The Process of Writing Prescriptions and Strategies to Manage Medication Errors

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NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

Assignment: Ethical and Legal Implications of Prescribing Drugs
Assignment: The Process of Writing Prescriptions and Strategies to Manage Medication Errors.

Medications are used for used for treatment, prevention and control of various diseases processes, regardless of how careful the prescriber may be, errors may occur. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs Many preventable medication errors are said to frequently occur at the prescribing stage, due to errors in medication selection, dosing (Sabatino, Pruchnicki, Sevin, Barker, Green & Porter, 2017). Prescribing error is believed to be the most serious type of medication error (Acheampong, Anto & Koffuor, 2014), with legal consequences including civil actions, medical or Nursing board discipline and, or criminal charges. To prevent medication errors at this stage, education and knowledge on safe prescribing is paramount for all prescribers, from physicians to advanced nurse practitioners. Any error in prescribing phase could lead to serious harm to patients (Velo & Minuz, 2009), errors in dose selection omitted transcripts or poorly written scripts are typical examples. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

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Ethical and Legal Implications of Writing Prescriptions.

The responsibility of prescribing medications to patients is an honor, and guided by state laws hence every prescriber (physician or advanced nurse practitioner), must be cognizant of the obligation to safely and effectively prescribe medications while having sound knowledge of disease processes and medications to manage them (Rosenthal & Burchum, 2018). For the advanced nurse practitioner to have the legal authority to prescribe medications, she must have been declared competent by the national accrediting board to do so, these authorities vary by states and class of drugs involved (Rosenthal, & Burchum, 2018) NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs. It is therefore wise for a prescriber to be prudent in decision making, for patients’ safety and protection of professional license. Some states, like Texas, where I practice require APRN to prescribe under the supervision of a physician, who possess full prescribing authority.

Strategies to address Disclosure and Nondisclosure

It is believed that 70% of medication errors resulting in adverse effects are caused by prescription errors (Velo & Minuz, 2009), which can be prevented if detected on time. The term medical errors encompass all errors by healthcare providers, but most claims for damages are directed to physicians, or hospitals and rarely against other health care providers (Guillod, 2013). It is estimated that about 10% of adverse events leads to a patient’s death, with nearly 50,000 to 100,000 people dying from medical errors in the United States (Guillod, 2013). Most health care professionals face the dilemma to or not disclosure medical errors, but an advanced nurse practitioner need be aware of her state’s prescribing guidelines and practice laws. In state of Texas, APRN, has limited prescribing authority (Rosenthal, & Burchum, 2018). Disclosure of errors and adverse events are considered reportable by several State and Federal organizations (Agency for health research & quality.gov, 2019). The Joint Commission now requires full disclosure of unanticipated health outcome of care, and the national quality forum accepting full disclosure of serious unanticipated outcomes as one of it’s 30 safe health care practices (AHRQ, 2019), with inclusion of safe practices, standards of care for health care practitioners as key elements of disclosure. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

Strategies Guiding Decision Making

Errors in prescribing may result from erroneous writing while prescribing fault may arise from irrational prescribing, careless prescribing, overprescribing, under prescribing or ineffective prescribing, all arising from poor medical judgement or decision making in treatment (Velo & Minuz, 2009). It is wise to check, and use stated prescribing guidelines for managing specific disease and symptoms (Rosenthal, & Burchum, 2018). When in doubt of what to prescribe, make use of current guidelines, according to disease condition, age and comorbidities, and availability of medication (Rosenthal, & Burchum, 2018). It is recommended to start low, and increase slowly especially when prescribing for the elderly, the very young or expectant women. Bearing in mind kidney and liver functions slows down with age, altering metabolism and elimination of medications (Mayor, 2017).

                                     Process of Writing Prescriptions

The process of writing prescription is complex, the first step is to form a relationship with the patient, get to know them and their disease processes, age, current weight and height to ensure accurate medication calculation, allergy history, other medications taken including over the counter medications (Rosenthal, & Burchum, 2018). Prescribers are advised not to attend to family members or friends, as emotions may alter their judgement leading to medication errors.

Certain medications require prior authorization from future scripts, to ensure the most clinically appropriate medication is been prescribed, at the lowest cost-sharing available (Futurescripts.com, 2020). This is common when new drugs are used to prevent medication errors. The prescriber must abide by the United States food and Drugs Administration (FDA), guidelines, regarding age and gender limits. Certain drugs meant for females only (prenatal vitamins), may not be prescribed for boys non medications for use for people over 14yrs, like ciprofloxacin (Futurescripts.com, 2020). The prescribing must bear in mind, the patients ’liver and kidney functions as most drugs are excreted through these avenues. Use of abbreviations in prescribing must be avoided, no trailing zeros, and check for need for medication monitoring for certain drugs like coumadin, lithium or opioids. The prescribing pads must bear the prescriber’s full name, address, title, name of medication, reason, quantity, and number of refills (Rosenthal, & Burchum, 2018). If no refill is needed, until drug level is monitored, follow up appointment need be made with patient before dispensing the medication. Patient education provided to ensure compliance (Thornton, 2016).

Strategies to Minimize Medication Errors.

Interventions aimed at reducing medication errors at prescribing stage is essential, with focus education and continued orientation of prescribers coupled with online aids (Velo & Minuz, 2009). The use of system-oriented interventions like use of automated prescribing model and prescription charts has proven effective in reducing medication errors (Velo & Minuz, 2009). The use of regular internal audits by pharmacists is recommended to minimize prescribing errors too. The use of patient’s photo on screen during order entry is an initiative used by some hospitals, the display of patient’s full name, matching them with exact location, and the prompting of re-entry of names with identification number before finalizing entry are measures to prevent prescribing errors (Thornton, 2016). Involving pharmacists in the early stages of prescribing is another measure to curb medication errors at this stage, and the implementation of frequent educational sessions with physicians and students on correct and latest prescribing procedures are key measures to prevent medication errors (Acheampong, Anto & Koffuor, 2014) NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs.

References

Acheampong, F., Anto, B. P. & Koffuor, G.A. (2014). Medication safety strategies in hospitals-A systemic review. Httpts://eds-b-ebscohost-com-ezp.waldenulibrary.org/eds/pdfviewer/

Agency for healthcare research & quality.gov (2019). Disclosure of errors. Https://psnet.ahrq.gov/primer/disclosure-errors.

Futurescripts.com. (2020). Safe prescribing procedures. Https://www.futurescripts.com/resources/safe-prescribing-opoids.html NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

Mayor, S. (2017). Pharmacokinetics: optimizing and effective prescribing safe and effective prescribing. Https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1551

Rosenthal, L.D & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Sabatino, J.A., Pruchnicki, M. C., Sevin, A, M., Barker, E., Green, C.G., & Porter, K. (2017). Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students. Https://oce-ovid-com.ezp.waldenulibrary.org/articles/0174002-201705000/html

Thornton, P. (2016). Medication safety. Https://eds-b-ebscohost.com-ezp.waldenulibrary.org/eds/pdfviewer/pdfviwewer/

Velo, G. P., & Minuz, P. (2009). Medication errors: prescribing faults and prescription errors. Https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723200/ NURS 6521 WEEK 1 Assignment: 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? NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

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

Photo Credit: Getty Images/Caiaimage

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. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs

To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs
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. NURS 6521 WEEK 1 Assignment: Ethical and Legal Implications of Prescribing Drugs
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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.

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