The Ethics and Legalities of Medication Error Disclosure

Application: The Ethics and Legalities of Medication Error Disclosure
American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to
the error that counts” (Goodreads, 2012). Whenever you make an error when writing a
prescription, you must consider the ethical and legal implications of your error-no matter
how seemingly insignificant it might be. You may fear the possible consequences and feel
pressured not to disclose the error. Regardless, you need to consider the potential
implications of non-disclosure. How you respond to the prescription error will affect you,
the patient, and the health care facility where you practice. In this Assignment, you
examine ethical and legal implications of disclosure and nondisclosure of personal error.
Consider the following scenario:
You are working as an advanced practice nurse at a community health clinic. You make an
error when prescribing a drug to a patient. You do not think the patient would know that
you made the error, and it certainly was not intentional.
To prepare:
� 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
To complete:
Write a 3- to -4 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. My state is Texas
� 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

The ethics and legalities of medication error disclosure 2

The Ethics and Legalities of Medication Error Disclosure

Accidents are inevitable and so are mistakes, working with this reality then makes health
practitioners, patients, government agencies, communities and societies realize the severity of
mistakes that might cause loss of lives or permanent impairments. Such impairments are often
costly to the state, to the institution where the physicians work, to the government and it is even
more painful to the patient. As a result the ethical and legal liabilities against nurses have to be
weighed against the argument of negligence or mere accident but bearing in mind the physical
and psychological effect created on the patients who might be permanently maimed, it calls for
responsibility whereby the harsh realities fall back on the nurses. In medical practice, clinical
ethics describes a discipline that determines what ought to be done for the common good of the
society while law is often termed as an established set of rules that govern socializing, conduct
and non-conduct between patients and nurses failure to which civil or criminal liabilities are
charged against the offender (Tauber, 2005, p 37).
Disclosure of information with regard to medical errors is purely ethical but legally it is
contentious because at times legality does not rhyme with ethics. Likewise non-disclosure is
unethical yet it might be the only way to bypass legal barriers set by stringent laws against
medical errors. A dilemma is created while trying to strike a balance between ethics and legality
because the two have been known to overlap each other. In my opinion, being ethical is better
than following legal reparation since human life is prestigious. This brings in the question of
medical error disclose or nondisclosure.
Medical error disclosure is related to the two terms described above in the sense that it
determines medical principles underlying risk management which can be regulated through;

The ethics and legalities of medication error disclosure 3

policies, training, practice and professionalism (Beauchamp and Childress, 2001, p 43). With the
ideals on risk management there is a need for informed consent incase an advanced practice
nurse realizes that she has made an error. From the given case study, it is often said “better late
than never” this means that owing up to a mistake made might help in preventing life changing
circumstance and uncertainties likely to be noted during advanced stages of medication. This is
because the severity of an overdose or a wrongly prescribed drug might catch up with the patient
later on during the medication process and this will demand that legal steps are followed.
Once more, some mistakes are very hard to run away from. For instance, a postmortem
indicating a drug overdose will call for intelligence investigation on the medical prescriptions
administered to the patient after which severity of the medicine will be calculated and in the
instance that it is identified that the prescription is the reason behind the death then liability will
be taken against the nurses responsible for the undisclosed prescription errors. This means that
disclosure is a better remedy than disclosure since sooner or later the mistakes are bound to catch
up with the person who committed them. With the dire severity that might come with
undisclosed, there emanates the need for utmost honesty while communicating with patients and
their relatives (Tauber, 2005, p 32). Honesty is ethically imperative even if legal measures will
be taken against the advanced practice nurse but it is better because it will serve her conscience
According to The University of Washington School of Law (2010), good interpersonal
skills and honest communication between the patient and the advanced practice nurse will help
eliminate possible misunderstandings or conflicts in healthcare. It will also help reducing the
likelihood that a patient will seek legal redress after realizing that the drugs were wrongly

The ethics and legalities of medication error disclosure 4

prescribed. From the case, I would disclose the error to the patient with immediate effect seeking
advice from the department head in relation to the matter. The reason why nurses fear disclosure
is first because of the risks involved when a patient decides to use the statements in order to file
malpractice lawsuits. Secondly the patient might seek for compensation or make claims against
the medical service providers. An increase in such claims will affect the credibility of the
facility, and this will have the overall impact of reputation and insurance cover policies.
The Texas state has reinstated stringent rules and regulations to guide the delivery of
medical services by advanced practice nurses involved in medical suits regarding medical errors
and disclosure. The Non-Disclosure Agreement is a legal document that is binding between a
nurse and the employer or it might be between the patient and the nurse (Epstein, 2009, p 4). The
Texas legal system has been known with its rationality in handling disclosure in medical errors
whereby a mistake done by a nurse is punishable only to some certain degree. Whereas other
states advocate for apology to the patient then a disclosure after which the patient is compensated
as a way of reducing legal claims, the Texan legal system has acted in such a way to protect the
interest of both the nurses and the patients. This is so because mistakes are inevitable and with
such a reality there is need for compromise unless it is identified that the nurse is entirely to
The other reason for flexibility in the legal system is to encourage nurses to practice
professionalism and make informed consent while administering medical procedures (Lakhan,
Hamlat, McNamee and Laird, 2009, p 99). This is to mean that in Texas, a nurse or the provider
is allowed to apologize to the patient, after which the medical error can be reported. This denies

The ethics and legalities of medication error disclosure 5

the patient the right to use the information to make legal claims on the ground that the nurse was
liable for the medical error.
With technology there are computerized prescriptions which are more accurate and
precise but there are circumstances where written prescriptions are inevitable. Every state has its
regulations regarding writing of prescriptions which means that there is no one standard way of
writing prescriptions but universally it is required that the information should be clearly written,
legible and should indicate the name of the drug (Aronson, 2006, p 34). In addition a local
language is preferred. The prescriber should write his or her name and address with a telephone
number in case the pharmacist issuing the drugs needs clarification. The date of prescription and
the strength of the drug should also be written. It is in order for the prescriber to acquire
information through systems designed to report errors. This could be done by use of automation
or computerized prescription. Also, the prescriber’s knowledge can be improved through
education and subsequent use of on-line aids. Medical facilities could use feedback control
systems to monitor effects caused by intervention.

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Aronson, J.K (2006). A prescription for better prescribing. New York: ClinPharmacol, PubMed

Beauchamp, T. L. & Childress, F. (2001). Principles of Biomedical Ethics. New York: Oxford
University Press.

Epstein, S. (2009). Inclusion: The Politics of Difference in Medical Research. University of
Chicago Press.

Lakhan, S & Hamlat, E. & McNamee, T. & Laird, C. (2009). Time for a unified approach to
medical ethics. Philosophy, Ethics, and Humanities in Medicine

Tauber, A. I. (2005). Patient Autonomy and the Ethics of Responsibility. Cambridge: MIT Press.

The University of Washington School of Law. (2010). How to Research a Legal Problem: A
Guide for Non-Lawyers. Washington: American Association of Law Libraries.