NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

Walden University  NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS  – Step-By-Step Guide

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The introduction for the Walden University  NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS   is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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After the introduction, move into the main part of the  NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS   assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

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After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for  NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS  

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

Ethical and Legal Implications of Prescribing Drugs
The promotion of safety and quality in the prescription of medications is
imperative in nursing practice. Advanced registered nurses make treatment
decisions based on best practices available and utilize interprofessional
collaboration to optimize treatment outcomes. Therefore, this paper explores the
ethics of prescribing a new drug, which has not been approved to a 7-year-old child
for asthma.

Ethical and Legal Implications

The prescription of unapproved drug to the 7-year-old child is associated
with significant ethical and legal implications to the nurses’ role in practice. First,
the new drug has not been tested or approved for its efficiency and effectiveness in
asthma treatment. The drug has also not been used in children under the age of 12
years. As a result, it raises the concerns related to the safety of the drug(Woo et al.,
2019). The drug predisposes the 7-year-old to harm because of the lack of
information about its safety in children below 12 years.
The prescription of the new drug to the 7-year-old violates the nurses’ code
of ethics and standards of practice. Advanced registered nurses have the
professional and legal responsibility of promoting safety, quality, and efficiency in
their practice. They make decisions based on best available evidence, practice
guidelines, and protection of the patient’s rights in the treatment process. The

3
professional standards of practice require them to make decisions that minimize
harm while optimizing treatment benefits(Grace & Uveges, 2022). The new drug
has never been tested or studied to determine its safety and efficacy profile.
Therefore, prescribing the drug will violate the stated codes of practice and ethics
in nursing.

Strategies to Address Disclosure and Non-Disclosure

Disclosure and non-disclosure influence the actions that nurses implement in
their practice. disclosure entails the provider informing the patient and their
significant others about the events that have happened to them in the care process.
Advanced practice nurses have the professional obligation to inform their patients
about any health interventions implemented to promote their health and recovery.
The code of ethics by the American Nurses Association requires that nurses should
promote and advocate the patients’ rights, safety, health, and wellbeing(Passini et
al., 2023). Non-disclosure entails not informing the patients about any events that
have happened to them in the care process.
The state of California requires that healthcare providers to disclose any
information that influences health and outcomes to the patients. The disclosure
includes providing information about any error that has been made in the delivery
of the care. The patient then makes the decision to either share the information
with other people or not. The disclosure will also extend to the hospital’s

4
management for the implementation of interventions that will minimize error
occurrence in the future. Disclosure of information would promote patient’s
autonomy, beneficence, and non-maleficence in the treatment process(Fairchild,
2021). Non-disclosure will translate into nurse’s lack of professional responsibility
and negligence, which violates provision 3 of the American Code of Ethics for
nurses.

Strategies to Guide Decision Making

One of the strategies that I will adopt to guide my decision-making is
interprofessional collaboration. I will involve the other healthcare providers in
assessing if we should prescribe the new drug to the 7-year-old. Interprofessional
collaboration will ensure the collective examination of the potential alternatives
that we may consider to optimize outcomes in the treatment process. Collaboration
will also enable the team to examine any evidence that supports the use of the new
drug in the treatment and potential risks if any(Donnelly et al., 2021). Therefore,
interprofessional collaboration will ensure the adoption of an ethical and most
relevant solution in the scenario.
The second strategy that I will use to guide my decision making is relying on
the set organizational policies and guidelines. Health organizations have policies
that guide nurses in making decisions. The guidelines limit the nurses’
involvement in activities that predispose patients to unintended harm. Relying on

5
them will ensure that I make an informed decision about the issue(Grace &
Uveges, 2022). I will disclose the error. As noted above, disclosure is crucial to
promote the adoption of interventions that will minimize any harm. Disclosure will
also ensure accountability and professional responsibility as an advanced practice
nurse.
Process of Writing Prescriptions and Strategies to Minimize Medication

Errors

Writing prescriptions should follow developed guidelines to minimize
medication errors. One of the processes in writing prescriptions is writing clearly
and accurately the patient’s data such as name, age, gender, and diagnosis.
Information about the medication name should also be written clearly and
accurately to avoid confusion. The prescriber should avoid abbreviations and
illegible writing. The dosage information should be concise with clear and specific
directions. The therapeutic duration of the drug should also be specific alongside
the drug’s therapeutic intervention. Any supplemental instructions such as
medication refill or warnings should also be included. The strategies that can be
adopted to minimize medication errors include provider training and education
about best practices, use of health technologies, double checking and encouraging
open reporting of medication errors(Royce et al., 2019; Sutton et al., 2020).

Conclusion

6
The promotion of safety and quality in prescribing medications is important.
I will disclose the medication error. The issue has significant and ethical
implications to nursing practice. Advanced registered nurses should adopt best
practices that minimize errors in their practice.

7

Also Read:

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS 

ASTHMA AND STEPWISE MANAGEMENT

PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS

DIABETES AND DRUG TREATMENTS

DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL

COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER

WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS

OFF-LABEL DRUG USE IN PEDIATRICS

References

Donnelly, S., Ó Coimín, D., O’Donnell, D., Ní Shé, É., Davies, C., Christophers,
L., Mc Donald, S., & Kroll, T. (2021). Assisted decision-making and
interprofessional collaboration in the care of older people: A qualitative
study exploring perceptions of barriers and facilitators in the acute hospital
setting. Journal of Interprofessional Care, 35(6), 852–862.
https://doi.org/10.1080/13561820.2020.1863342
Fairchild, A. (2021). The ethical conflict of truth, hope, and the experience of
suffering: A discussion of non-disclosure of terminal illness and clinical
placebos. Clinical Ethics, 16(2), 130–136.
https://doi.org/10.1177/1477750920959556
Grace, P. J., & Uveges, M. K. (2022). Nursing Ethics and Professional
Responsibility in Advanced Practice. Jones & Bartlett Learning.
Passini, L., Bouedec, S. L., Dassieu, G., Reynaud, A., Jung, C., Keller, M.-L.,
Lefebvre, A., Katty, T., Baleyte, J.-M., Layese, R., Audureau, E.,
&Caeymaex, L. (2023). Error disclosure in neonatal intensive care: A
multicentre, prospective, observational study. BMJ Quality & Safety.
https://doi.org/10.1136/bmjqs-2022-015247
Royce, C. S., Hayes, M. M., &Schwartzstein, R. M. (2019). Teaching Critical
Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic

8

Errors and Improve Patient Safety. Academic Medicine, 94(2), 187.
https://doi.org/10.1097/ACM.0000000000002518
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., &
Kroeker, K. I. (2020). An overview of clinical decision support systems:
Benefits, risks, and strategies for success. Npj Digital Medicine, 3(1), Article

1. https://doi.org/10.1038/s41746-020-0221-y
   Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. W. S. (2019). Practice patterns and
   role perception of advanced practice nurses: A nationwide cross-sectional
   study. Journal of Nursing Management, 27(5), 992–1004.
   https://doi.org/10.1111/jonm.12759

Sample Answer 2 for NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

In the case study provided for this assignment, an elderly male patient was admitted to the ICU after suffering a severe stroke that left him unresponsive and unable to talk. It was decided to mechanically ventilate the patient. Although the patient’s wife lacks advanced healthcare directives, she intuitively knows what the patient would have preferred, which is very different from the opinion of her adult daughter. While their daughter is adamant that her father would have desires to be supported in case there is any prospect of things becoming better, she is fairly certain that her husband might not want to live like this. The scenario’s ethical and legal ramifications for all parties involved are explained in this paper, along with methods for dealing with disclosure and nondisclosure issues and the decision-making process. 

Ethical and Legal Implications 

According to the scenario given, the patient suffered serious consequences as a result of the medication error, including a severe stroke that rendered him comatose. This case has several moral and legal ramifications. For instance, the prescriber can interfere with the patient’s right to self-determination (Ozeke et al., 2019). The concepts of beneficence and non-maleficence as well as disclosure and the right to information are additional ethical consequences. A malpractice lawsuit or the loss of the prescriber’s practicing license are other potential legal repercussions. Contrarily, the pharmacist is in charge of double-checking the prescription and notifying the prescriber of any medical errors so that the appropriate adjustments can be made. 

As a result, in the scenario described above, the pharmacist may also suffer legal repercussions, such as losing his or her ability to practice medicine. The medication error has caused the most harm to the patient. Despite being denied his right to information and self-determination, he is unconscious. But, by bringing a lawsuit or complaining to higher authorities about the medical error, his family members can fight for the patient (Samundeeswari, 2018). Yet, because there are no advanced directives, they are unable to make decisions on the patient’s behalf.  

Disclosure and Non-disclosure 

Hospitals in Massachusetts are required by law to submit what are termed “serious reportable events” (SREs) to the Health and Human Services Department of Public Health as part of an attempt to identify and track issues with the delivery of healthcare. Additionally,  disclosure of unexpected results with a substantial medical problem is necessary under the Massachusetts Health Payment Reform Act, which took effect in November 2012 (Olazo et al., 2022). The MA legal system, and particularly tort law, which allows individuals or organizations to be sued in civil court for negligence and recover damages, puts a lot of pressure on the medical system to acknowledge mistakes, reimburse victims, and make adjustments to prevent further errors. Not reporting medical mistakes is also against patient-centered ethics. For the corrective action to be undertaken, the provider must investigate the healthcare organization’s policy and rules on the disclosure of medication errors and discuss with the supervisor how to do so (Ozeke et al., 2019).  

Decision Making 

I will be required to inform my supervisor of the error before informing the patient’s family following the patient’s right to self-determination and awareness. The policy and procedures for disclosing medication errors set forth by the healthcare organization served as the basis for this judgment (Robertson & Long, 2018). My supervisor will therefore assist in determining the best course of action to pursue as well as any potential legal repercussions that may be connected to the mistake. Since the patient is unconscious, his family members will be informed of this information and the appropriate course of action will be implemented (Melnyk et al., 2021).  

Writing Prescriptions 

To ensure patient safety and prevent medication errors, prescribing medications requires a high level of knowledge and skills. To write a valid prescription, the prescriber must adhere to all informational standards. The following steps are crucial when writing a prescription. The initial step is gathering patient data, such as diagnosis and demographics (de Arajo et al., 2019). Providing your information as the prescriber is the second step. The name, dosage form, strength, and frequency of the medicine to be administered are determined in the third phase. It’s crucial to record the precise dosage of the medication that has been prescribed. The indication of use and the number of refills are provided in the fourth phase. The prescriber must then sign the document at the conclusion. Prescribers are urged to use automated provider order entry to reduce prescription errors.   

Conclusion 

To ensure patient safety, it is critical to take into account legal and ethical standards given that nurses have a rising extent of prescriptive privileges. As a result, prescriptive practice among RNs is governed by particular laws in each state. Similar to the case study under discussion, breaking such rules is unethical for the patient and may have legal repercussions for the prescriber.  

References 

de Araújo, B. C., de Melo, R. C., de Bortoli, M. C., Bonfim, J. R. de A., & Toma, T. S. (2019). How to Prevent or Reduce Prescribing Errors: An Evidence Brief for Policy. Frontiers in Pharmacology, 10. https://doi.org/10.3389/fphar.2019.00439 

Melnyk, B. M., Tan, A., Hsieh, A. P., Gawlik, K., Arslanian-Engoren, C., Braun, L. T., Dunbar, S., Dunbar-Jacob, J., Lewis, L. M., Millan, A., Orsolini, L., Robbins, L. B., Russell, C. L., Tucker, S., & Wilbur, J. (2021). Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors. American Journal of Critical Care, 30(3), 176–184. https://doi.org/10.4037/ajcc2021301 

Olazo, K., Wang, K., Sierra, M., Barr-Walker, J., & Sarkar, U. (2022). Preferences and Perceptions of Medical Error Disclosure Among Marginalized Populations: A Narrative Review. The Joint Commission Journal on Quality and Patient Safety. https://doi.org/10.1016/j.jcjq.2022.06.008 

Ozeke, O., Ozeke, V., Coskun, O., & Budakoglu, I. I. (2019). Second victims in health care: current perspectives. Advances in Medical Education and Practice, Volume 10, 593–603. https://doi.org/10.2147/amep.s185912 

Robertson, J. J., & Long, B. (2018). Suffering in Silence: Medical Error and its Impact on Health Care Providers. The Journal of Emergency Medicine, 54(4), 402–409. https://doi.org/10.1016/j.jemermed.2017.12.001 

Samundeeswari, A. (2018). Nurses’ Knowledge on Prevention of Medication Error. Journal of Medical Science and Clinical Research, 6(3). https://doi.org/10.18535/jmscr/v6i3.45 

Sample Answer 3 for NURS 6521 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

The promotion of safety and quality in the prescription of medications is imperative in nursing practice. Advanced registered nurses make treatment decisions based on best practices available and utilize interprofessional collaboration to optimize treatment outcomes. Therefore, this paper explores the ethics of prescribing a new drug, which has not been approved to a 7-year-old child for asthma.

Ethical and Legal Implications

The prescription of unapproved drug to the 7-year-old child is associated with significant ethical and legal implications to the nurses’ role in practice. First, the new drug has not been tested or approved for its efficiency and effectiveness in asthma treatment. The drug has also not been used in children under the age of 12 years. As a result, it raises the concerns related to the safety of the drug(Woo et al., 2019). The drug predisposes the 7-year-old to harm because of the lack of information about its safety in children below 12 years.

The prescription of the new drug to the 7-year-old violates the nurses’ code of ethics and standards of practice. Advanced registered nurses have the professional and legal responsibility of promoting safety, quality, and efficiency in their practice. They make decisions based on best available evidence, practice guidelines, and protection of the patient’s rights in the treatment process. The professional standards of practice require them to make decisions that minimize harm while optimizing treatment benefits(Grace & Uveges, 2022). The new drug has never been tested or studied to determine its safety and efficacy profile. Therefore, prescribing the drug will violate the stated codes of practice and ethics in nursing.

Strategies to Address Disclosure and Non-Disclosure

Disclosure and non-disclosure influence the actions that nurses implement in their practice. disclosure entails the provider informing the patient and their significant others about the events that have happened to them in the care process. Advanced practice nurses have the professional obligation to inform their patients about any health interventions implemented to promote their health and recovery. The code of ethics by the American Nurses Association requires that nurses should promote and advocate the patients’ rights, safety, health, and wellbeing(Passini et al., 2023). Non-disclosure entails not informing the patients about any events that have happened to them in the care process.

The state of California requires that healthcare providers to disclose any information that influences health and outcomes to the patients. The disclosure includes providing information about any error that has been made in the delivery of the care. The patient then makes the decision to either share the information with other people or not. The disclosure will also extend to the hospital’s management for the implementation of interventions that will minimize error occurrence in the future. Disclosure of information would promote patient’s autonomy, beneficence, and non-maleficence in the treatment process(Fairchild, 2021). Non-disclosure will translate into nurse’s lack of professional responsibility and negligence, which violates provision 3 of the American Code of Ethics for nurses.

Strategies to Guide Decision Making

One of the strategies that I will adopt to guide my decision-making is interprofessional collaboration. I will involve the other healthcare providers in assessing if we should prescribe the new drug to the 7-year-old. Interprofessional collaboration will ensure the collective examination of the potential alternatives that we may consider to optimize outcomes in the treatment process. Collaboration will also enable the team to examine any evidence that supports the use of the new drug in the treatment and potential risks if any(Donnelly et al., 2021). Therefore, interprofessional collaboration will ensure the adoption of an ethical and most relevant solution in the scenario.

The second strategy that I will use to guide my decision making is relying on the set organizational policies and guidelines. Health organizations have policies that guide nurses in making decisions. The guidelines limit the nurses’ involvement in activities that predispose patients to unintended harm. Relying on them will ensure that I make an informed decision about the issue(Grace & Uveges, 2022). I will disclose the error. As noted above, disclosure is crucial to promote the adoption of interventions that will minimize any harm. Disclosure will also ensure accountability and professional responsibility as an advanced practice nurse.

Process of Writing Prescriptions and Strategies to Minimize Medication Errors

Writing prescriptions should follow developed guidelines to minimize medication errors. One of the processes in writing prescriptions is writing clearly and accurately the patient’s data such as name, age, gender, and diagnosis. Information about the medication name should also be written clearly and accurately to avoid confusion. The prescriber should avoid abbreviations and illegible writing. The dosage information should be concise with clear and specific directions. The therapeutic duration of the drug should also be specific alongside the drug’s therapeutic intervention. Any supplemental instructions such as medication refill or warnings should also be included. The strategies that can be adopted to minimize medication errors include provider training and education about best practices, use of health technologies, double checking and encouraging open reporting of medication errors(Royce et al., 2019; Sutton et al., 2020).

Conclusion

The promotion of safety and quality in prescribing medications is important. I will disclose the medication error. The issue has significant and ethical implications to nursing practice. Advanced registered nurses should adopt best practices that minimize errors in their practice.

References

Donnelly, S., Ó Coimín, D., O’Donnell, D., Ní Shé, É., Davies, C., Christophers, L., Mc Donald, S., & Kroll, T. (2021). Assisted decision-making and interprofessional collaboration in the care of older people: A qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting. Journal of Interprofessional Care, 35(6), 852–862. https://doi.org/10.1080/13561820.2020.1863342

Fairchild, A. (2021). The ethical conflict of truth, hope, and the experience of suffering: A discussion of non-disclosure of terminal illness and clinical placebos. Clinical Ethics, 16(2), 130–136. https://doi.org/10.1177/1477750920959556

Grace, P. J., & Uveges, M. K. (2022). Nursing Ethics and Professional Responsibility in Advanced Practice. Jones & Bartlett Learning.

Passini, L., Bouedec, S. L., Dassieu, G., Reynaud, A., Jung, C., Keller, M.-L., Lefebvre, A., Katty, T., Baleyte, J.-M., Layese, R., Audureau, E., &Caeymaex, L. (2023). Error disclosure in neonatal intensive care: A multicentre, prospective, observational study. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2022-015247

Royce, C. S., Hayes, M. M., &Schwartzstein, R. M. (2019). Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Academic Medicine, 94(2), 187. https://doi.org/10.1097/ACM.0000000000002518

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. Npj Digital Medicine, 3(1), Article 1. https://doi.org/10.1038/s41746-020-0221-y

Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. W. S. (2019). Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study. Journal of Nursing Management, 27(5), 992–1004. https://doi.org/10.1111/jonm.12759

Prescriber

Ethical Implications:

• The prescriber must consider the principle ofbeneficence, which involves promoting the well-being of the patient. The new medication could potentially improve JJ’s condition, but it has not been approved for children under 12. The prescriber must weigh the potential benefits against the risks.
• The principle ofnon-maleficence, or “do no harm”, is also relevant. The prescriber must ensure that the potential harm of the new medication does not outweigh its potential benefits.

Legal Implications:

• Prescribing a medication that has not been approved for use in children under 12 could potentially lead to legal consequences if harm comes to the patient.

Pharmacist

Ethical Implications:

• The pharmacist also has a duty ofbeneficence and non-maleficence. They must ensure that the medication is dispensed correctly and that the patient and their family understand how to use it.
• The principle ofautonomy is also relevant. The pharmacist must respect the decisions of the patient and their family, provided they are informed and capable of making such decisions.

Legal Implications:

• The pharmacist could potentially face legal consequences if they dispense a medication that is not approved for use in children under 12 and harm comes to the patient.

Patient and Patient’s Family

Ethical Implications:

• The patient’s family must consider the potential benefits and risks of the new medication. They have a responsibility to make decisions in the best interest of the patient.
• The principle ofautonomy is also relevant. The patient’s family must be given all the necessary information to make an informed decision about the new medication.

Legal Implications:

• The patient’s family could potentially face legal consequences if they consent to the use of a medication that is not approved for use in children under 12 and harm comes to the patient.

In conclusion, all stakeholders must carefully consider the ethical and legal implications of using a new medication that has not been approved for use in children under 12. They must weigh the potential benefits against the risks, and ensure that all decisions are made in the best interest of the patient.

Strategies to address disclosure and nondisclosure

Disclosure

1. Informing about the New Medication: The first step would be to inform JJ’s parents about the new medication being developed. This should include details about the medication’s components, its potential benefits, and the fact that it has not been approved for children under 12.

“I would like to inform you about a new medication being developed that might help JJ’s condition. It’s a combination of a bronchodilator, steroid, and antihistamine. However, it’s important to note that this medication has not yet been approved for children under 12.”

2. Discussing the Risks and Benefits: The potential risks and benefits of the new medication should be clearly explained. This includes potential side effects, the possibility of the medication not working, and the potential benefits if the medication does work.
3. Explaining the Study: If the parents are interested, the details of the study should be explained. This includes the study’s purpose, procedures, potential risks and benefits, and the voluntary nature of participation.

Non-Disclosure

While full disclosure is generally the norm, there may be instances where non-disclosure could be considered:

1. If Disclosure Causes Harm: If it is believed that the disclosure could cause significant distress or harm to JJ or his parents, non-disclosure might be considered. However, this should be a rare exception and not the norm.
2. If Parents Explicitly Request Non-Disclosure: If JJ’s parents explicitly request not to be informed about certain aspects of the treatment or study, their wishes should be respected. However, it’s important to ensure they understand the potential implications of this decision.

In all cases, the guiding principle should be the best interest of the patient. It’s also important to remember that these strategies should be tailored to the specific circumstances and cultural, ethical, and legal context.

Two strategies

Strategy 1: Evidence-Based Practice

The first strategy to guide decision making in this scenario is the use of Evidence-Based Practice (EBP). EBP involves the integration of clinical expertise, patient values and preferences, and the best available evidence in decision-making for patient care. 

In this case, the new asthma medication is still under study and has not been approved for children under the age of 12. Therefore, it would be prudent to review the available research and evidence regarding the safety and efficacy of this medication in children. This can be done by:

• Reviewing the literature on the medication and its use in children.
• Consulting with colleagues or experts in the field.
• Considering the potential risks and benefits of the medication.

Strategy 2: Ethical Considerations

The second strategy involves considering the ethical implications of the decision. This includes considering the principles of autonomy, beneficence, non-maleficence, and justice.

• Autonomy: Respecting the patient’s (or in this case, the parents’) right to make informed decisions about their care. This would involve discussing the new medication, its potential benefits and risks, and the fact that it is still under study and not approved for children under 12.
• Beneficence: Acting in the best interest of the patient. If the current treatments are not working and the new medication has potential to improve the patient’s condition, it may be in the patient’s best interest to consider it.
• Non-maleficence: Avoiding harm to the patient. This involves considering the potential risks of the new medication and whether they outweigh the potential benefits.
• Justice: Treating patients equitably. This involves considering whether the patient would have access to the new medication and whether its use would be fair and equitable.

Regarding the disclosure of errors, it is generally considered ethical and professional to disclose medical errors to patients (or their parents, in the case of minors). This is based on the principles of honesty and transparency in healthcare. However, in this scenario, it is not clear what error is being referred to. If it is an error related to the patient’s treatment, it should be disclosed and discussed openly with the patient’s parents. 

In conclusion, the decision to use the new medication should be guided by the best available evidence and ethical considerations, and any errors should be disclosed in the interest of honesty and transparency.

The process of writing prescriptions, including strategies to minimize medication errors.

Writing Prescriptions

Writing prescriptions is a critical task that requires precision and attention to detail to ensure patient safety. Here are the steps involved:

1. Patient Information: Include the patient’s full name, date of birth, and address.
2. Medication Information: Write the name of the medication, strength, dosage, route of administration, frequency, and duration of therapy.
3. Dispensing Instructions: Specify the quantity of medication to be dispensed and any specific dispensing instructions.
4. Refill Information: Indicate the number of refills, if any.
5. Signature: Sign the prescription.

Strategies to Minimize Medication Errors

1. Use Generic Names: Always use the generic name of the drug to avoid confusion with brand names.
2. Avoid Abbreviations: Avoid using abbreviations that can be misinterpreted.
3. Specify Units: Always specify units of measure for doses.
4. Double-Check: Always double-check the prescription before handing it over to the patient.
5. Patient Education: Educate the patient about the medication, its purpose, how to take it, and potential side effects.
6. Electronic Prescriptions: Use electronic prescriptions whenever possible to avoid errors due to illegible handwriting.

Special Considerations for JJ

Given that JJ is a minor and the new medication has not been approved for children under 12, it’s crucial to proceed with caution. The medication should only be prescribed if the potential benefits outweigh the risks, and with informed consent from JJ’s parents or guardians. Regular monitoring should be done to assess JJ’s response to the medication and to detect any adverse effects early

Reference:

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

Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R. Z., Mohaini, M. A., Al Mutairi, A., Rabaan, A. A., Awad, M., & Al-Omari, A. (2021). The Effective Strategies to Avoid Medication Errors and Improving Reporting Systems. Medicines (Basel, Switzerland), 8(9), 46. https://doi.org/10.3390/medicines8090046

Aseeri, M., Banasser, G., Baduhduh, O., Baksh, S., & Ghalibi, N. (2020). Evaluation of Medication Error Incident Reports at a Tertiary Care Hospital. Pharmacy (Basel, Switzerland), 8(2), 69. https://doi.org/10.3390/pharmacy8020069

NURS 6521 Pharmacokinetics and Pharmacodynamics

I had a recent clinical experience where a patient of mine was sensitive to medications. She had recently had high blood pressure in the 200’s and acute kidney failure. She was given IV hydralazine and labetalol in the emergency room. She had a reaction to the medication and her heart rate dropped into the 20’s and she became unresponsive. The emergency room staff performed chest compressions and administered to the patient, and she was transferred to the ICU. 

A case study writes about adverse effects of hydralazine and notes “Hydralazine was chosen for its antihypertensive effect and 2 mg were administered intravenously (IV). Within a brief period of time (30-45 sec) the patient developed a profound bradycardia from 52-10 beats/min occasioned by premature ventricular contractions (PVCs)” (Wehner & Romanauskas, 1981). A different case study notes a similar adverse effect of labetalol, “She was thought to have an anaphylactoid reaction and was treated intravenously with fluids, diphenhydramine (50 mg), and methylprednisolone (250 mg), without initial improvement. While urinating in the bedpan, she developed bradycardia and hypotension, with a pulse of 30/min and a blood pressure of 60/40. Trendelenburg’s position and 2 L of normal saline were needed to restore her blood pressure to normal, although her bradycardia resolved spontaneously” (Ferree, 1986). 

This patient had orders to receive hydralazine IV to maintain a blood pressure of 140/80 so that she could have a kidney biopsy. “Most patients who undergo renal biopsy have hypertension, but hypertension is almost never considered a single or leading indication for biopsy” (Stompór & Perkowska-Ptasińska, 2020). 

I diluted the hydralazine and pushed it over 10 minutes minimum and monitored the patient closely. I checked her blood pressure 15-30 minutes after administration and monitored her heart rate. She did not have any adverse reaction to the hydralazine when I administered it. I instructed the patient to use her call light button if she had any strange reactions or felt odd. I kept the physician updated on the patient’s blood pressure and heart rate throughout the night. The patient was able to transfer to a medical-surgical floor for a lower level of care. 

References 

FERREE, C. E. (1986). Apparent Anaphylaxis from Labetalol. Annals of Internal Medicine, 104(5), 729–730. https://doi-org.ezp.waldenulibrary.org/10.1059/0003-4819-104-5-729_2  

Links to an external site. 

Stompór, T., & Perkowska-Ptasińska, A. (2020). Hypertensive kidney disease: a true epidemic or rare disease? Polish Archives of Internal Medicine, 130(2), 130–139. https://doi-org.ezp.waldenulibrary.org/10.20452/pamw.15150  

Links to an external site. 

Wehner RJ, & Romanauskas VS. (1981). An adverse reaction with hydralazine: a case study. AANA Journal, 49(3), 274–276.