Ethical and Legal Implications of Prescribing Drugs

Ethical and Legal Implications of Prescribing Drugs

Scenario 2:

A friend calls and asks you to prescribe medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

While some practitioners can prescribe drugs to their friends and family members, this is often seen as ‘not a good idea’. The regulations and laws differ from one state to another. Some states expressly forbid physicians and authorized healthcare workers from prescribing to kin and friends, while some states simply advise against the action. There is an ethical problem because the close relationship between a practitioner and the patient can cloud the practitioner’s judgment. Depending on the state, the nurse practitioner can face legal action for prescribing the medication to a friend. If the state requires that the NP has a collaborative relationship with a physician, then the prescribing authority is limited to the practice setting. Writing a prescription when the NP is under a collaborative relationship will result in legal action against the NP (Manworren & Gilson, 2015). On the other hand, where the NP has an independent practice, then prescribing the medication would result in focusing on the patient’s best interest and whether the local ethics boards have opinions on the issue. The defense, in this case, is difficult to determine.

Strategies to Address Disclosure and Non-disclosure

Ethics statements by the American College of Physicians and American Medical Association and others, warn relationships between patients and physicians can be complicated because of pre-existing emotional and social relationships. The statements recommend that physicians first look for other alternatives of care or refer the patient to other providers and only take care of kin and friends when there are no other options. In such cases, expectations need to be set when it comes to friends and relatives, and the NP should put every effort into treating these with the same professionalism as would with other patients. The insurance plans and medical boards may have guidelines that govern such relationships. Nonetheless, where there are concrete regulations, a physician ought to decide on themselves what the appropriate boundaries are. The key issue is whether the NP is able to maintain objectivity, confidentiality, and professional judgment. If this is not possible, the NP will be best suited by steering the patient to another source of care.

Additionally, state laws require that physicians use prescription drug monitoring programs, or PDMPs in analyzing the use of prescription drugs by patients (Haffajee, Jena, & Weiner, 2015). This should be done before the NP prescribes any other drug and, more so, for highly addictive drugs such as OxyContin, Vicodin, and Percocet.

Explain Two Strategies That You, As an Advanced Practice Nurse, Would Use to Guide Your Decision Making and Whether You Would Disclose Your Error.

The first strategy is to establish what the friend’s current medical conditions are, the current drug history, and if she is taking any over-the-counter drugs. Doing so will ensure that the friend is not over-prescribed and feeding a drug addiction. Also, this will help the NP to determine which appropriate drug to prescribe, one that will not have negative interactions with any existing drugs that the patient may be taking. The second strategy is to carry out an adequate assessment in identifying the probable cause of the medical condition. The NP will need to do a physical exam to determine the medical condition before prescribing the drug.

The NP should report the medication error if it results in an adverse event. However, if the patient does not have any effect, then the NP will not report the incident. In addition, the NP should ask the patient to visit the clinic within 24 hours for assessment to ensure that the patient does not suffer any negative effects of the prescription.

Explain the Process of Writing Prescriptions, Including Strategies to Minimize Medication Errors.

The first step will be to evaluate and clearly define the problem of the patient. The NP needs to define the problem clearly, which will lead to a management course that is more appropriate. The second step is to specify the objectives of therapy as those will allow the physician to prescribe to a goal that is clear with the expected outcomes. Thirdly, the appropriate drug therapy should be selected. The WHO guide (De Vries, Henning, Hogerzeil, and Fresle 1994) proposes that a physician should develop personal drugs formulary (P-drugs). P-drugs are inexpensive, effective, and well-tolerated drugs prescribed regularly by physicians in the treatment of common problems. Fourthly, the NP initiates appropriate details in therapy and also considers non-pharmacological therapies. The prescriptions should be clear and written in plain English, which is legible to all. The fifth step is to give information, warnings, and instructions to the patient. The NP ought to educate the patient on the expected outcomes, intended use, and potential side effects of the prescribed medication. The sixth step is to carry out a regular evaluation of the therapy. The NP should systematically review the medications at every patient visit as this will allow the NP to monitor the effectiveness of treatment and minimize problems, and more so in elderly patients who are highly susceptible to the negative effects of polypharmacy. The seventh step is considering the cost of drugs when writing a prescription; the NPs should ask the patient whether they have a medical prescription card as this can help in avoiding any delays in initiating therapy and formulary conflicts. The last step is the use of computers and tools that can help in reducing prescription errors. The optimal use of the seven steps requires that the NP has a working knowledge of the most current medications and is up-to-date on new drugs.

References

De Vries, T. P. G., Henning, R. H., Hogerzeil, H. V., Fresle, D. A., Policy, M., & World Health Organization. (1994). Guide to good prescribing: a practical manual (No. WHO/DAP/94.11). World Health Organization.

Haffajee, R. L., Jena, A. B., & Weiner, S. G. (2015). Mandatory use of prescription drug monitoring programs. Jama, 313(9), 891-892.

Manworren, R. C., & Gilson, A. M. (2015). Nurses’ Role in Preventing Prescription Opioid Divers. The American journal of nursing, 115(8), 34-40.

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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.

Ethical and Legal Implications of Prescribing Drugs

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.