As depicted in the very famous words of the 18th Century poet Alexander Pope, it is human to error. Nurses are not an exception to this general rule despite meticulous attention, great skill, and years of experience. Among the fundamental elements of the reaction to the error is the decision on whether to disclose the error to the patient or not. Medical errors by nurses fall under the provisions of the Federal Food, Drug, and Cosmetic Act (FD&C Act) as enforced by the National Coordinating Council for Medication Error Reporting and Prevention, the National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA) itself (Westrick & Jacob, 2016). If the error involves prescription of drugs, it may fall under several federal and state laws as codified by the Drug Quality and Security Act (DQSA) of 2013. The ethical and legal issues emanating from errors entail the scope of the error, the aftermath of the error, and the reaction of the professional to the error.
Generally, the legal implications of any activity are premised on whether or not the activity itself is discovered. Ethics however, are not subject to discovery but are always in application. Therefore, the ethical implications of non-disclosure of a material error are immediate double-jeopardy (Westrick & Jacob, 2016). A disclosed and explained error will almost cure any ethical implications but non-disclosure makes even the most innocent error a breach of ethics. Regarding legal implications, disclosure reduces legal liability whether criminal or civil, but increases the chances of being sued. Non-disclosure on the other hand creates double-jeopardy and eliminates any chance of using error as a defence (Westrick & Jacob, 2016). The intentional act of non-disclosure establishes malice to the chain of events and exponentially increases liability to the individual nurse and the institution. If the practitioner happens to be a senior nurse, the vicarious liability to the institution increases (Westrick & Jacob, 2016).
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As a practicing nurse, if I would realize a material error in the course of duty, my immediate action would be to inventory the magnitude of the error and whether delay exacerbates it. If the effects are exacerbated by delay, my immediate recourse would be to immediately seek to mitigate the effects of the error. The second step would be to record the procedure followed when the error happened so as to have a clear understanding of the error. Finally I would find out if the error has legal implications on the institution and I as a senior nurse. If there are no legal implications, it becomes purely a matter of ethics and I would make full disclosure with an apology forthwith. If however, there is the issue of vicarious liability, it immediately becomes an administrative issue. I would, therefore, follow the laid down procedure including reporting to my immediate supervisor or a union representative. This will enable mitigation of individual as well as institutional legal liability.
However, to reduce propensity for prescription errors, FDA has come up with a bar-code based labeling system whose particulars were published in February 2004 (U.S. Food and Drug Administration, 2015). The system provides for the issuance of a bar-coded identification with access to the IT system to every patient upon entry into a medical institution. Every nursing station visited by the patient will have a computer with a scanner connected to the hospital’s IT system. The nurse will, therefore, use the scanner to access the prescriptions and use this when giving any medication to the patient (U.S. Food and Drug Administration, 2015).
Whereas it is impossible to eliminate errors in any field, extreme and meticulous attention should be paid to reduce their occurrences. Further, it is vital to seek to mitigate the effect of any errors made upon discovery. From an ethical perspective, every error made must be disclosed with due apology as soon as practically possible. This is however, subject to the legal and administrative policies of the institution the nurse is serving under. With the current tort law and class action regimen, a mishandled nursing error can bring down an entire institution through aggravated damages.
References
U.S. Food and Drug Administration. (2015). Strategies to reduce medication errors: Working to improve medication safety . Retrieved from <http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143553.htm/>
Westrick, S. J., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12 (2), 120-126.
