Introduction
An advanced practice nurse is a registered nurse with additional education and clinical training in a specific area of nursing, such as pediatrics, obstetrics, oncology, or geriatrics. As an advanced practice nurse at a community health clinic, I provide primary care to patients. Such care includes diagnosing and treating illnesses, prescribing medications, and educating patients (Wong, 2018). Advanced practice nurses also play a role in preventive care and often serve as the point of contact for patients with chronic conditions. In case of any error in writing a medical prescription, I would report to the relevant body to ensure the patient’s safety, apologize to the patient, and rectify the mistake.
Ethical and Legal Implications
There are a few ethical and legal implications of disclosing or not disclosing an error when prescribing a drug to a patient. The 2005 Patient Safety and Quality Improvement Act and the growth of patient safety organizations have made increased transparency among healthcare organizations and doctors possible (Gandhi et al., 2018). From a legal standpoint, California has specific laws governing the disclosure of medical errors.
The Patient Safety Act in California was enacted to reduce medical errors and improve patient safety (Gandhi et al., 2018). The act applies to all healthcare providers in California, including pharmacies, hospitals, and healthcare facilities. The nurse may be subject to disciplinary action, including termination of employment, civil penalties, and criminal prosecution if they do not report the medical error (Maher & Cwiek, 2022). Under the act, healthcare providers are required to report any serious adverse events resulting from medical care (including prescription errors).
Moreover, from an ethical perspective, California law demands that healthcare providers disclose any potential risks or complications related to treatment. This is known as the duty of disclosure (Gandhi et al., 2018). Second, healthcare givers are similarly required to take corrective action if an error occurs, including discontinuing treatment, notifying the patient, and even reporting the error to the appropriate authorities. However, there are some instances where it may be in the patient’s best interest not to disclose an error. For example, if the mistake is minor and would not cause any harm if left untreated, then disclosing it may only cause unnecessary anxiety for the patient.
Error Disclosure Rationale
Given the prescription error, I would take some key steps to disclose the error immediately to correct the mistake. I would disclose the error to the patient; the reason for doing this is twofold. First, it is the ethical thing to do, and second, it may be in the patient’s best interest (Choi et al., 2019).
If an error is made, patients must be notified so they can make decisions about their health care. For example, if a patient takes a medication not prescribed for them, they may need to go to the hospital for treatment. By disclosing the error, I will allow the patient to make an informed decision about their health care and whether or not they want to continue seeing me as their provider.
The disclosure steps will include contacting the patient’s doctor for clarification on the prescription or contacting the pharmacy to ensure the medication is being dispensed correctly. Communication with the doctor or pharmacist will be crucial since the error could have serious consequences for the patient (Choi et al., 2019). For example, if a patient is allergic to a mistakenly prescribed medication, it could result in an allergic reaction. Correcting this error will ensure the patient receives the proper treatment and avoids potential harm. I would also document what happened in the patient’s medical chart.
Finally, I would apologize to the patient and explain the mistake causative. The apology will show that I am aware of my error and thus take responsibility for it. It will also help build trust between me as a nurse and the patient (Gandhi et al., 2018). Patients are more likely to report future errors if they trust the nurse not to take offense or react defensively. An apology will similarly convey a sense of professionalism and care, both of which are essential for delivering quality nursing care.
Prescription Writing
As an advanced practice nurse, I take the process of writing prescriptions seriously. A prescription is a legal document and, as such, needs to be accurate and legible. The first step in writing a prescription is to determine what medication the patient needs.
Once the medication has been selected, the next step is calculating the dosage (Siebert et al., 2019). This calculation is based on many factors, including the patient’s weight, the severity of their illness, and any other medications they may be taking. Once the dosage has been calculated, selecting the appropriate route of administration and formulation for the medication is essential.
Dosage calculation during the prescription process is critical for several reasons. One reason why it is important to calculate the dosage accurately is that incorrect dosages can lead to serious health complications. For example, if a patient is given an overdose of medication, it could potentially lead to death (Siebert et al., 2019).
Another reason for calculating the dosage accurately is that some medications can be dangerous when combined with other medications. If two medications are prescribed together without taking into account their individual dosages, this could lead to an adverse reaction that could be life-threatening. Moreover, after selecting the appropriate medication, dosage, and strength, writing out the instructions for taking the medication will be the last step.
Medication Error Minimization Strategies
Furthermore, different strategies can be used to minimize medication prescription errors. One strategy is to always use a provider’s full name and professional title when prescribing medication. This will help ensure that the correct provider is contacted in the event of an error.
Another strategy is to use a standard order for prescribing medication. This will help ensure that all of the necessary information is included in each prescription and that it is easier to read and interpret.
Additionally, it is vital to double-check prescriptions before they are administered to ensure there are no mistakes (Douglass et al., 2018). Similarly, double-checking can involve confirming all medication orders against the patient’s chart before giving them to the pharmacist to ensure no mistakes in transcription.
Another strategy is to avoid using abbreviations whenever possible to prevent misunderstandings about what medication is prescribed. Likewise, if unsure about a particular medication’s spelling, it should be checked in the drug reference book before writing the order.
Conclusion
In conclusion, when prescribing drugs to patients, it is advised to take all necessary precautions to avoid errors. Unfortunately, even with the best intentions, mistakes can sometimes happen. If an error occurs, it is important to be aware of the California Patient Safety Act and what it requires.
It is advised that the error be reported or rectified and the patient be apologized. Failing to report the error can result in severe legal penalties. Similarly, it is significant to learn about prescription writing and have some strategies for minimizing such errors.
References
Choi, E. Y., Pyo, J., Ock, M., & Lee, S. I. (2019). Nurses’ perceptions regarding disclosure of patient safety incidents in Korea: A qualitative study. Asian Nursing Research, 13(3), 200-208. Web.
Douglass, A. M., Elder, J., Watson, R., Kallay, T., Kirsh, D., Robb, W. G., Kaji, A. H., & Coil, C. J. (2018). A randomized controlled trial on the effect of a double check on the detection of medication errors. Annals of Emergency Medicine, 71(1), 74–82. Web.
Gandhi, T. K., Kaplan, G. S., Leape, L., Berwick, D. M., Edgman-Levitan, S., Edmondson, A., Meyer, G. S., Michaels, D., Morath, J. M., Vincent, C., & Wachter, R. (2018). Transforming concepts in patient safety: A progress report. BMJ Quality & Safety, 27(12), 1019–1026. Web.
Maher, V., & Cwiek, M. (2022). Criminal liability for nursing and medical harm. Hospital Topics, 1–8. Web.
Siebert, J. N., Ehrler, F., Combescure, C., Lovis, C., Haddad, K., Hugon, F., Luterbacher, F., Lacroix, L., Gervaix, A., Manzano, S., & PedAMINES Trial Group (2019). A mobile device application to reduce medication errors and time to drug delivery during simulated pediatric cardiopulmonary resuscitation: A multicentre, randomized, controlled, crossover trial. The Lancet. Child & Adolescent Health, 3(5), 303–311. Web.
Wong, F. K. Y. (2018). Development of advanced nursing practice in China: Act Local and Think Global. International Journal of Nursing Sciences, 5(2), 101-104. Web.
