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The Ethics and Legalities of Medication Error Disclosure

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Human activity is not without errors. However, the instinctual human reaction to mishaps is to avoid the adverse consequences of those errors. In the healthcare scenario, medical errors could mean the difference between life and death for a patient. In a bid to avoid consequences,  a care giver may choose to conceal  errors or completely misrepresent facts about those errors. This paper explains the ethical and legal implications of disclosure or nondisclosure of medical errors. The paper also discusses actions that would be taken in a given scenario of an inadvertent medical error. The paper then concludes by describing the process of writing prescriptions and how to avoid or minimize medical errors in that process.

Ethical and legal implications of disclosure and nondisclosure

Disclosure of medical errors is a requirement of law and policies governing healthcare practices. Nondisclosure can lead to financial losses in lawsuits and claims by patients or their relatives who suffer from the resultant adverse effects (Guilod, 2013). It can also lead to the withdrawal of practice license for individual practitioners or facility. In worse case scenarios, non-disclosure could lead to prosecution in a court of law. Nurses need to understand the laws, ethics, and ramifications of disclosure and nondisclosure. This explains why in the State of Texas, it is a requirement that all nurses have a license and complete a two-hour periodical training on nursing jurisprudence and nursing ethics (Arnold, 2011). This legislation is part of the State Nursing Practice Act which is established by the Board of Nursing (BON). The BON sets specific rules that nurses must follow. The overall spirit of these rules is that nurses must protect the rights of patients. 

By disclosing medical errors, facilities will be complying with the law. They would also be holding themselves to high ethical standards which are good for business. Good ethical practices result in a good reputation. Timely disclosure can enable the hospital to take immediate pre-emptive actions against adverse effects, thus saving the life of a patient. The principle of beneficence in the practice of medicine states that one should not do harm to self and to others in the process of care (Ghazal, Saleem & Amlani, 2014). Nondisclosure would amount to harm to patients. Even if the medical error does not predict severe adverse effects, nondisclosure amounts to a betrayal of the patient’s trust in the healthcare profession and facility. From an ethical standpoint, the disclosure of medical errors is also the right thing to do for medical practitioners. It is in keeping with the American Nurses Association (2015) code of ethics. In Provision 9 of the code, for instance, ANA (2015) states: “The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.” One way to realize the spirit of this provision is through full disclosure of medical errors. 

Advanced practice nurse disclosure scenario

A nurse practitioner would never commit a medical error deliberately. Nevertheless, inadvertent prescription errors could occur due to the pressures that nurse practitioners experience as they handle a large number of prescription orders in a single day (Crigger & Holcomb, 2008). In the scenario, I would admit the error first to the patient and to the nurse manager. I would then go ahead to try and minimize the outcomes even as I try to fix the root cause of the error. In its code of ethics, the ANA (2015) provides eight key points by which nurses must live and work. Provision 2 of the ANA code states “The nurses’ primary commitment is to the patient” and Provision 3 states, “The nurse promotes, advocates for and protects the right, health, and safety of the patient.” These two provisions underscore the fact that the patient’s rights come first. Among these rights, the patient has the right to know everything that affects them and their health. As such, the rationale for disclosing a medical error has its basis on the recognition of patient rights. The ANA (2015) code of ethics also touches on other aspects of nurses’ integrity, responsibility, duty, professionalism and commitment to nursing values and social justice. These codes reinforce the importance of disclosing the prescription error, especially to the patient. 

Writing prescriptions

Prescription of drugs follows a clear set of steps that nurse practitioners know full well. Crigger and Holcomb (2008) discuss what they call rational prescribing, which is not a new term in pharmacology. It refers to the application of evidence-based practices in the process of prescribing medicines. In other words, all prescriptions must follow well-documented evidence of the drug use and the presenting characteristics of the illness in question. Arcangelo and Peterson (2013) discuss the major factors to consider in the process of prescription. Abiding by factors will limit or eliminate potential medical errors during the prescription process. They argue that the writing of a prescription begins with ascertainment of the need for the specific drug in the treatment of the condition that the patient presents. The next step is to consider if that particular drug is the best for that particular problem. There are different drugs for the same condition; the progression of the illness, patient characteristics and availability of the drug could inform a practitioner’s choice to administer one drug over the other. Therefore, the next factors to consider in the prescription process are the patient characteristics. Certain patients may be allergic to some chemical content of the drug. The nurse practitioner must always check for contraindications and confirm if the patient has corresponding allergies. Next, the nurse practitioner needs to document any other medications that the patient may be using currently. Such information will help to determine whether or not the new drug would be compatible with the existing one in the patient’s body system. The nurse should also consider the best possible method of administration of the drug.

Moreover, the duration of treatment will determine the number of drugs to issue. Next, there is the factor of the cost of the drug to consider. Another important factor to consider is the patient’s behavior. Some drugs or dosage may interfere with certain routine behaviors of a patient. Patients need to have this information so that they can make adjustments to their lifestyle accordingly. It is also important for the nurse to reinforce instructions for the patient. For instance, patients need to abide by the dosage. They also need to know that sharing of drugs is illegal and could result in adverse effects. Lastly, patients should understand the importance of a proper storage of drugs within the optimal weather conditions indicated on the container.

Conclusion

This paper has taken the position that disclosure of medical errors is better than nondisclosure. In any healthcare organization, the many businesses of the day can lead to practitioner’s fatigue leading to a reduction in efficiency and even medical errors. Healthcare professionals are not perfect, and it is important that they recognize this fact. Acknowledging errors when they occur is, in fact, a show of commitment to professional values. It is also a sure way to guarantee patient rights. By adopting a culture of disclosure, hospitals will also avoid the huge financial and image implications they would incur litigating lawsuits owing to negligence or nondisclosure.

 

 

References

American Nurses Association (2015). Code of ethics with interpretative statements. Silver Spring, MD: ANA. Retrieved February 23, 2018, from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-ofEthics-For-Nurses.htm

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

Arnold, K. (2011). Texas Nursing Jurisprudence and Ethics. KLA Education Services LLC.

Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120-125.

Ghazal L, Saleem Z, Amlani G (2014) A Medical Error: To Disclose or Not to Disclose. J Clin Res Bioeth., 5, 174.

Guilod, O. (2013). Medical Error Disclosure and Patient Safety: Legal Aspects. J Public Health Res., 2(3), e31.

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