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?

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.

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.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

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

This article provides NPs with information regarding state-based laws for NP prescribing.

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. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Required Media (click to expand/reduce)

Introduction to Advanced Pharmacology
Meet Dr. Terry Buttaro, associate professor of practice at Simmons College of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse. (8m)
Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Nature Video. (2016). The evolution of oral anticoagulants [Video]. https://www.youtube.com/watch?v=Gp-ucDRiaUA
Note: This media program is approximately 5 minutes.

Speed Pharmacology. (2015). Pharmacology – Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.

Speed Pharmacology. (2017).  Pharmacology – Diuretics (Made Easy) [Video]. https://www.youtube.com/watch?v=9OBvNpnS0h4&t=664s
Note: This media program is approximately 18 minutes.

Speed Pharmacology. (2017). Pharmacology – Antiarrhythmic Drugs (Made easy) [Video]. https://www.youtube.com/watch?v=9xSqezCMHnw&t=1205s
Note: This media program is approximately 23 minutes.

Speed Pharmacology. (2015). Pharmacology – Pharmocokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Note: This media program is approximately 14 minutes.

Speed Pharmacology. (2016). Pharmacology – Adrenergic receptors & agonists (MADE EASY) [Video]. https://www.youtube.com/watch?v=KtmV-yMDYPI&t=372s
Note: This media program is approximately 18 minutes.

Speed Pharmacology. (2017). Drugs for Hyperlipidemia (Made Easy) [Video]. https://www.youtube.com/watch?v=Of1Aewx-zRM&t=24s
Note: This media program is approximately 14 minutes.

pls use three resources for this assignment

• For this assignment, consider the concept of interprofessional teamwork and patient outcomes.
  • Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.)
  • Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)
  • iCARE components are:
    • C ompassion
    • A dvocacy
    • R esilience
    • E vidence-Based Practice (EBP)
  • How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?

1. Select one scholarly nursing article from CINAHL as a resource for your paper.
   • Additional scholarly sources can be used but are optional.
   • When searching in the CINAHL database, please limit your search word to one component of the paper you wish to emphasize, such as ‘Resilience’.  Searching for the term iCARE will not produce the results you need.
2. Elements of iCARE paper
   • Title page
   • Below are the headings to be used for this assignment. 
     • Introduction: (No heading needed here in APA) Explain the type of work setting you are discussing and whether interprofessional teams are currently present. If interprofessional teams are present, indicate a team function that could be improved. If interprofessional teams are NOT present, indicate what type of team you think might be possible in the setting.
     • Describe a nursing action item for each component below that could contribute to: interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.
       • Compassion
       • Advocacy
       • Resilience
       • Evidence-Based Practice
     • Summary: Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes. Address how you may be able to influence this process of support for interprofessional teams overall in your unit or organization.
     • References: List any references used in APA format.

I need a response to the following 2 peers

Peer 1

 

Elements of Malpractice in Nursing

A nursing intervention may result to a medical error, and this error may occur due to the nurse’s failure to competently treat a patient. This occurrence constitutes a case of malpractice, and it is associated with various elements including negligence. As one of these elements, negligence involves failing to follow the due clinical procedures or directives for performing an intervention. This is noticeable in a scenario where a nurse, instead of examining a patient and performing diagnosis tests, puts a patient on a medication regimen (Cheluvappa & Selvendran, 2020). This amounts to negligence because the nurse fails to perform diagnosis, which is necessary to inform the kind of treatment to administer.

Breach of duty, still, is an element linked to the act of malpractice. It is characterized by a provider failing to meet the required standards of caring for patients. A nurse has a duty of preventing injury of the patient by administering the correct medication. If a nurse receives instructions from a physician to administer a certain medication, and the nurse instead of administering the medication, administers another medication that serves the same purpose, this amounts to breach of duty (Kim, 2017). This is because they go against the physicians’ decisions to have the patient receive a particular treatment that might be less risky. 

Cases of malpractice can be costly to the nurses and the organizations they work for, and this warrants the need for nurses as well as hospitals to prevent these cases. For nurses, adopting measures or practices such as documentation medical information in clear and accurate manner, can help limit their risks of making mistakes. Being consistent in observing the protocols of administering care, still, can limit the occurrence of negligence (Hågensen et al.,2018). 

PEER 2

 Advanced nurse practitioners work in complex healthcare environment vulnerable to malpractice lawsuits. Over the past years, malpractice lawsuits have increased as healthcare consumers become informed (Myers, Sawicki, Heard, Camargo Jr & Mort, 2020). Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. it is a subset of tort law that deals with professional negligence. Professional negligence is defined as conduct that fall short of a standard by a reasonable professional (Cooper, 2016). Negligence can be a result in diagnosis errors, errors in treatment, aftercare, or management. The four core elements of medical malpractice personal injury include duty, breach of duty, damage, and cause (Joel, 2017). For a patient to claim malpractice, they must demonstrate that a healthcare practitioner owed them a duty to care. Duty of care is based on nurse-patient or physician-patient relationship. The healthcare practitioner who had the duty of care must have failed n their duty by not exercising the expected degree of care that another professional in the same capacity and specialty would have used in an equal situation. In this case, an expert must testify as to what constitutes appropriate standard of care. The expert must hold the same or higher qualification in the same field or be a professional or regulatory body. The patient must demonstrate that the breach of duty resulted to damage, including emotion or physical injury. The breach of duty may cause a new injury or worsen an existing injury. Finally, it must be proven beyond reasonable doubt that the breach of duty by the practitioner caused the injury. For instance, the patient or plentiful must demonstrate that a medical error led to injury or harm.  

The professor has made new comments on the project and it requires for the comments to be incorporated into the project. You can also see the professor’s comments in the attached 10 Strategic Points.

Areas Needing corrections are as follows: It must be updated in the 10 Strategic Points and in the main project ATTACHED.

1. Interventions

a. This has to be for Diabetes. Currently, it is not the right methodology

b. The intervention is what will be done for each patient which should be based on educating the patients on lifestyle changes. It should be like this: –

i. Diet Teaching Education- what type of education will be used for teaching the patients. Where are you going to get the materials from? You must explain the Therapy in full. This must be rearranged in the project.

2. Lifestyle Changes Education must be addressed as follows: –

a. Discuss Medication Nutrition Education Therapy in full

b. Discuss Medication Adherence Education in full

c. It must specify Disease Education on Diabetes

d. It must indicate who is doing it e.g. RN, Nurse Practitioner etc.? How are they doing it? How long is it going to take or for long?

3. You must indicate what the expected result is going to be. 

4. How do you plan to measure Medication Adherence and the tools that will be used to measure it.

5. The Problem Statement must now change based on these new listed additions. It must start with “It is not known the extent to which………………

6. SAMPLE:

a. Explain why you are picking the specific number of patient population

b. Use population of adults 18 and above. Don’t limit to 45 and older.

7. Inclusion Criteria

a. Adult 18 – above with Type 2 Diabetes

b. It should state who identified it in the home health setting such Physicians since they are the ones that refer patients to the home health care for non-compliant or non-adherent to medication

8. Exclusion Criteria

a. It should state that you will exclude patients with cognitive impairment

9. Data Collection and Data Analysis

a. You must adjust both of them by using an existing method of Data Collection-please, do not make up your own

Please make corrections in all the chapters including 1, 2 and 3.

APPENDIX A is the 10 Strategic Points

PLEASE DO NOT INCLUDE THE CRITERION TABLES.