Legal Profession Example Paper

You are working as an advanced practice nurse at a community health clinic. You unintentionally make an error when prescribing a drug to a patient. You do not think the patient knows that you made the error.

To prepare:

Consider the ethical implications of disclosure and nondisclosure.
Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
Consider what you would do as the advanced practice nurse in this scenario including whether you would disclose your error.
Review the Institute for Safe Medication Practices website. Consider the process of writing prescriptions, and think about strategies to avoid medication errors.
To complete:

Write a minimum 4-page paper in APA format (excluding cover page and references) that addresses the following:

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in this scenario including whether you would disclose your error. Provide evidence for your rationale.
Explain the process of writing prescriptions and include strategies to minimize medication errors.
Include four or more appropriate scholarly sources from the last five years throughout the paper.

Legal profession paper

Introduction

Nurses have a responsibility to address patients’ needs. This responsibility is fulfilled within legal, ethical, moral and practice standards. This is justified by the trust assigned to nursing personnel to provide the best possible medical care and the potential for harm. This statement is particularly true for prescription activities that have a high potential for harm when prescription errors occur that are either caused by the patient or nurse. Regardless of who causes the error, responsibility for the error must be assigned and more often than not, nursing personnel will share some of that responsibility that could include fines, sanctions and even criminal cases. Given the awareness that prescription errors could have a negative effect on the nurse in terms of career trajectory, loss of freedom (prison time) and financial losses (paying fines), most nurses question whether or not they should disclose the occurrence of medication errors and how much information they should disclose  (Arcangelo et al., 2017). The present paper presents a discussion on the implications of disclosure and nondisclosure, how to approach such scenarios, and how to reduce the risk of medication error.  Legal Profession Example Paper

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Discussion

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.

Nursing personnel have an ethical and legal responsibility to disclose health information to the patient. This is particularly true when the patient could be required to make a decision and the disclosure presents the information that facilitates decision-making. To be more precise, nursing regulatory bodies recognize the need for disclosure and present formal standards that direct nursing personnel on when to make open disclosures. These standards are implemented through the use of a code of conduct that is presented by the American Nurses Association with input from state bodies. In addition, health policy documents also help in the implementation of these standards. The implementation of these standards not only details disclosure requirements, but presents the implications for violating the standards to include being fined, and having a formal reprimand. The nurse could also lose the practice license, be deregistered and spend time in jail for the more severe cases that result in the patient’s death (Potter et al., 2018). Overall, it is evident that based on the existing practice standards, nursing personnel should make open disclosures to manage the existing legal risks as well as the ethical implications linked to addressing the patients’ primary interests. It is notable that while no statutory instructions existing to direct open disclosure, ethical arguments and common law judgment supports open disclosure, especially when listed as part of torts affecting professional practice and work contract terms. Although open disclosure is encouraged in nursing practice based on legal and ethical justifications, there are unique circumstances under which these justifications do not hold weight. These unique circumstances include variations in the apology laws, when the information is uncertain and could be erroneous, when the legal implications are far-reaching if an error is admitted during the disclosure, possibility of contract voiding by insurers, and inadequate education and training on how to make a disclosure. Still, it is important to note that barring the special circumstances mentioned, nursing personnel have an ethical and legal obligation to make an open disclosure to patients (Arcangelo et al., 2017).

Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.

As a nursing personnel who handles patients on a regular basis, I acknowledge the possibility of committing errors. In addition, I acknowledge that I have an ethical obligation to disclose the error to enable the patient make an informed decision on how to proceed with care. Ultimately, my primary responsibility is to provide care that is consistent with the patient’s needs, and this is only possible if the patient has access to all the relevant information that facilitates informed decision-making. The right information would include what error occurred, how it occurred, why it occurred, who caused the error, its implications for care outcomes, strategies for minimizing harm, steps that can be implemented to address the error, and how the patient will be protected from a similar error occurring in the future (Arcangelo et al., 2017). Through providing the patient with information on the error, the patient is reassured that the care is prioritized for the best outcomes. Although I advocate for full disclosure, I am realistic enough to acknowledge that there are cases where making a disclosure is not possibility. This is particularly true when the error has legal implications. In such cases, it would be prudent to seek legal advice before making the disclosure and gaining adequate legal protection that can offset the blowback from the disclosure (Potter et al., 2018).

Explain the process of writing prescriptions including strategies to minimize medication errors.

Writing a prescription involves a structured and sequential process intended to minimize the occurrence of medication errors. The process sequence involves seven steps that must be completed before the prescription can be considered valid. The first step is to identify the individual writing the prescription in terms of the unique identification number, name, designation, contact information, and any other identifiers considered relevant. The second step is to date the prescriptions in terms of the day of the month, the month and year. The third step is to list the medication name, strength, generic name, daily dosage, and quantity required by the patient. This ensures that the patient gets the right amount of medication without shortages or excesses, thus reducing the potential for medication abuse. It also reduces the possibility of the wrong medication being dispensed (Institute of Safe Medication Practice, 2019). The fourth step is to tamper proof the prescription documentation. This involves signing the document, using a dated stamp and writing using indelible ink from a single pen. The fifth step is to ensure that the writing is legible and does not present an opportunity for misunderstanding the instructions. The sixth step is to identify the patient receiving the medication in terms of age, name, address and gender. The final step is to educate the patient on the effects of the medication included in the prescription (American Nurse Today, 2019).

Conclusion

It is evident that nursing personnel are often involved in prescription activities, and this introduces a risk of medication errors. In addition, it is clear that the medication errors from prescription activities by nurses have both legal and ethical implications, especially when it is considered that disclosures are necessary to inform patients. Still, it is notable that although nurses are obligated to make disclosures about errors, they should practice prudence by seeking legal advice before making the disclosure and gaining adequate legal protection that can offset the blowback from the disclosure. Also, the prescription writing process should follow a sequential approach targeted at reducing the possibility of medication errors occurring.

References

American Nurse Today (2019). Medication errors: best practice. Retrieved from https://www.americannursetoday.com/medication-errors-best-practices/

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: a practical approach (4^th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Institute of Safe Medication Practice (2019). List of error-prone abbreviations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

Potter, P., Perry, A., Stockert, P., Hall, A. & Castaldi, P. (2018). Study guide for essentials for nursing practice. St. Louis, MO: Elsevier.  Legal Profession Example Paper