Medication Error Paper
A medication error refers to an avoidable occurrence that causes inappropriate medication use or patient harm while the medication is in the control of a consumer, patient, or healthcare provider (Assiri et al., 2018). An estimated 7 million patients are affected by medication errors which cost approximately $21 billion across all healthcare settings (Assiri et al., 2018).
Similarly, medication errors and adverse drug reactions are underreported. The complex and complicated healthcare system increases the incidence of medication errors. However, healthcare providers, particularly advanced practice nurses, should be at the frontline, safeguarding patient safety by practicing meticulously.
This discussion will be based on a scenario where an advanced practice nurse commits an unintentional prescription error. In the subsequent paragraphs, ethical and legal implications of disclosure and nondisclosure, subsequent action, the process of prescription writing, and strategies to minimize medication errors shall be explored.
Ethical and Legal Implications of Disclosure and Non-disclosure
Prescription writing is an integral part of care provision. Prescription errors are derelictions that occur while prescribing medications. Following a prescription error, nurses are subjected to ethical and legal consequences. After committing medication errors, nurses will remain in an ethical dilemma regarding whether to disclose the blunder to relevant authorities and patients or keep the information to themselves (Kim & Lee, 2020).
However, the ethical and legal considerations of care provision for advanced practice nurses have stretched enormously. For instance, disclosing a nursing error is an ethical and legal responsibility. Disclosing nursing errors ensures that nurses are held accountable and improves patient safety outcomes (Kim & Lee, 2020). Nursing practice is founded under a professional code of conduct that outlines ethical responsibilities for all nurses.
This code of conduct requires that all errors are reported and disclosed (Haddad & Geiger, 2020). Disclosure ensures that nurses promote, advocate for, and protect patients’ rights, health, and safety (Haddad & Geiger, 2020).
Nevertheless, ethics isn’t a clear-cut science, and laws define certain situations. The state of California has recently granted nurse practitioners full practice authority. However, in the event of medication errors, the California Board of Registered Nurses, as well as the California Medication error law require prompt disclosure of potentially harmful medication errors within five days of their occurrence (Law section, 2020).
However, in the event of life-threatening medication errors, they must be reported within 24 hours. Non-disclosure may attract penalties of $100 per day. Finally, California Nurses Association, through its healthcare perspective, outlines policies and procedures that guide unintended medication error acknowledgment and apology processes (California Board of Registered Nursing, 2018).
Committing a prescription error that the patient does not know about becomes an ethical dilemma for any nurse practitioner. For instance, failure to report might result in patient harm or even death, while reporting may make one face serious disciplinary action, including loss of a practicing license. Nevertheless, one has no choice but to disclose this error. The disclosure should be first to the immediate supervisor in a calm, private, and remorseful way who will subsequently disclose the error to the patient privately and most suitably.
The rationale behind disclosure is that patient safety is paramount. Failure to disclose conspicuously places the nurse’s interests over the patient’s and to the disadvantage of the patient, which violates patient-centered ethics. As a nurse, one of the provisions of the professional code of conduct provisions necessitates governing and safeguarding patient safety. Similarly, California state laws and regulations demand reporting of any unintended medication errors within five days of their occurrence but within 24 hours if life-threatening (Law section, 2020).
Similarly, disclosure of this error may facilitate prompt actions to be taken that may subsequently minimize future life-threatening complications. Finally, California Nurses Association, through its healthcare perspective, outlines policies and procedures that guide unintended medication error acknowledgment and apology processes (California Board of Registered Nursing, 2018).
Prescription Writing and Strategies to Minimize Medication Errors
Prescription writing should be done carefully to ensure patients’ safety. Prior to prescription writing, an advanced practice nurse should have an elaborate understanding of the disease and the medication, including drug side effects and drug-drug interactions, to minimize patient harm. The process of prescription writing involves seven steps, including prescriber’s information, patient’s information, Recipe (Rx), Signatura (Sig), dispensing instructions (Disp), number of refills (Rf), and prescriber’s signature (Nkera-Gutabara & Ragaven, 2020).
The prescriber’s information is ordinarily at the pinnacle of the paper. It includes the clinician’s name, office address, and contact information. Meanwhile, the date of prescription writing and the patient’s full name. age and birth of birth are documented under the patient information section (Nkera-Gutabara & Ragaven, 2020). The prescriber then documents the prescribed medication, dose, and dosage form under the Rx part.
The Sig section gives directives to the patient on how to take the medication while the dispensing instructions are directed to the pharmacist and outline the quantity and the form to be dispensed. The number of times a prescriber would like patient medications to be refilled is written under the number of refills section (Nkera-Gutabara & Ragaven, 2020). Finally, the prescriber includes his name in the prescriber’s signature and his National Provider Identifier (Nkera-Gutabara & Ragaven, 2020). Occasionally, a prescriber would include Drug Enforcement Agency Number, particularly while prescribing controlled substances.
Prescription errors account for more than 70% of medication errors and, therefore, a threat to patient safety (Mutair et al., 2021). Strategies to minimize medication errors include writing in clear and legible handwriting since illegible prescriptions cause frustration and predispose to errors (Mutair et al., 2021). Similarly, avoid the use of ambiguous or uncommonly used abbreviations.
Likewise, an effective and friendly error reporting system should be developed. Effective communication should be implemented as it minimizes medication errors prone to occur during handing off and transitioning of care. Additionally, nurses administering medications must adhere to all rights of medication administration. Finally, all patients must be educated regarding their medications, including their indications, contraindication, side effects, time to be taken, actions in case of missed doses, and potential drug-drug interactions.
Medication errors are a threat to patient safety. Nurses should advocate, protect and promote patient health and safety. Nurses must practice according to their professional code of ethics as well as statutory regulations. Consequently, all nurses should disclose medication errors to their patients and relevant authorities in a friendly and proper manner to be held accountable and enhance the safety of their patients. Prescription writing should be done carefully and meticulously to document all components of a prescription. Finally, healthcare providers and facilities should implement strategies that effectively minimize the prevalence of medication errors and their associated complications.
Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101. https://doi.org/10.1136/bmjopen-2017-019101
California Board of Registered Nursing. (2018). Nursing practice act. Rn.ca.gov. https://www.rn.ca.gov/practice/npa.shtml
Haddad, L. M., & Geiger, R. A. (2020). Nursing ethical considerations. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054
Kim, Y., & Lee, E. (2020). The relationship between the perception of open disclosure of patient safety incidents, perception of patient safety culture, and ethical awareness in nurses. BMC Medical Ethics, 21(1), 104. https://doi.org/10.1186/s12910-020-00546-7
Law section. (2020). Legislature.ca.gov. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1279.1.&lawCode=HSC
Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R. Z., Mohaini, M. A., Al Mutairi, A., Rabaan, A. A., Awad, M., & Al-Omari, A. (2021). The effective strategies to avoid medication errors and improve reporting systems. Medicines (Basel, Switzerland), 8(9), 46. https://doi.org/10.3390/medicines8090046
Nkera-Gutabara, J. G., & Ragaven, L. B. (2020). Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals. African Journal of Primary Health Care & Family Medicine, 12(1), e1–e11. https://doi.org/10.4102/phcfm.v12i1.2263
Assessment 4 Instructions: Analyzing a Current Health Care Problem or Issue
Write a 4-6 page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications.
Assessment topic is — Medication errors
With peer-reviewed articles and references.