Introduction
There are many different ethical and legal concerns associated with the disclosure of medication error within the United States. When an individual enters into the healthcare field, they must already have an idea as to how he or she will respond to or address a situation, should one occur. It is important to remember that error is a natural part of the human state and as such, an individual must have a plan in place to work to deal with and address such issues when, not if, they occur. Through a review of the different ethical and legal concerns associated with medication error disclosure in the state of Maryland, it will be possible to address a hypothetical situation in which medication error occurs, providing a justification for the rationalization for the decision and working to identify the different strategies that may be taken to ensure that such an action does not occur.
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"The Ethics of Medication Error Disclosure".
Legal Standpoint
From a legal standpoint, “ten states since 2002 have implemented public policy that mandates disclosure of adverse events/ medical errors to the patient and/or family;” Maryland is one of those states (QuPS.org, 2014). As such, when looking at the question of whether or not to disclose a medication error within the state of Maryland, legally, there is no question; the advanced practice nurse who makes an error or who identifies when an error has occurred has a legal responsibility to notify the patient and/or the patient’s family, depending on the age of the patient, the patient’s illness, and other mitigating factors. The issue with the legal wording of this public policy is, however, the inclusion of the word “adverse” (QuPS.org, 2014). Legally, this means that the medical professional is not technically required to report any “non-harmful” medical errors or other events, including a medication error (Chamberlain, et al., 2012, p.282). This is a slippery slope, however, as any medication error could result in a chain reaction of events that causes harm to come to the patient, making a non-harmful error become a harmful or adverse error, something that the advanced practice nurse or other medical professional could not have been aware of in advance. In terms of a potentially non-harmful error, the most legally accurate advice to give the medical professional in that situation would be to speak to their lawyer regarding the matter in order to gain insight into the best course of action to take and whether or not to report the error.
Ethical Standpoint
From an ethical standpoint, the matter is far more complex. Ethically, the medical professional has a responsibility to act in the best interests of the patient, which means reporting the issue, however, it is important to note the intense stigmatization associated with whistleblowing in the medical profession and, regardless of whether or not the situation is investigated as a result of the report, there is the potentiality for adverse effects to befall the reporting individual (Philipsen & Soeken, 2011). Many healthcare professionals that ultimately report errors that occur within their practice are required to disclose their names, removing any protection that they may have had and resulting in consequences up to and including the loss of their job with their practice and a stigmatization that may cause the individual to be unable to get another job in their chosen profession (Philipsen & Soeken, 2011). The individual who is doing the reporting, or considering reporting an error, must make a decision regarding whether or not to report based on the effects on their own life as well; is it worth the loss of the medical professional’s livelihood and career to report little errors, or should only the large errors be reported? For this reason, there is no good answer, as there is no current true protection in place for whistleblowers. As such, the only advice that may be given is to speak with legal representation before taking action.
Hypothetical Situation
In the hypothetical situation given, I am working as the advanced practice nurse and I have personally made the error and have caught the error that I have made. In this situation the error is one that would not cause harm to the patient and was not intentional. The first thing to do would be to call the pharmacy, as most prescriptions are transmitted electronically in today’s day and age. If the pharmacy has not yet filled the prescription, the error may be fixed immediately by nixing the original prescription and putting in a new prescription. If the prescription has already been filled and picked up, it would be my responsibility to call the patient to find out if they have started taking the medication. If they have, they should be advised to discontinue the prescription and told that a new prescription has been sent to the pharmacy and that they should take the first back for disposal. It should be phrased that a mistake was made, without stating where the mistake was made, an apology should be issued, and the situation would then be resolved, with the patient perceiving that the error has been made, corrected, and that there is no issue, absolving the ethical concerns while ensuring that the patient remains healthy.
Conclusion – Strategies for Implementation and Prescription Writing Practices
In order to prevent such issues from occurring, prescriptions should be typed in manually, checked multiple times, and confirmed against the chart before being sent off to the pharmacy. If the prescription is for a controlled substance and must be written on paper still, then it should be written in a legible manner, as opposed to the traditional doctor’s chicken scratch and confirmed with the chart before being provided to the patient. The pharmacy will then confirm this with the office prior to filling, resolving any potential issues in the prescription writing process while working to ensure that the error rate for such an issue is reduced.
- Chamberlain, C., Koniaris, L., Wu, A., & Pawlik, T. (2012). Disclosure of “Nonharmful” Medical Errors and Other Events. Arch Surg, 147(3), 282. doi:10.1001/archsurg.2011.1005
- Philipsen, N., & Soeken, D. (2011). Preparing to Blow the Whistle: A Survival Guide for Nurses. The Journal For Nurse Practitioners, 7(9), 740-746. doi:10.1016/j.nurpra.2011.07.006
- QuPS.org. (2014). Medical Errors and Patient Safety – US States Comparison – Disclosure. Retrieved 28 February 2015, from http://www.qups.org/med_errors.php?c=state_comparison&t=10
