Loyalty versus Patient Safety

Nurses are charged with the responsibility of providing quality healthcare and safety for the patients. Health facilities have adopted Health Information Technology systems to ensure efficient and effective delivery of services (Felkey & Fox, 2015). These systems can also bring about negative outcomes as a result of errors. Felkey & Fox (2015) stated that these errors are usually as a result of omission or commission. Errors of omission are those that are brought about by the failure of a health practitioner to carry out a certain activity. Errors of commission on the other hand are those that occur as a result of an action that the healthcare worker undertakes. As a result, ethical issues can arise from omission or commission especially in wrong medication administration. Lang (2014) stated that patients are given medicine so as to improve their health conditions and also to assist them to recover completely. A patient’s recovery process is dependent on receiving the correct medication in the right dosage. 1.5 million people in Boston are affected by mistakes in medication resulting into serious conditions and deaths that could have been avoided (Lang, 2014). Administration of wrong medication to patients has resulted into an ethical dilemma among the healthcare workers. These errors can occur as a result of negligence, inability to read a prescription due to ineligible handwriting, missing some information and the selection of wrong drugs (Lang, 2014). Felkey & Fox (2015) observed that any erroneous entry into the Health Information Technology system will lead to an error in medical care. Hence an error in the spelling of a drug name will result into the wrong medication being administered to the patient.  Due to the assumption that technology cannot make mistakes healthcare workers have become complacent ( Felkey & Fox, 2015). The healthcare workers administer the services without questioning the information received leading to erroneous medication in some instances. Following the discovery of such an error, the health practitioner can decide to overlook the mistake and keep quiet. This could lead to the deterioration of the patient’s condition and in some instances death. In future, the same error could occur as there will be no controls in place. In another instance, the person who discovers the mistake can decide to confront the nurse who had made the mistake and stop the wrong medication and try to cover up the error. The patient’s health condition can become worse at times resulting into fatality. Such a decision also presents an opportunity for the error to occur again. The third decision that the healthcare worker can make is to inform the patient and his family about the error that has occurred. The healthcare team will also be notified of the error and the hospital administration. The error will then be documented by the healthcare worker. In this scenario, the patient and his family will be able to make decisions from an informed point as they are aware of all the necessary information. The healthcare team will be guided on how to handle the negative outcomes of the error and prevent more mismanagement of the patient’s condition. Documentation of the error will avoid further complications to the patient’s care and reporting to the hospital administration will lead to the improvement in the hospital’s safety measures.  The decision on whether to report the error of wrong medication can be analyzed using the virtue ethics approach. McGonigle & Mastrain (2018) viewed virtues as the desirable characteristics in others that can be taught. This theoretical theory therefore looks at the character of the individual who is making a decision. This theory assumes that once individuals are taught about the norms and expectations from them, then they will be able to rectify their behaviors as they consider the impact of their actions. This is however subjective as people naturally tend to make decisions that will not cause harm to themselves even if it means harming the other party.  The conduct of healthcare workers handling the Health Information Technology systems is guided by a code of ethics. The code of ethics considers autonomy, equality and justice, beneficence, non-maleficence and integrity in the healthcare professionals’ actions (International Medical Informatics Association, 2013).  By keeping quiet about the incident, the healthcare worker will be going against these principles by interfering with the patient’s right to justice and autonomy in decision making. The healthcare worker will also be causing harm to the patient. There will also be room for a repeat of the error in future. The second case scenario would also have the same effects on the concerned parties. In addition, the action would lead to jeopardizing the security of the patient. International Medical Informatics Association (2013) prohibited health professionals from losing, using, manipulating and degrading any patient information. Informing the relevant parties and recording of the error would save the patient’s life, enable the patient to access justice if he pursues the case legally, the health worker will also be upholding their integrity and controls to prevent similar future errors will be put in place by the hospital administration. When a patient’s life is threatened due to administration of wrong medication, it is the responsibility of the whole healthcare team to save the patient despite the consequences. The health worker should inform the patient and his family, the health care team, the hospital administration and prepare a report on the error. Medical practitioners are required to report any medical error by their code of ethics (International Medical Informatics Association, 2013).The healthcare worker should ensure that the patient’s health improves and the health condition managed despite the repercussions on the erring nurse and hospital at large. The nurse who committed the error should own up to the wrong doing and take liability despite the consequences so as to ensure that she does not commit the same error in future. While the hospital and the healthcare team responsible for the patient’s health risk legal actions, they should inform the patient and face the repercussions so as to ensure that controls are put in place to prevent such occurrence in future. Felkey & Fox (2015) observed that while the use of technology will always result into emerging risks, the potential benefits outweigh the risks. Following the decision to disclose information on the medication error, the patient and his family will be taken through a counseling session. They will be informed on the causes and consequences of the error. They will also be informed on the need for additional medical care so as to manage the negative outcome of the error. The patient will be able to seek for justice for the negative outcomes while at the same time make decisions on what actions to take next with the consequences in mind (International Medical Informatics Association, 2013). The nurse who committed the error will also be taken through counseling so as to understand the consequences of her error. The healthcare team of the department including the nurse will be taken through training so as to learn how to manage the patient’s current medical condition. The nurses and other department team charged with the responsibility of transferring data from patient files to electronic media will undergo a training so as to avoid such errors in future. Felkey and Fox (2013) recommended a regular review of Information Technology in order to detect errors and arrest them. The hospital administration will evaluate the hospital’s Health Information Technology system and incorporate controls that detect errors early before they occur. The hospital legal team will also prepare itself for legal action in case the patient decides to look for legal redress. Some funds will also be set aside for compensation purposes in case the court directs the hospital to compensate the patient. Felkey & Fox (2015) observed that human beings are bound to make mistakes at one point or the other. However, the health workers should be able to recognize that they have limits in terms of competence and therefore seek for guidance when necessary while at the same time taking responsibility for their actions (International Medical Informatics Association, 2013). When a patient is exposed to wrong medication therefore posing a risk to one’s health, it is important for the healthcare workers to take liability for the negative health outcomes that the patient experiences. Lang (2014) observed that errors relating to medicine administration can be minimized by involving the patient. The patient should then be involved in the selection of the best possible medication process so as to avert the condition. The hospital should also allow the patient to seek legal redress if they desire and compensate them if need be. Health Information Technology should also be reviewed to ensure such errors do not occur in future. In conclusion, healthcare workers should exercise care when handling patients’ information as a single error can result into negative outcomes at times fatalities. Despite these negative outcomes, healthcare workers should make decisions concerning the matter while putting the code of conduct that is in place guiding their actions and decisions.

References

Felkey, B.G & Fox, B.I. (2015), Health information technology risks, external threats and human complacency, Hosp Pharm, 5 (6) 550-551 International Medical Informatics Association (2013), The IMIA code of ethics for Health Information professionals, retrieved from http://www.imia-medinfo.org/new2/pubdocs/Ethics_Eng.pdf Lang, B.D. (2014), Understanding the cause and effects of medication errors, Anesthesia & Medication Errors, retrieved from https://www.lawdoctors.com/blog/2014/08/understanding-the-cause-and-effect-of-medication-errors.shtml NcGonigle, D & Mastrian, K.G. (2018), Nursing informatics and the foundation of knowledge (4th ed), Burlington, MA: Jones and Barlett Learning, LLC