*Consider the ethical implications of disclosure and nondisclosure.
*Research federal and state laws for advanced practice nurses. *Reflect on the legal
implications of disclosure and nondisclosure for you and the health clinic.
*Consider what you would do as the advanced practice nurse in this scenario including
whether or not you would disclose your error.
*Review the Institute for Safe Medication Practices website in the Learning Resources.
Consider the process of writing prescriptions. Think about strategies to avoid medication
errors.
**Write a 3-page paper that addresses the following:
-Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to
reference laws specific to your state.
-Describe what you would do as the advanced practice nurse in this scenario including
whether or not you would disclose your error. Provide your rationale.
-Explain the process of writing prescriptions including strategies to minimize medication
errors.
***Use current resources of less than 5years old.
Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you.
American Nurse Today, 5(3), 23-28.
The Ethics and Legalities of Medication Error Disclosure
Introduction
Medical errors are ranked as the fifth cause of death in the United States and lead to costs of
$29 per year (Pal, 2009). This paper examines the ethical and legal implications of disclosure
and non-disclosure of errors and what an advanced practice nurse should do in case of an
occurrence of a medical error. The paper further explains the process of writing prescriptions
including strategies to minimize medication errors.
- The ethical and legal implications of disclosure and nondisclosure
Within the medical profession, the practice of non-disclosure is an ethical doctrine that brings
into question the fundamental principles of fidelity, beneficence, non-malfeasance, and
autonomy between the nurse-patient relationships (Edwin, 2009). As a fiduciary relationship, the
healthcare provider owes the patient the duties of candor, confidence, trust, and faith. Non-
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disclosure deprives patients of their right to have control over their own healthcare information,
and the right to be aware of their diagnosis and prognosis and make treatment decisions.
According to the American Medical Association Code, the relationship between the patient and a
healthcare provider is essentially based on moral principles arising from the necessity to care for
patients and to alleviate suffering (Pal, 2009).
The ethical principle of non-malfeasance obligates health care providers not to inflict harm
on patients (Edwin, 2009). Medical errors threaten the basis upon which generations of
healthcare providers have practiced and continue to practice medicine. Although the error may
be harmful to the patient, failing to disclose the error to the patient becomes an ethical wrong.
This is because a prolonged suffering by the patient due to the error may cause the patient to be
affected psychologically as he / she is unable to know what is happening. Since most patients
seek to know about even minor errors, non-disclosure breaches the ethical principle of fidelity.
Owing to the fact that the core of the doctor-patient relationship is honest communication, a
healthcare that deceives his patient not only damages the genuineness of the individual
healthcare provider, but also imputes serious doubt on the trustworthiness of all medical
practitioners.
Studies show that most medical errors arise from systemic flaws and not mistakes by
individual healthcare providers. Examples of systemic flaws include inadequate labeling of drug
interactions and poor communication between the various healthcare providers. In New Jersey,
the Patient Safety Act of 2004 changed the approach towards the handling of medical errors and
adverse health events. The Act imposed a legal duty on healthcare providers to disclose errors to
patients or their surviving family members in the event of death. New Jersey’s legislation falls
under ‘apology laws’ which have been adopted by most states in the United States. Full
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disclosure of an error involves a description of the error, acceptance of liability, and an apology
(Pal, 2009).
Apologies often have negative financial effects to the hospital because it may be compelled
to compensate the patients or families in case of admission of a medical error. This makes most
insurance companies, hospital administrators, and attorneys to advise health care providers to
avoid apologizing for medical errors. On a positive side, an apology is therapeutic in the sense
that it decreases anger and restores the dignity and respect of the patient, and prevents
antagonistic behaviors. Despite all the controversies surrounding the disclosure and non-
disclosure of medical errors, ethicists have endorsed the full disclosure of medical errors to
patients (Pal, 2009).
- What I would do as the advanced practice nurse in this scenario and whether I would
disclose the error
In case an error occurs while administering medications on a patient, I would disclose the
error to the patient or the surviving family members in case of an occurrence of death. It is
important to disclose the error so that a root cause analysis can be carried out to avoid future
occurrence of a similar event. Though the admission of the error may open a door for litigation,
it is better to disclose the information to the patient and let them know the cause of their
suffering than cause the psychological torture. However, sometimes it may be compelling to
avoid admitting an error in a case where such admission will lead to disciplinary action by the
state board of nursing, criminal or civil charges, mental anguish, and job dismissal (Pal, 2009). - The process of writing prescriptions and strategies to minimize medication errors
Prescription errors include illegible details, incorrect doses, and inappropriate medication
orders. While prescribing medication, the healthcare provider should seek all relevant
MEDICAL ERRORS 4
information about the patient such a medical history. The next step is to check for any filled
information about the patient, and whether there are any inconsistencies. The provider should
correct the correct drug, and be sufficiently knowledgeable about the uses and effects of that
particular drug. The prescription should be properly recorded, and if handwritten, it should be
legible. The drug should be double-checked before being administered. There are various
strategies that a nurse should apply in order to minimize the occurrence of errors. This will
include avoiding the use of workarounds to bypass safety systems, reading the back and
verifying medication orders given over the phone or through verbal means, asking a colleague to
double-check the medication while administering high-alert drugs, assessing, and becoming
familiar with the hospital’s list of abbreviations for prohibited medications and tools. Nurses
should be encouraged to use the safety practices within the facility, avoid distractions while
preparing and giving medications, and have sufficient knowledge of the drug being administered
(Anderson & Townsend, 2010).
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References
Anderson, P. & Townsend, T. (2010). Medication Errors: Don’t Let Them Happen to You.
American Nurse Today, 5(3).
Edwin, A. K. (2009). Non-Disclosure of Medical Errors an Egregious Violation of Ethical
Principles. Ghana Medical Journal, 43(1): 34-39.
Pal, N. (2009). To Tell or Not to Tell.