Application: The Ethics and Legalities of Medication Error Disclosure
When making an unintentional error in prescribing a drug to a patient, and considering the ethics of disclosure and nondisclosure, there are many implications that can come as a result of such an action. From an ethical standpoint, the ANA Code of Ethics is quite clear; in the case of an error, “nurses are expected to follow institutional guidelines in reporting errors committed or observed to the appropriate supervisory personnel” (2010). From a legal standpoint, errors are equally maligned; in the state of Texas, the Texas Board of Nursing states their belief that “protection of the public is not enhanced by the reporting of every minor incident that may be a violation of the Texas Nursing Practice Act or a board rule”; nurses are not required to report an error to the board if it qualifies as a ‘minor’ incident. (Texas Board of Nursing, 2009). Minor incidents, particularly ones that can be attributed to the nurse, are merely recorded in the incident report. The joint position of the Texas Board of Nurse Examiners and the Board of Pharmacy is that there is a primarily systemic cause for many medication errors; if a nurse performs a prescription error, they were simply not sufficiently competent in that area of knowledge, and the work environment must be adjusted (Texas State Board of Pharmacy, 2013).
The advanced practice nurse in this scenario has an ethical and moral obligation to report the error, according to the established codes of ethics and legislation currently available, with no exceptions. The ANA specifically state that “under no circumstances should the nurse participate in, or condone through silencean attempt to hide an error,” establishing that the simple act of withholding disclosure is a violation (ANA, 2010). Nurses often run the risk of being seen as incompetent, as well as lowering the public trust in their health care facility; at the same time, benefits of disclosure include a greater sense of objective medical ethics, and being perceived as honest by the medical and patient community (Philipsen & Soeken 2011, p. 745). Reporting errors and making them known can be seen as putting one’s career in jeopardy, but this move is preferable to the alternative of failing to disclose the error. One can never be completely certain that the patient would never find out, or that some adverse effect could come from the error, so it is best all parties have all available information.
One of the most important things one could do to ensure that these medication errors do not recur is to cement strategies of prescription writing that would allow nurses to be as accurate as possible with writing prescriptions, as well as act in the best interests of the patient. First and foremost, the concept of rational prescribing (RP) is an ideal strategy for writing prescriptions; RP as a practice is based on “knowledge, reasoning, clear and logical thinking about the patient problem, and a plan of evidence-based care” (Crigger and Holcomb 2008, p. 121). Rational practice typically involves reducing rates of polypharmacy, avoiding a ‘magic bullet’ strategy with patients in which more cost generates greater value, and so on (Crigger and Holcomb 2008, p. 122). One primary strategy for improving efficacy in writing prescriptions is to be aware of a nurse’s fiduciary duty to the patient; nurses must value the tenets of social justice and the welfare of the patient, and make sure that we do not focus on the agendas of the health care facility, special interest groups, or other third parties who might interfere with decision making (Crigger and Holcomb, 2008).
References
American Nursing Association. (2010). Code of Ethics for Nurses. NursingWorld.
Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational
prescribing. Journal for Nurse Practitioners: 120-125.
Philipsen, N.C., & Soeken, D. (2011). Preparing to blow the whistle: a survival guide for nurses.
Texas Board of Nursing. (2009). Reporting of minor incidents. Texas Administrative Code
§217.16.
Texas State Board of Pharmacy. (2013). Texas Board of Nurse Examiners/Board of Pharmacy
joint position statement on medication errors. Texas State Board of Pharmacy. http://www.tsbp.state.tx.us/about/medication_errors.html.
