med,
24(6), 11.
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
Mastroianni, A. C., Mello, M. M., Sommer, S., Hardy, M., & Gallagher, T. H. (2010). The flaws
in state ‘apology’and ‘disclosure’laws dilute their intended impact on malpractice MEDICATION ERRORS DISCLOSURE AND ETHICS /LEGALITIES
suits. Health Affairs, 29(9), 1611-1619. Wittich, C. M., Burkle, C. M., &Lanier, W. L. (2014). Medication errors: an overview for
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