Ethical and Legal Implications of Prescribing Drugs

Assignment 2: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

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As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. CORE SKILL: locating the specific ETHICAL PRINCIPLE and the specific LEGAL RULE at stake — not gesturing at “ethics” in general.
THE SCENARIO TYPES this assignment uses and what each raises: prescribing errors; disclosure of an error to a patient; prescribing for a family member or oneself; a colleague’s impairment; a patient requesting a drug that isn’t indicated; off-label prescribing; controlled-substance diversion; pharmaceutical industry gifts and conflict of interest; prescribing across state lines / telehealth licensure.
ETHICAL FRAMEWORK: the four principles (autonomy, beneficence, nonmaleficence, justice) plus VERACITY (truthfulness) and FIDELITY. The ANA Code of Ethics — cite the actual provision, not the document generically (Provision 3 covers advocacy and patient protection; Provision 4 covers accountability and responsibility for practice).
THE ERROR-DISCLOSURE QUESTION, since it’s the most common scenario: the ethical answer is DISCLOSURE, grounded in veracity and autonomy — and the evidence supports it pragmatically too. “Apology laws” exist in most states (rendering expressions of sympathy inadmissible), and communication-and-resolution programs (the University of Michigan model is the standard citation) show that HONEST DISCLOSURE PLUS APOLOGY REDUCES litigation and cost rather than increasing it. Clinicians’ intuition here is backwards, and saying so with evidence is a strong move. Distinguish DISCLOSURE (to the patient — a duty) from REPORTING (to the institution/incident system — also a duty, but a different one), and connect to JUST CULTURE: distinguishing human error (console and support), at-risk behavior (coach), and reckless behavior (discipline). Punishing honest error destroys reporting and therefore destroys safety.
LEGAL LAYER — be specific: state Nurse Practice Act and the SCOPE OF PRACTICE it defines; prescriptive authority (full, reduced, or restricted practice authority — VARIES BY STATE, and naming your state’s actual status is what the rubric wants); collaborative practice agreements; DEA registration and controlled-substance schedules I–V; PRESCRIPTION DRUG MONITORING PROGRAMS (mandatory query in most states); the Controlled Substances Act; HIPAA; and malpractice elements — DUTY, BREACH, CAUSATION, DAMAGES (all four required; a breach without causation is not malpractice, and students routinely omit causation).
OFF-LABEL PRESCRIBING: legal and common; not FDA-approved for that indication but not prohibited. The obligations are (1) an evidence basis, (2) DISCLOSURE to the patient that use is off-label, and (3) documentation of the rationale.
STRATEGIES TO PREVENT ERRORS — go beyond “be careful”: avoid dangerous abbreviations (the ISMP “do not use” list — U for units, QD, trailing zeros); use TALL-MAN LETTERING for look-alike/sound-alike drugs; independent double-checks for high-alert medications; CPOE with clinical decision support; MEDICATION RECONCILIATION at every transition of care (the single highest-yield intervention); teach-back with the patient; and awareness of ALERT FATIGUE, which undermines the very decision support meant to protect you.