THE ETHICS AND LEGALITIES OF MEDICATION ERROR DISCLOSURE1
The Ethics andLegalities of Medication Error Disclosure
In America, more than one million preventable adverse effects happenannually in healthcare facilities. Out of this number 44,000-98,000cases result in the death of the patient (Edwin, 2011). While themajority of healthcare practitioners believe that medication errorsshould be disclosed, in reality, most institutions and doctors do notreveal information about mistakes originating in the course oftreatment to their patients. This paper maintains that medicationerrors should be disclosed to the affected individuals.
According to the American Medical Association Principles of MedicalEthics, doctors should ensure that they are honest in all theirprofessional interactions with their clients (Edwin, 2011). Consequently, a physician who hides a medication error violates theethical principles that governs the medical fraternity. Under theprinciple of beneficence, the patient’s interest comes first. Assuch, failing to disclose information emanating from the treatmentprocess, a healthcare practitioner would be putting his/her interestabove that of his/her patients.It is, therefore, crucial thatdoctors exercise moral courage for them to do the right thing whenfaced with a personal dilemma where the health of a patient is atrisks.
The doctor-patient relationship is fiduciary in nature which meansthat it must be governed by the principles of justice, autonomy,beneficence, and non-maleficence at all times (Edwin, 2011). Underthe principle of autonomy, a patient has the right toself-determination which means that medication errors should bedisclosed to the affected individuals to allow them to make decisionson what to do. The principle of nonmaleficence forbids health carepractitioners from inflicting harm on others which make nondisclosureof medication errors unethical. According to Edwin (2011),institutions should facilitate doctors to reveal medication errors byputting in place guidelines and policies aimed at ensuring thatimportant information is not withheld from the patients regardless ofthe consequences. Besides, health care practitioners should betrained on how to disclose medical errors as well as on approachesthey can use to provide emotional supports to their colleagues whomake mistakes in the course of providing medications to patients.
Compensation, retribution and accountability are the major goalsguiding most legal actions taken against doctors and health carefacilities who make medication errors. According to MacDonnell &Guenther (2013), in 8 States, full disclosure is protected, butadmissions of fault are not. On the other hand, 28 States haveprohibited the expression of sympathy from being used in the trialagainst the concerned doctor or health care facility (MacDonnell &Guenther, 2013). In Massachusetts, cases of medication errors aredealt with by the Apology Laws. These laws allow doctors or healthcare clinics to apologize to the victims of their errors and not tohave their words used to criminalize them in the event that a case isbrought to the court concerning the mistakes in question (Mass.Const. Chap, 233. Sec. 79 L).
If I were the advanced practice nurse in the case scenario, I woulddisclose the mistake to the affected individuals. The reason for thedisclosure of a medication error in case it ever happened is becausethe benefits of revealing it outweigh any possible detriment. It isonly best to admit that a human being is not perfect and disclosingthe error is one way of acknowledging this fact. Additionally,revealing the error will give the patients a chance to seek redress.Some of the errors can be rectified by assessing the healthimplications the mistake had on the patient. After the assessment,proper diagnosis can be made and the right medication issued toaddress the health consequences of the medication error. For some ofthe errors where nothing or little can be done to correct themistake, informing the patients about the mistakes will allow him/herto seek for compensation. Some errors have lifetime implications,such as paralysis or even death, which means that the patients orimmediate victims need to be helped to continue with their livesafter the mistakes.
After choosing to disclose the error, the next step that I would takeis to ensure that the patient and his/her family understand that themistake was not intentional. According to Edwin (2011), poorcommunication after the occurrence of a medication error is the majorfactor that results in the patients choosing to sue the concerneddoctor. The second step would be to ensure that the patientunderstands the ramifications of the medication error I made tohim/her and his/her family.
Prescriptions refer to the instructions from a prescriber to adispenser. From the beginning, one must ensure that the instructionsare legible and that the local language is used if possible. A healthcare practitioner is legally obligated to write clearly. The effectsof poorly written prescriptions can be lethal (Institute for SafeMedication Practices, 2016). Secondly, the prescriber should includehis/her name, address, and telephone number. This makes it easy forthe pharmacist to reach out to him/her in case he/she has any queryabout the particulars of the prescription.
Also, the person writing the instruction must include the date of theprescription. In most jurisdictions, there is no limit for thevalidity of a prescription although, in other countries, pharmacistsare barred from issuing drugs when the date when the instructionswere issued is more than three months ago. The other element thatmust be present in a prescription is the name and strength of thedrug. The letter “R” in a prescription stand for Recipe which isa Latin word meaning “take”. The letter “R” should befollowed by the name of the drug as well as its strength. On thisnote, prescribers are required to desist from using the proprietaryname of a drug. This prevents them from recommending a certain drugbrand which may be unnecessarily expensive to the patient. However, ahealthcare practitioner may feel obligated to prescribe a specificdrug brand and in this case, he/she should indicate its trade name onthe prescription. However, this should be followed by either"dispense as written" or "do not Substitute." Thestrength of a drug provides information on how many milligrams arerequired for each tablet. When indicating the strength of the drug,the prescriber should use internationally approved abbreviations suchas “ml” for milliliter and “g” for gram.
Besides, the prescriber should try as much as possible not to includedecimals. Instead, he/she should write the words in full to eliminateany possible misunderstandings. For example, instead of writing 0.050milligrams, one should write levothyroxine 50 micrograms. Writing inwords prevents any possible tampering of the instructions. Awell-written prescription should include information to be includedon the package label. On this note, letter “S” stand for Sigmawhich is a Latin word which means “to write." The pharmacistis required to write the information following letter S onto thelabel of the drug’s package. Such information includes the amountof the drug to be taken, how often, as well as the specificdirections and warnings (Institute for Safe Medication Practices,2016). When writing this information, the health care practitionershould use simple language without any abbreviations and statementssuch as “as directed” and “as before."
In conclusion, medication errors result in the death of manyAmericans while a large number of the victims suffer permanent damageto some of their organs. Failing to disclose these errors isunethical as it goes against the principles of honesty, integrity,beneficence, and autonomy that guide the medical fraternity. MostStates protect physicians and healthcare facilities that disclose themistakes and seek to remedy the situation. To avoid the errors,prescriptions must be legible and contain all essential elements.Besides, abbreviations and decimals should be avoided at all timeswhen writing prescriptions.
Edwin, A.K. (2011). Non-disclosures of medical errors an egregiousviolation of ethical principles. Ghana Medical Journal, 43(1).
Institute for Safe Medication Practices. (2016). Key element III:Communication of Drug Orders and other drug information.” AccessedSeptember 9, 2016.https://www.ismp.org/communityRx/aroc/files/KEIII.pdf
Mass. Const. Chap, 233. Sec. 79 L. Accessed on September 9, 2016.https://malegislature.gov/Laws/GeneralLaws/PartIII/TitleII/Chapter233/Section79L
McDonnell, W. M. & Quenther, E. A. (2013). “Narrative review:do state laws make it easier to say “I’m sorry?”https://psnet.ahrq.gov/resources/resource/8830