Ethical And Legal Implications Of The Medical Prescribers Discussion

Introduction

Professionals in the medical field, particularly advanced practice nurses, must be able to write prescriptions. Prescribers may face legal repercussions if they make medication mistakes that hurt their patients. The physician, pharmacist, patient, and the patient’s family are all parties in the scenario and have obligations under the law and ethics (Al-Worafi, 2020)Ethical And Legal Implications Of The Medical Prescribers Discussion.

Ethical and legal implications of the scenario

AC’s case is a difficult legal and ethical dilemma, especially because he cannot talk for himself, and the family members differ on what should be done to their loved one. A difficult ethical decision is facing the wife and the daughter as they are supposed to decide what should be done to the man without his own conscience because he cannot express himself. To the wife, she thinks that she knows her husband more, so the idea she is suggesting is somehow the same as the husband would have chosen if he could tell. On the other hand, the daughter wants her father to stay alive as long as possible, hoping he might find himself out of the live machine one day Ethical And Legal Implications Of The Medical Prescribers Discussion.

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A difficult ethical dilemma is facing the prescriber here, for they must decide whether to let the patient die or continue with life sustenance. They could be held accountable for whatever decisions they make, especially if the patient’s desires are not considered. He should also consider the desires of the family members. The pharmacist also has to deal with a challenging moral and legal dilemma. Even if the patient’s desires are unknown, the pharmacist must decide whether to prescribe the medications required to maintain life. The pharmacist is legally required to make sure that any pharmaceuticals they dispense are done in line with the law and have an ethical commitment to guarantee that the patient’s desires are respected (Sabatino et al., 2017)Ethical And Legal Implications Of The Medical Prescribers Discussion.

Strategies to address disclosure and nondisclosure

In my state, Missouri, healthcare providers are a law to provide patients with information about their diagnoses, available treatments, and any risks and benefits (Gerke et al., 2019). There are, however, some exceptions to this norm, such as in cases where the patient would suffer harm from disclosure or in which the patient is incapable of understanding or participating in treatment decisions. In the AC’s scenario, disclosing his information to the wife and daughter might be ok. However, their individual wishes and needs will determine the level of disclosure. For instance, the wife might want to learn more about the illness and its prognosis, but the daughter might prefer all treatment options to be tried. Health care decisions act must be followed in Missouri, which states that the patient is the decision maker and the guardian is the surrogate decision-maker (Gerke et al., 2019)Ethical And Legal Implications Of The Medical Prescribers Discussion. In this case, therefore, the decisions of the guardian must be followed.

In Missouri, the patient’s prognosis and available treatments must be disclosed to the surrogate decision-maker. The medical staff should provide the wife and daughter with all the information they require so they may make an educated decision. In addition, the team should ensure that both family members are aware of the possible results of their decision and that it is respected. The patient’s values and beliefs, as well as any advance care planning, should be taken into account by the healthcare team. The patient’s relatives should know their rights and the selection procedure. Together with ensuring that the patient’s family is supported throughout the procedure and that their rights are honored, the healthcare team must also make sure that they are respected.

Two strategies I would use to guide decision-making as an advanced practice nurse

In such a scenario, my decision-making as an advanced practice nurse would be guided by medical and ethical strategies. On the ethical strategy, I would employ the respect for autonomy principle. By taking into account the patient’s values, beliefs, and preferences, I can respect their autonomy and ability to make decisions. Since the patient in this situation is not speaking, the wife and daughter would be the ones to decide what is best for the patient. I would employ this moral approach by paying attention to the wife’s and daughter’s divergent points of view and attempting to decide based on what is best for the patient.

On the medical strategy, I would use the principle of beneficence in this scenario. According to this principle, I must act in the patient’s best interests and give them therapies that are good for their health and well-being (Castaldelli-Maia et al., 2019)Ethical And Legal Implications Of The Medical Prescribers Discussion. In this situation, I would evaluate the patient’s health to see if there was hope for recovery. If not, I would give the patient comfort care to ensure they were not in any pain or feeling comfortable. I would also be open about any mistakes made in the patient’s care. According to Al-Worafi (2020), it is good to be open and honest about any errors made so that the patient’s family is aware of the situation and may make an educated choice.

The process of writing prescriptions

Selecting the appropriate medication, the appropriate dose, and the appropriate route of administration are all important elements in the complex process of writing a prescription (Sabatino et al., 2019). According to Theisen et al. (2019), several steps are taken while prescribing such scenarios, including:

1. Documenting accurate records of the patient’s medical history, including any allergies, prescriptions, and bad drug reactions in the past.
2. Choosing the best prescription for a patient based on their diagnosis, medical history, and other pertinent information.

• Writing the prescription in legible and clear handwriting, including the dosage, medication name, route of administration, and the frequency

1. Checking the completeness and accuracy of the prescription before giving it out
2. Giving the patient or caretaker precise directions on taking their prescription, potential adverse effects, and other pertinent information.
   

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Conclusion

The scenario presented legal and ethical implications for healthcare professionals, patients, and family members while making decisions; the nurse can use clear communication, consult with the ethical committee or legal counsel, and apply the Best Interest or Substituted Judgment standards. Medication error prevention techniques can reduce the probability of unfavorable outcomes because writing prescriptions is a crucial operation that demands attention to detail. In the end, the nurse must strike a balance between moral and legal requirements while giving the patient’s autonomy, beneficence, and justice a top priority Ethical And Legal Implications Of The Medical Prescribers Discussion.

References

Al-Worafi, Y. M. (2020). Medication errors. In Drug safety in developing countries (pp. 59-71). Academic Press.

Castaldelli-Maia, J. M., e Gallinaro, J. G. D. M., Falcão, R. S., Gouttebarge, V., Hitchcock, M. E., Hainline, B., … & Stull, T. (2019). Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. British Journal of Sports Medicine, 53(11), 707-721.

Gerke, S., Minssen, T., Yu, H., & Cohen, I. G. (2019). Ethical and legal issues of ingestible electronic sensors. Nature Electronics, 2(8), 329-334.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner studentsLinks to an external site.. Journal of the American Association of Nurse Practitioners, 29(5), 248–254.

Theisen, K. M., Myrga, J. M., Hale, N., Cochran, G., Sewall, C., Macleod, L. C., … & Davies, B. J. (2019). Excessive opioid prescribing after major urologic procedures. Urology, 123, 101-107. Ethical And Legal Implications Of The Medical Prescribers Discussion

Write a 2- to 3-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state. MY STATE IS MISSOURI.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

Assigned case for assignment 2:

• AC is a 72-year-old male who is admitted to your ICU after suffering a massive stroke that has left him unresponsive and unable to communicate.  He is currently on a ventilator.  His wife of 48 years is available along with their one adult daughter.  The wife informs you that they don’t have any advanced directives, but she is “pretty sure her husband would not want to live like this.”  However, their daughter is adamant her dad would want to be kept alive in case there is any chance to come out of this.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.)Ethical And Legal Implications Of The Medical Prescribers Discussion. All papers submitted must use this formatting.

RESOURCES

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
  • Chapter 1, “Prescriptive Authority” (pp. 1–3)
  • Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
  • Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
  • Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
  • Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
  • Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
• American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society Download Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767 Ethical And Legal Implications Of The Medical Prescribers Discussion

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

• Drug Enforcement Administration. (2021). CFR – Code of Federal Regulations Title 21Links to an external site.. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=1300

This website outlines the code of federal regulations for prescription drugs.

• Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by stateLinks to an external site.. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

• Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations Links to an external site.. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list
  

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This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

• Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students Links to an external site.. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446
  The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator. Ethical And Legal Implications Of The Medical Prescribers Discussion