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Medical Errors, Disclosures and Legal Outcome
Walden University
NURS 6521: Advanced Pharmacology
Date
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Introduction
Medication error is a significant cause of patient healthcare, yet it remains confusing and
underappreciated concept
This week’s scenario is:
"As a nurse practitioner, you recommend medication for your patients. You make a medical error
when prescribing medication to a young patient aged 5 years old. Instead of prescribing the
appropriate dose, you prescribe a dose suitable for an adult."
The Ethical and Legal Implications
In reference to Rosenthal and Burchum, (2018) you will take a great responsibility as a doctor
when you take care of patients. While you may know many medicines as a registered nurse or
other health care provider in your previous career, providing medications and prescribing
medication are two different things.
Ethical and legal implications on prescriber and pharmacist
Civil6actions,6criminal6charges6and6medical6discipline6may6be6common6consequences6for6doctors6
following6drug6errors.
According to Kachalia, Kaufman and Boothman, (2010) unsuitable prescribing of medication
that entails medication errors, is among the main reasons that results to nurses being sued for
medical malpractice (Kachalia, et al. 2010). According to Institute for Healthcare Improvement,
(2014) a third possible outcome of a medication error is a legal action by regulatory board. Each
state board of medical practice has exceptional administrative uniqueness.
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Ethical and legal implications on patient, and patient’s family
In order for a civil action against a health care provider to proceed, negligence has to have taken
place and failure has to lead to injuries in the patient. The aggrieved party must demonstrate that
there was a standard of care, that this standard was not adhered by the physician, that the result
was an injury, and that the breach caused the injury (Ladd & Hoyt, 2016).
Strategies to address disclosure and nondisclosure
From a physician's point of view, the disclosure of a medical error may cause fear, reproach, or
litigation. Medical error disclosure research has shown that there is variability in the physician
over which mistakes are to be disclosed (e.g. harm vs missing) and apologies are used (Mazor,
Reed, Yood, Fischer, Baril & Gurwitz, 2006). Alternatively, nondisclosure is reported to reduce
patients’ trust in physicians and amplify the likelihood they will alter physicians (Mazor, et al.
2006).
Full disclosure of errors has positive influence on the way a patient respond to a medical error
and on the patient and physician relationship.
Under Texas law, “informed consent” describes the physician's duty to unveil to the patient the
risks of medical care that would influence a person's decision to give or refuse to give consent to
that treatment.6 Article 4590i, Section 6.016et seq. of the6Texas Revised Civil Statutes
Annotated6regulates claims based on medical errors and patient informed consent. 6Under this act
or law, the Texas Medical Disclosure Panel was formed to assess medical and surgical measures
and determine whether disclosure is necessary for them. If disclosure is required, the panel
determines the form of disclosure that is needed.
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Strategies to guide decision making
As a nurse, medical errors are encountered nearly on daily basis. However, as a qualified
practitioner, I believe that errors should be disclosed to the patients on a regular basis.
It is discouraging to healthcare providers when medical errors occur. Health care providers
concerned in a medical error also report dissatisfaction for their failure to be competent. The first
strategy I would use as a nurse to guide my decision making in this scenario will entail analyze
the context in which the medical error occurred. I would then categorize the probable options for
rectification of the medical error. As a skilled nurse, I would disclose the medical errors to the
patient.
The process of writing prescriptions, including strategies to minimize medication errors
Because the root causes of medication errors are varied, several strategies are necessary to avert
them.
Drug Labeling
The use of drug labeling has been influential in avoiding medication errors.
Historically, poisons were kept in cobalt blue bottles labeled with warnings such as “POISON”.
The bottles had rough texture so that a pharmacist would have a tangible warning that the
contents were poisonous. The FDA is in progress of reviewing all drug names and work with
drug firms to choose names that would avert confusion (Rwin, Mearns, Watson & Urquhart,
2013). To help stop confusion with drug names that look similar, the FDA and Institute for Safe
Medical Practices has suggested the use of “tall man letters (Rwin, et al 2013). Tall man lettering
has the possible to alleviate medication errors for some of the most dangerous medications
encompassing pressers and oral hypoglycemic agents.
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Medication Reconciliation
A precise and complete medication list is often extremely useful when providing medical care to
a patient. Medication reconciliation is defined by the Institute for Healthcare development as “a
procedure of identifying the most precise list of all medications a patient is taking including
name, quantity, incidence, and routed and using this list to provide accurate medications for
patients everywhere within the health care system” (Institute for Healthcare Improvement, 2014).
Conclusions
Medication error is a significant cause of patient mortality, yet it is a confusing concept.
Common outcome faced by medical doctors after medication errors can encompass loss of
patient trust, legal actions, and medical board discipline.
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References
Institute for Healthcare Improvement. (2014). Medication reconciliation review.
http://www.ihi.org/knowledge/Pages/Tools/Medication ReconciliationReview.aspx.
Accessed March 17, 2014.
Institute for Healthcare Improvement. (2014). Medication reconciliation review.
http://www.ihi.org/knowledge/Pages/Tools/Medication ReconciliationReview.aspx.
Accessed March 17, 2014
Kachalia A, Kaufman SR, Boothman R, et al. (2010). Liability claims and costs before and after
implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213-
221.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice
providersn. St. Louis, MO: Elsevier.
Rwin A, Mearns K, Watson M, Urquhart J. (2013). The effect of proximity, Tall Man lettering,
and time pressure on accurate visual perception of drug names. Hum Factors. 2013;55(2):
253-266.
Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for
Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17
Mazor KM, Reed GW, Yood RA, Fischer MA, Baril J, Gurwitz JH. (2006). Disclosure of
medical errors: what factors influence how patients respond? J Gen Intern Med.
2006;21(7):704-710.
