The administration of medical prescriptions by nurses to patients is a topic that should be understood by all aspiring professionals. There are various ethical, professional, and legal issues to be considered before nurses can prescribe drugs to patients. Besides, these requirements differ from state to state and, therefore, stakeholders may find the issues difficult to comprehend. This paper explains the ethical and legal implications of the scenario selected in this case study, the steps involved in prescribing medications, strategies to address disclosure and nondisclosure as well as those that advanced practice nurses can use to guide decision making during drug prescription.
The chosen case study is related to the independent prescribing concept that governs the abilities of advanced practice registered nurses to prescribe medication, controlled substances, and other medical equipment and devices. This prescriptive authority also advices professionals on whether APRNs need to be in collaboration with their supervisors. The state of Maryland allows Certified Registered Nurse Practitioners (CRNPs) to offer medical prescriptions to patients. However, there are various legal and ethical factors to be considered before a certified nurse can write prescriptions for friends and family. Medical professionals often find themselves in such dilemmas and it is therefore prudent that they understand the stakes involved.
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Maryland allows nurses to prescribe medication to patients as long as they adhere to the terms found within written agreements with their supervisory physicians. The forms can be retrieved from the Maryland Board of Nursing and nurses can use this form to gain authorization ( Buppert, 2009) . In the agreement, a nurse needs to indicate what population a patient belongs to and describe the nature of their nursing practice. In consideration of the current case study, therefore, the nurse should ensure that they are authorized by both the physician and the Maryland Board of Nursing. A failure to follow these guidelines may put both the nurse and the physician at risk of prosecution.
In terms of ethics, the nurse should aim to put the health of the patient at the forefront. In nursing practice, there is a code of ethics that guides how every nursing profession should show commitment to the nursing practice by following ethical obligations. The code of ethics is a commitment to society. Therefore, the nurse in the current case study should strive to first understand the patient’s medical history before giving the prescription. Additionally, the nurse has to follow all the steps involved in prescribing medications as will be discussed in the next section.
The Steps Involved in Prescribing Medications
Pollock, Bazaldua, and Dobbie (2009) recommend an eight-step approach meant to guide medical professional when giving out drug prescriptions to patients. Initially, a medical professional needs to understand and evaluate the problem that the patient suffers from. About the current scenario, understanding the patient’s medical history ought to be the first step. Secondly, the authors recommend that medical practitioners should strive to understand the specific therapeutic objectives of the prescription. That is, helping the patient to identify how the prescribed medication will help the patient get better. The third approach should focus on selecting the most appropriate drug therapy concerning the patient's conditions. This means that the practitioner should only prescribe drugs that will lead the patient towards recovery and not otherwise.
The fourth step is the initiation of drug therapy by offering the patient with the required details. However, the practitioner should also consider other non-pharmacologic methods of treatment. After that, the patient should be advised on how best to use the medication. The practitioner should, hence, provide sufficient information including administration instructions and cautions. It is also advised that a patient makes regular visits to the physician to enable evaluative procedures. During this stage, nurses are advised to make appropriate considerations including discontinuation of the therapy when it is not working. The seventh step in the recommended approach involves researching the costs of the medication to avoid delays where patients lack medical cover or the required resources.
The final step involves the use of information technology to minimize prescription errors. Being one of the most important steps during prescription, professionals are encouraged to incorporate the use of computers to maintain awareness on new forms of drug therapies, to gain access to certified guidelines from medical authorities, and to learn from evidence-based sources on how best to improve the prescription process in the future.
Strategies to Address Disclosure and Nondisclosure in Maryland
In such a scenario, the best thing would be to notify the patient’s family of the medical error, to notify the rest of your medical care team, and making relevant documentation to aid future remedies. Nursing professionals who make medical errors have an ethical duty towards the patient’s family. It has been found that making full disclosure to the family reduces the probability of a civil suit against the professional ( Secemsky, 2013 ). Secondly, by notifying the rest of the healthcare team of medical errors, practicing nurses can ensure that no further mismanagement is experienced. Additionally, making proper documentation and alerting the authorities helps improve a patient’s well-being. Maryland has a Public and Private Policy concerning the reporting and disclosure of medical errors. However, reporting of the error in the case scenario would be important if t led to adverse effects on the patient.
Strategies to Guide Decision Making In Such a Scenario
As a nurse, it is important to note that medical errors are part of everyday practice. Pharmacists and physicians too can make medical errors. Therefore, in such a scenario, it is important to maintain calm and implement a good strategy. It is also prudent to make full disclosure of the error to avoid putting the patient risk of medical complications, or yourself and the affiliated physician at risk of prosecution.
To avoid such an error in the future, one of the most crucial factors in ensuring that there is adequate communication between all the parties involved. Anderson (2017), alludes that most medication errors are caused by miscommunication and, hence, the elimination of communication barriers is key to their avoidance. As a nurse, it would have been important to first ask the patient to provide sufficient medication history including the names of medical professionals she has relied upon in the past. Secondly, consulting with a physician would have been important. The physician needs to know the various steps being taken by their PA regarding the administration of medication to patients.
An alternative strategy that I will implement in the future will be ensuring that I keep up to date with emerging internal and external medication errors. The study of such updates will ensure that I understand what is required of me in such a scenario. Additionally, it will be important to gain an in-depth understanding of procedures, policies, and protocols that should be followed when a nurse makes a medication error.
In conclusion, certified nurses may experience medication errors in the course of their duties. As a professional, it is important to understand the various legal and ethical implications of making such errors. Although the state of Maryland allows nurses to make prescriptions, understanding a patient’s medical history and consulting with a certified physician is key. Finally, is recommended that nursing professionals implement preventive strategies such as efficient communication and staying up to date with emerging medical error issues.
References
Anderson, P. (2017, September 22). Medication errors: Best Practices. Retrieved from https://www.americannursetoday.com/medication-errors-best-practices/
Buppert, C. (2009, November 5). Can the NP Write a Prescription For Someone Who Is Not a Patient?. Retrieved from https://www.medscape.com/viewarticle/711575
Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing , 20 (2), 1-10.
Pollock, M., Bazaldua, O. V., & Dobbie, A. E. (2009). Appropriate prescribing of medications: An eight-step approach. Am Fam Physician , 75 (2), 231-6.
Secemsky, B. J. (2013, September 16). What to do after you make a medical error. Retrieved from https://www.kevinmd.com/blog/2013/09/medical-error.html
