Advanced Pharmacology: The Ethics and Legalities of Medication Error Disclosure

Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week's assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
• Chapter 1, “Issues for the Practitioner in Drug Therapy” (pp. 3–14)
This chapter introduces issues relating to drug therapy such as adverse drug events and medication adherence. It also explores drug safety, the practitioner’s role and responsibilities in prescribing, and prescription writing.

• Chapter 59, “The Economics of Pharmacotherapeutics” (pp. 1009-1018)
This chapter analyzes the costs of drug therapy to health care systems and society and explores practice guideline compliance and current issues in medical care.

• Chapter 60, “Integrative Approaches to Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
This chapter examines issues in individual patient cases. It explores concepts relating to evaluation, drug selection, patient education, and alternative treatment options.
Due to the importance of ethical and legal considerations in advanced practice nursing, several resources have been provided for your reference.
Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.
Note: Retrieved from the Walden Library databases.

This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.
Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.
Note: Retrieved from the Walden Library databases.

This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www(dot)nursingworld(dot)org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.
Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from https://americannursetoday(dot)com/medication-errors-dont-let-them-happen-to-you/

This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.
Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www(dot)deadiversion(dot)usdoj(dot)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(dot)deadiversion(dot)usdoj(dot)gov/pubs/manuals/pract/index.html

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.
Drugs.com. (2012). Retrieved from http://www(dot)drugs(dot)com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Institute for Safe Medication Practices. (2012). ISMP's list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www(dot)ismp(dot)org/Tools/errorproneabbreviations.pdf

This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Optional Resources
Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www(dot)medscape(dot)com/viewarticle/440315
Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www(dot)deadiversion(dot)usdoj(dot)gov/21cfr/cfr/1300/1300_01.htm
Drug Enforcement Administration. (n.d.). Registration. Retrieved August 23, 2012, from http://www(dot)deadiversion(dot)usdoj(dot)gov/Registration.html
In addition, refer to the Optional Resources listed in Week 1.
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Discussion: Ethical and Legal Implications of Prescribing Drugs
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?
These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. 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. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
Scenario 1:
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.
Scenario 2:
A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.
Scenario 4:
During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.
To prepare:
• Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Anderson and Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
• Select one of the four scenarios listed above.
• Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the 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.
With these thoughts in mind:
By Day 3
Post an explanation of 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. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.
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Assignment:
The Ethics and Legalities of Medication Error Disclosure
American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error.
Consider the following scenario:
• You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.
To prepare:
• Consider the ethical implications of disclosure and nondisclosure.
• Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
• Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.
• Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.
By Day 7
Write a 2- to 3- page paper that addresses the following:
• Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.
• Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.
• Explain the process of writing prescriptions including strategies to minimize medication errors.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter(dot)waldenu(dot)edu/57.htm). All papers submitted must use this formatting.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary/conclusion, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter(dot)waldenu(dot)edu/57.htm). All papers submitted must use this formatting.
Rubric Detail

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Name: NURS_6521_Week2_Application_Rubric

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Excellent Good Fair Poor
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking. 27 (27%) - 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics. 24 (24%) - 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing goodbreadth and depth about each of the assignment topics. 21 (21%) - 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. 0 (0%) - 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Quality of Work Submitted:
The purpose of the paper is clear. 5 (5%) - 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria. 4 (4%) - 4 (4%)
Purpose of the assignment is stated, yet is brief and not descriptive. 3.5 (3.5%) - 3.5 (3.5%)
Purpose of the assignment is vague or off topic. 0 (0%) - 3 (3%)
No purpose statement was provided.
Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student's ability to:
Understand and interpret the assignment's key concepts. 9 (9%) - 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts. 8 (8%) - 8 (8%)
Demonstrates a clear understanding of key concepts. 7 (7%) - 7 (7%)
Shows some degree of understanding of key concepts. 0 (0%) - 6 (6%)
Shows a lack of understanding of key concepts, deviates from topics.
Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student's ability to:
Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources. 18 (18%) - 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view. 16 (16%) - 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view. 14 (14%) - 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. 0 (0%) - 13 (13%)
Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.
Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student's ability to:
Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections. 18 (18%) - 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. 16 (16%) - 17 (17%)
Summarizes information gleaned from sources to support major points, but does not synthesize. 14 (14%) - 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped. 0 (0%) - 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance. 5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 4 (4%) - 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time. 3.5 (3.5%) - 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time. 0 (0%) - 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 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: NURS_6521_Week2_Application_Rubric