Ethical and Legal Implications of Prescribing Drugs
In healthcare, prescription of medication and medical devices can be performed by doctors, nurses, and in some cases, pharmacists. The drug enforcement administration (DEA) classifies drugs into five main schedules. Narcotics can fall in schedule II or V because of the composition of the preparations in which they are prescribed.
Narcotics in schedule II have a higher potential for abuse (US Department of Justice & Drug Enforcement Administration, n.d.). This week, my assigned scenario is about a fellow nurse practitioner who is seen prescribing a narcotic for her husband, but her husband is not her patient.
There are various moral, ethical, and legal implications of the practitioner’s actions. The purpose of this discussion is to explain my viewpoints and strategies to address this situation as an advanced practice registered nurse.
Ethical and Legal Implications
The nurse practitioner’s intentions are not clear as the reasons and intentions for her prescription. Assuming that the nurse wanted to her husband’s pain, it can be argued that she intended to prevent harm from pain to the patient. However, the legal implications of this nurse’s actions are contrary to the ethical implications.
Pennsylvania, my state, is still a reduced practice authority state. This means that nurses cannot practice to the full extent of their training and education (American Nurses Association, 2018). Fortunately, there are legislations currently in the legislature to make Pennsylvania a full practice authority. With this reduced practice authority, they cannot prescribe medications without the supervision of a physician. Legally, the nurse practitioner violated this regulation in my state.
Narcotics have been widely used to severe pain in patients but are highly at risk of being abused. For example, hydromorphone is an opioid analgesic more efficacious than morphine and can alleviate acute moderate to severe pain. This medication is a schedule II agent with a high potential for abuse and thus can cause adverse events such as fatal respiratory depression, constipation, sedation, and urine retention (Rosenthal & Burchum, 2020).
In combination with other sedating agents, this medication can cause lethal effects that can lead to death if its effects are not reversed in time. Therefore, the prescription required higher-level education practitioners to offer correct prescription information and monitoring instructions.
Another concept arising from this situation is a health professional’s self-treatment or treatment of a family member. According to the American medical association (AMA), healthcare professionals are ethically discouraged from treating family members. The argument is that their feelings and emotions may deter them from making accurate decisions and obtaining more sensitive information crucial in patient care (Chua et al., 2019).
The various implication of the situation is that the patient, the husband, in this case, may suffer from toxicity in the nurse’s attempts to alleviate the pain in the shortest time possible fully. Based on the laws of the Pennsylvania Code (Legal Information Institute, 2021), the pharmacist dispensing the medication is allowed to refuse this dispensation because the prescriber is not permitted by law (The Pennsylvania Code, 2022).
If the pharmacist proceeds with dispensation, they may be liable for the legal charges under the state board of pharmacy laws. The burden of managing the toxicity of the medication, if not properly prescribed, would be felt by the patient’s family, including the nurse as a family member.
Addressing Disclosure and Nondisclosure
In Pennsylvania, the Pennsylvania ACT 13 of 2002 (Mcare) demands disclosure of serious events (Health Information & the Law, n.d.). Serious events in this law refer to events that resulted in death or compromise of patient safety (Painter et al., 2018).
In this case, the nurse’s action could result in patient safety risks. She might have the educational capacity to do prescriptions, but the potential medication errors might land her in legal implications earlier discussed. I would choose nondisclosure to the state authorities to prevent the potential risk to patient safety. However, I would advise the nurse practitioner against the prescription and related legal implications and seek assistance from the physician and the patient’s primary care provider.
Decision Making Strategies
My decisions in this situation will be guided by collaborative coordination with the nurse and understanding the intentions of the nurse’s actions. Understanding the reason for the nurse’s decision to make the prescription would allow me to provide necessary ethical advice that would help her.
Collaborating with her to make her understand the implications of the actions would maintain an excellent collaborative team environment and seek alternatives before making errors. Therefore, disclosure of the error will be int6ernal and within the unit for corrective actions.
The Process of Writing a Prescription
Writing a prescription starts by identifying the patient’s details such as name, age, sex, and race. The next step includes medication name and dosage with route, strength, frequency, and amount to be taken. This is followed by indicating the amount of the medication to be dispensed at the pharmacy. This prescription is incomplete without signing off by the prescriber through signature and DEA number or other identifiers.
My assigned case scenario presents an ethical dilemma that would require a consultative, collaborative process to prevent the medication error. The legal implication would arise from the limitation of the scope of practice by the state board of nursing regulations.
It would also be unethical to treat a family member as there are factors that would interfere with clinical judgment. In this situation, the decision for nondisclosure will be based on the objective to maintain a collaborative environment with a good nursing leadership environment. Educating the nurse about her action will be my strategy.
American Nurses Association (Ed.). (2018). The Opioid Epidemic: The Evolving Role of Nursing. https://www.nursingworld.org/~4a4da5/globalassets/practiceandpolicy/work-environment/health–safety/opioid-epidemic/2018-ana-opioid-issue-brief-vfinal-pdf-2018-08-29.pdf
Chua, K.-P., Brummett, C. M., Conti, R. M., Haffajee, R. L., Prosser, L. A., & Bohnert, A. S. B. (2019). Assessment of prescriber and pharmacy shopping among the family members of patients prescribed opioids. JAMA Network Open, 2(5), e193673. https://doi.org/10.1001/jamanetworkopen.2019.3673
Drug Enforcement Administration. (2018, July 10). Drug scheduling. DEA. https://www.dea.gov/drug-information/drug-scheduling
Health Information & the Law. (n.d.). Privacy and confidentiality in Pennsylvania. Healthinfolaw.Org. Accessed June 3, 2022, from http://www.healthinfolaw.org/state-topics/39%2C63
Legal Information Institute. (2021, December 25). 49 pa. Code § 27.18 – standards of practice. LII / Legal Information Institute. https://www.law.cornell.edu/regulations/pennsylvania/49-Pa-Code-SS-27-18
Painter, L. M., Kidwell, K. M., Kidwell, R. P., Janov, C., Voinchet, R. G., Simmons, R. L., & Wu, A. W. (2018). Do written disclosures of serious events increase the risk of malpractice claims? One health care system’s experience. Journal of Patient Safety, 14(2), 87–94. https://doi.org/10.1097/pts.0000000000000178
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.
The Pennsylvania Code. (2022, March 26). 49 pa. Code § 27.18. Standards of practice. Pacodeandbulletin.Gov. http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter27/s27.18.html&d=reduce
US Department of Justice, & Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Usdoj.Gov. Accessed June 3, 2022, from https://www.deadiversion.usdoj.gov/drugreg/practioners/index.html