Strategies to Minimize Medication Errors

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.  It was discovered that the stroke was the result of a medication error. 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.

• 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.
• 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.
• Introduction and conclusion

Introduction:

The scenario presented involves AC, a 72-year-old male who has suffered a massive stroke due to a medication error. He is currently unresponsive and on a ventilator. The ethical and legal implications in this situation are significant, particularly regarding the stakeholders involved: the prescriber, pharmacist, patient, and patient’s family. Additionally, the issue of disclosure and nondisclosure arises, as well as the role of the advanced practice nurse in decision-making and the process of writing prescriptions while minimizing medication errors.

Ethical and Legal Implications:

1. Prescriber: The prescriber, who may be a physician, is responsible for prescribing the medication. In this case, there may be ethical and legal implications for the prescriber if the medication error was due to negligence or failure to follow appropriate prescribing practices. The prescriber could face legal consequences and professional repercussions.
2. Pharmacist: The pharmacist plays a crucial role in dispensing medications and ensuring patient safety. If the medication error occurred at the pharmacy level, the pharmacist may face legal and ethical implications for dispensing the wrong medication or an incorrect dosage. Like the prescriber, the pharmacist could face legal consequences and professional sanctions.
3. Patient: AC, the patient, is directly affected by the medication error. He has suffered a massive stroke and is now unresponsive and on a ventilator. The patient’s well-being, autonomy, and quality of life are at stake. The ethical question arises as to what extent medical interventions should be pursued in light of his current condition and the potential for recovery.
4. Patient’s Family: The patient’s family, including his wife and daughter, are also stakeholders in this situation. The wife believes her husband would not want to live in his current condition, while the daughter holds a different opinion and wants to pursue all possible interventions. The ethical dilemma centers around honoring the patient’s autonomy and making decisions in his best interest, taking into account his values and wishes.

Strategies for Disclosure and Nondisclosure:

Disclosure and nondisclosure should be approached with sensitivity and adherence to legal requirements, which may vary by state. In this scenario, it is essential to consider the laws specific to the state in which the healthcare provider practices. However, some general strategies can be applied:

1. Disclosure: If the error is discovered, open and honest communication with the patient’s family is crucial. The healthcare provider should explain the situation, the potential cause of the error, and the implications for the patient’s condition. Discussions should focus on the patient’s prognosis, treatment options, and the potential benefits and risks associated with each option.
2. Nondisclosure: In some cases, nondisclosure may be necessary if the error would not significantly impact the patient’s care or prognosis. However, this should be approached cautiously, and healthcare providers should seek legal guidance to ensure compliance with applicable laws and regulations.

Strategies for Decision Making as an Advanced Practice Nurse:

1. Ethical Decision-Making: As an advanced practice nurse, two strategies to guide decision-making in this scenario are: a) Utilizing an ethical framework, such as the four principles approach (autonomy, beneficence, non-maleficence, justice), to analyze the situation and consider the best course of action for the patient’s well-being. b) Engaging in interdisciplinary collaboration by consulting with other healthcare professionals, including physicians, pharmacists, and ethicists, to ensure a comprehensive approach to decision-making.
2. Error Disclosure: Disclosing the error is an ethical and professional obligation. Openly acknowledging the mistake, explaining the circumstances, and expressing remorse can help establish trust and facilitate a collaborative decision-making process with the patient’s family. Disclosing the error can also contribute to systemic improvements and prevent similar errors in the future.

Process of Writing Prescriptions and Strategies to Minimize Medication Errors:

The process of writing prescriptions involves several critical steps to ensure patient safety and minimize medication errors. Strategies to minimize errors include:

1. Accurate Medication Reconciliation: The healthcare provider should gather complete and up-to-date information on the patient’s current medications, including prescription drugs, over-the-counter medications, and supplements, to avoid potential drug interactions or duplications.
2. Use of Electronic Prescribing Systems: Electronic prescribing systems reduce the likelihood of errors by providing automated checks for potential drug interactions, allergies, and appropriate dosages. They also facilitate legible and standardized prescriptions.
3. Clear Communication: Prescribers should use clear, unambiguous language when writing prescriptions, including specifying the medication name, dosage, route of administration, and frequency. Avoiding abbreviations and ambiguous terminology reduces the risk of misinterpretation.
4. Verification and Double-Checking: Healthcare professionals, such as pharmacists, should verify the accuracy of the prescription and double-check for potential errors before dispensing the medication. This serves as an additional safety measure to catch any mistakes.

Conclusion:

The ethical and legal implications of a medication error resulting in a stroke have significant consequences for all stakeholders involved. Strategies for disclosure and nondisclosure should be guided by legal requirements and ethical considerations. As an advanced practice nurse, using ethical decision-making frameworks, engaging in interdisciplinary collaboration, and disclosing errors are essential strategies in guiding decision-making. Minimizing medication errors requires accurate reconciliation, utilizing electronic prescribing systems, clear communication, and verification processes. By addressing these aspects, healthcare professionals can strive to ensure patient safety and promote optimal care in medication management.