Assignment 2: Ethical and Legal Implications of Prescribing Drugs

Assignment 2: Ethical and Legal Implications of Prescribing Drugs

Advanced Pharmacology 6051C

Introduction

The scenario involves a nurse practitioner being requested by a friend to prescribe medication. However, even though the practitioner does not have the friend’s complete medical history, the NP goes ahead and writes the prescription. According to Cooper & Fitzpatrick (2021), a medication prescription is not supposed to be written without complete health history and physical examination. Writing prescriptions should be done according to the medical history of the patient, including past and current medications, as well as diagnosis. It is also important for the prescriber to first perform a risk-to-benefit analysis prior to writing a prescription (Cooper & Fitzpatrick, 2021). Therefore, advanced practice nurses need to be aware of the responsibilities allied to prescribing drugs. This paper will provide an analysis of the legal and ethical implications in the provided scenario.

Ethical and Legal Implications and Relevant Stakeholders

States regulate and control prescriptive practices and depending on the state, an NP writing a prescription without performing the required tests, physical examination, and gathering medical history may be liable for unprofessional conduct, leading to legal implications like omission (Peterson, 2017). Therefore, an NP prescribing for a friend without a medical history may have some legal implications because the NP may not know the patient’s allergies and current medications; this may result in adverse reactions, which can lead to patient harm (Halli-Tierney et al., 2019). NPs also have the ethical duty to prescribe correctly, which is possible through physical examination, collecting medical history, and assessment. Moreover, prescribing to friends and family without documentation may result in legal implications in case of patient harm (Coombes et al., 2020). The patient and the family are also involved as they can take legal action if the prescription caused harm to the patient. The pharmacist is also involved in the scenario. When filling and dispensing the prescription, the pharmacist has the duty of checking the prescriptions before dispensing and filling the medication to patients in order to make sure the patient receives the correct prescription.

Strategies to Address Disclosure and Nondisclosure

Health practitioners recognize medical errors occur during practice. As a result, there are established processes to prevent and report medical errors. The state government passed HB 1614 (Quality and patient safety, n.d). legislation that requires medical practitioners to have a detailed entry of medical error incidents (Gracia et al., 2019). This strategy ensures surveillance of medical practitioners who make medical errors frequently and the intensity of the errors leading to legal actions. This strategy can be implemented to identify and take disciplinary action against practitioners who are rampant in medical errors, negligence, and other errors. The strategy also helps to identify quack practitioners (Gracia et al., 2019). The second strategy is to obligate healthcare practitioners to document medical errors and implement legal frameworks to handle court cases (Gracia et al., 2019). This strategy can improve the cautiousness among healthcare practitioners and minimize medical errors and the resulting adverse events.

Strategies for Decision Making

The response to this scenario should be guided by the principles of honesty and integrity. These principles guide an individual when it comes to adhering to the codes of conduct and professional ethics. Therefore, codes of conduct and ethics can effectively guide the response to this scenario. For example, Kantian deontology requires individuals to base their actions on the rule of law, irrespective of the consequences to both the recipient and the actor (Suri et al., 2020). Therefore, in this scenario, it is appropriate to report the incident because this is what the state law requires. Therefore, this incident should be reported as per ethical principles. It is also important for the NP to follow up with the patient to establish if any adverse event occurred after prescribing the medication without physical assessment and the required history.

The Process of Writing Prescriptions

It is important for the nurse practitioner to have the required health history, medication history, patient information, and laboratory findings before prescribing medications. This information helps the prescriber to know the type of medication and dosage of the medication, as well as the route of administration (Cooper, & Fitzpatrick, 2021). The pharmacist also needs to have an overview of this patient information in order to ensure the correct dispensing of medication.

Conclusion

Prescribing of medications should not be done without the complete patient’s health information. This is because a lack of vital information such as allergies, diagnosis, and current medications could lead to adverse effects and patient harm. As a result, can result in the violation of both legal and ethical prerequisites, resulting in legal implications on such a prescriber.

References

Coombes, I., Markwell, A., Kubler, P., Redmond, A. M., McGurk, G., & Roberts, J. A. (2020). Principles of ethical prescribing for self and others: hydroxychloroquine in the COVID-19 pandemic. Australian prescriber, 43(3), 76–77. https://doi.org/10.18773/austprescr.2020.030

Cooper, S. M., & Fitzpatrick, R. W. (2021). Implementation and evaluation of a good prescribing tip email to reduce junior doctors’ prescribing errors. Journal of Patient Safety and Risk Management, 26(5), 214-220.

Gracia, J. E., Serrano, R. B., & Garrido, J. F. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC health services research, 19(1), 1-9.

Halli-Tierney, A. D., Scarbrough, C., & Carroll, D. (2019). Polypharmacy: evaluating risks and deprescribing. American family physician, 100(1), 32-38.

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

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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.

Photo Credit: Getty Images/Caiaimage

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.
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.

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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.
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.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information
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Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
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Week 1 Assignment 2 Rubric

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Week 1 Assignment 2
Rubric Detail

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Name: NURS_6521_Week1_Assignment_Rubric
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Excellent Good Fair Poor
Explain the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.
23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.
20 (20%) – 22 (22%)
The response explains the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved.

The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.
0 (0%) – 17 (17%)
The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing.

The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.
Describe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state.
18 (18%) – 20 (20%)
An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes specific, detailed, and accurate reference to state laws related to the scenario.
16 (16%) – 17 (17%)
An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes accurate reference to state laws related to the scenario.
14 (14%) – 15 (15%)
A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes inaccurate or vague reference to state laws related to the scenario.
0 (0%) – 13 (13%)
A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing.

The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.
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.
18 (18%) – 20 (20%)
The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.
16 (16%) – 17 (17%)
The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy.

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The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing.

The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.
Explain the process of writing prescriptions including strategies to minimize medication errors.
18 (18%) – 20 (20%)
The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.
16 (16%) – 17 (17%)
The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.
14 (14%) – 15 (15%)
The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.
0 (0%) – 13 (13%)
The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
Name: Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

 

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

 

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

 

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

 

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

 

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

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