Ethical and Legal Implications of Prescribing Drugs
Introduction
Advanced Practice Registered Nurses (APRNs) are RNs who have gotten more training and specialized in a certain area. They are very important to the health care system because they can diagnose, treat, and manage patients’ conditions. As with many other health care jobs, this level of responsibility comes with its own set of legal and moral rules that every licensed APRN must follow. The law and code of ethics for APRNs may be different from one state to the next. But they are all there to make sure that patients and APRNs are safe. When it comes to the law and ethics, giving care and writing prescriptions can sometimes go against each other. Because of this, APRNs need to know all of the state and federal rules that apply to their practice and specialty (American Association of Nurse Practitioners, 2015) What it means morally and legally to prescribe drugs. This paper will talk about the ethical and legal issues that come up when an APRN prescribes narcotics to a family member who is not a patient. It will also talk about how prescriptions are written and how to avoid making mistakes.
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What the ethical and legal consequences are for an APRN who prescribes drugs to a family member
In the United States, APRNs have been given different levels of prescribing power for medications, procedures, and services. APRNs need to know what their state’s and the federal government’s legal and ethical rules say about what they can and can’t do. As with most medical services, prescribing medication requires an assessment, a review of the patient’s history, a diagnosis, education, and follow-up (American Association of Nurse Practitioners, 2015). This rule is in line with the nursing ethical responsibility to do no harm (ANA, n.d.). What it means morally and legally to prescribe drugs
Many state laws make it illegal or hard to give medicine or medical care to family members. This is done for safety reasons and to avoid legal and moral problems (Conde, 2017). For example, Texas doesn’t make it illegal to treat family members as long as a medical record is kept with the right assessment and diagnosis. However, you can’t give yourself, family, or friends controlled substances unless it’s an emergency (Conde, 2017). In this case, the APRN might have broken state law, which would be a legal problem. The ethical implications of this situation could be related to the APRN’s duty to do no harm, which could have led to a prescription for a narcotic if this was an emergency. It could also be against the duty to do no harm if the APRNs are prescribing narcotics to her spouse to help with his or her drug use. But this case scenario will need to be looked at more closely to see if this was done honestly.
How to Deal with Medication Error Disclosure and Non-Disclosure
Medication errors can happen at any point between writing the prescription and giving the medicine. For APRNs, the risk of making a mistake when writing a prescription is high. Medication mistakes can cause patients to get sick or even die, so state and federal laws are in place to help protect patients from these kinds of mistakes. When mistakes or abuse happen, it is the job of the APRN and any other healthcare worker who sees it to report it. (2016) Westrick and Jacob. It can be hard to decide whether to tell people about a medication error or not. Knowing the state and federal laws about reporting medication errors and the facility’s policy can help make the process a little less scary. So, it’s important for every APRN to know about state, federal, and institution policies on medication mistakes and how to report them. (Sorrell, 2017)
A medication error is one type of medical error that can happen at any time during a medical treatment. When medical mistakes happen, it’s important for the people who were hurt to know about them. This could stop more mistakes from happening and give the patient more control over their care in the future. In this situation, if there is a chance that the narcotics being prescribed are being abused, the spouse could be in trouble with the law. Section 74.106 of the Texas civil law says that not telling a patient about a medical error or possible harm is against the law. This could lead to criminal charges for negligence and the suspension or revocation of a license (Texas.gov, n.d.).
Two ways an advanced practice nurse would use this information to help make a decision:
All health care workers, including nurses, have a duty to do no harm, and patients have a right to know everything about their care. When a nurse sees something that could hurt a patient, it is their job to fix the problem. APRNs must be careful when making tough decisions about ethical dilemmas. The safety of the patient must be the most important thing to consider (Rosenthal & Burchum, 2018). In this situation, if you are a nurse and you see another APRN writing a prescription for a spouse who is not a patient, your first step should be to check the organization’s policy and follow the rules for reporting the incident. Another option is to talk to the APRN in a professional way to get more information and figure out if a law or code of ethics is being broken.
How Prescriptions Are Written
Because mistakes can be life-threatening, the process of writing a prescription is complicated and sensitive. Every provider, including the APRN, needs to know how it works. There are important things that must be in a prescription, whether it’s written or electronic. These things may vary by state and organization, but there are some things that should be in every prescription. These include the provider’s name and information (including signature and DEA/NPI number), the patient’s name and a second identifier (such as date of birth), the drug name, drug strength, route, and frequency (Rosenthal & Burchum, 2018)
Ways to reduce medication mistakes
Writing prescriptions is an important part of taking care of a patient. However, mistakes in writing prescriptions can hurt or kill patients (Dyasanoor & Urooge, 2016). Because of this, APRNs and organizations must pay close attention to the process of writing a prescription and always try to make it better. The use of EMAR has helped improve the way prescriptions are written and cut down on medication mistakes. When EMAR is used, it is less likely that some parts of a written prescription will be misread. For example, an abbreviation or word that is hard to read on a written order could lead to a medication error. On the other hand, an abbreviation is much less likely to be misread on an EMAR.
Avoiding verbal orders is another way to help keep prescriptions from being written with mistakes (American Academy of Ophthalmology, 2015). If a verbal order is misunderstood, it could lead to a mistake with the medication. Before giving out prescribed medicine, you could also use a system that checks the prescription twice. Take the pharmacy as an example. Healthcare organizations need to make sure their employees know how to report mistakes and feel comfortable doing so. This can be done by creating a safe, non-judgmental environment that encourages reporting (Moffatt-Bruce et al., 2016).
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There is a chance that getting medical services or prescriptions could hurt someone. So, APRNs who can write prescriptions need to know the state laws, federal laws, and ethical rules about how to write prescriptions. When prescribing medications, APRNs need to follow not only ethical rules and state laws, but also organizational policies and guidelines based on evidence. This is to avoid medical mistakes.
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.
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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. Ethical and Legal Implications of Prescribing Drugs
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. Ethical and Legal Implications of Prescribing Drugs
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.
