As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.”

• 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 (Maryland).

• 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.

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Solution

Legal and Ethical implications of Medical errors for Children

Medication errors and prescribing errors may pose significant implications on the pediatric age group in different settings including inpatient, outpatient, and emergency departments and even at home (Remley et al., 2020). The provided scenario demonstrates the extent to which children and young people can be at increased risk due to the limited communication ability, size and physiologic variability, reduced capacity to make informed consent and differential treatment by non-pediatric health care practitioners and providers.

Ethical and legal implications of the scenario

Research has established that prescribing errors in children is associated with a myriad of significant legal and ethical implications. A major ethical issue associated with my dosing error is harm done to the patient (Kadivar et al., 2017). Considering that the 5-year old child is completely unaware of the implications of the wrongly prescribed medication, the excessive dosage may pose negative effects on his health, and even lead to adverse events. A key ethical issue on the patient’s family is related to informing parents of the child (disclosure of medical errors) in a timely and honest manner by the head nurse or the chief physician of the healthcare facility (Remley et al., 2020). The ethical implication on the prescriber is eminent role of professionalism whereby the prescriber must fully adhere to the established ethical principles (beneficence and non-maleficence, accountability, due diligence) as the basis for identifying patient safety failures and preventing the occurrence of medication errors. Another major ethical implication of the scenario is the inability of the pharmacist to disclose information that the prescriber and patient needed in order to reach informed decision-making (Conn et al., 2019).

In terms of major legal implications, medical errors are implicated by a number of legal aspects including the failure of the prescriber and the pharmacist to ensure compliance with the established guidelines and standards of practice regarding drug prescription and dosing (Hirata et al., 2017). Equally, other legal implications are related to the ineffective communication concerning the failure to inform relevant stakeholders (patient, patient’s family, chief physician) about the medical ‘emergency’ practice emanating from the dosing error (Crook et al., 2020). Moreover, the inability of the prescriber and the pharmacist to adhere with the policy of the medical facility on disclosure of medical errors might undermine the promotion of open communication and transparency, leading to legal proceedings against the involved parties and even the health care provider (Conn et al., 2019).

Strategies to address Disclosure and Disclosure

Addressing the fundamental dilemma of disclosure or non-disclosure of the medical error, I must conduct a comprehensive assessment of this dosing error. In the state of Maryland, House Bill 821 is the most notable legislative intervention geared at mandating hospitals and healthcare providers in Maryland to report to the Department of Health when patients experience harm by the care provided to them (Office of Human Subjects Research, 2020). Under HB 821, the disclosure of medical errors is inspired by the greater need to promoting patient safety and encouraging hospitals to enhance care and prevent or reduce medical errors and other associated shortcomings.

Possible Solutions

Considering the complexity surrounding the actual degree of harm done to the 5-year old having not been informed about the dosing error, my commitment as an advanced practice nurse in this particular scenario would involve the use of the following strategies to guide my decision-making in this scenario:

• Informing the chief physician or head nurse at the particular healthcare facility regarding the dosing error. This would ensure the hospital’s protocol regarding disclosure of medical errors is followed to the latter, and appropriate measures are pursued by the top management of the facility to ensure proper disclosure and response to the harms done by the dosing error to the patient and other key stakeholders, within and outside the healthcare setting (Kadivar et al., 2017).
• Focusing on helping the patient who has experienced the harm caused by the error-induced adverse events. Moreover, engaging in a full empathic and competent disclosure to allow the 5-year old patient and his parents to understand the degree and effects of the harms associated with the dosing error (Conn et al., 2019).

Prescription Writing Process

Sorrell (2017) indicated avoidance of prescribing errors require the prescriber and pharmacist to gain relevant information and data from credible organizations and sources. The utilization of stakeholder evidence is integral in ensuring that the causes of errors (e.g. misplacement of decimal points, miscalculation or confusion around ‘mg/kg/day’ dosing equations) are identified and avoided when dealing with children. Similarly, Kadivar et al. (2017) argued that the prescription writing process must involve the active of children and parents in medication safety as well as the pursuit of shared arrangements with competent pediatric teams to increase error prevention and detection as well as foster accuracy when prescribing for children.

Strategies to Minimize Medication Errors

Slomski (2017) established that avoidance and prevention of medication errors is a prerequisite to avoid many of the ethical and legal consequences associated with medical malpractices. One of the key steps is to engage in genuine and reflective storytelling on the contexts and issues surrounding the experience as the basis for identifying what went wrong, and the most effective and efficient ways to address them (Crook et al., 2020). Moreover, the adoption of systematic management strategies by the healthcare providers and practitioners through invest in suitable disclosure mechanisms and strategies to enhance the reporting of errors as a top priority (Sorrell, 2017).

References

Conn, R.L., Kearney, O., Tully, M.P., & Shields, M.D. (2019).What causes prescribing errors in children? Scoping review. BMJ Open, 9(8):e028680. DOI: www.10.1136/bmjopen-2018-028680

Crook, J., Yorke, H., & Cooper, R. (2020). G107(P) Reducing paracetamol medication errors in children. Abstracts. https://doi.org/10.1136/archdischild-2020-rcpch.84

Hirata, K. M., Kang, A. H., Ramirez, G. V., Kimata, C., & Yamamoto, L. G. (2017). Pediatric weight errors and resultant medication dosing errors in the emergency department. Pediatric Emergency Care, Publish Ahead of Print. https://doi.org/10.1097/pec.0000000000001277

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of Medical ethics and History of Medicine, 10(15). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/

Office of Human Subjects Research, (2020). Relevant State Law Requirements. https://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/marylandlaw.html

Remley, T. P., Byrd, R., & Luke, C. (2020). Legal and ethical implications for working with minors. Counseling Children and Adolescents, 69-92. https://doi.org/10.4324/9781351133159-7

Slomski, A. (2017). The right tools help parents avoid medication dosing errors. JAMA, 318(12), 1099. https://doi.org/10.1001/jama.2017.14114

Sorrell, J.M. (2017).Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. OJIN: The Online Journal of Issues in Nursing, (22)2.DOI: www.10.3912/OJIN.Vol22No02EthCol01