Disclosure and Nondisclosure in Medical Care

Introduction

Administration of medication is a complex process that entails prescription, transcription, dispensing, administering of the drugs as well as monitoring of the patient’s response. During the process errors may occur at any step.  These errors are costly as patients may die in the process or permanent injuries may occur and is estimated to cost the American public close to $3.5 billion in terms of lost productivity and additional medical expenses. Moreover, medication administration errors account for 32 percent of total medication errors.

Through reporting of errors, systems problems are possible to detect with regard to reports of errors that cause harm to patients, errors that may occur but may not harm the patient, or errors that may have caused harm to the patient but were luckily noticed and reduced before they could reach the patient. Medication errors arise from miscommunication the healthcare practitioners therefore, communication barriers should be eliminated and drug information verified on all occasions (Hannawa et al., 2013). 

Ethical and Legal Implications of Disclosure and Nondisclosure.

It is recommended that competent communication should follow rules and norms as well as achieve the intended goals (Martinez et al., 2014). Moreover, disclosure of competent error requires that healthcare givers have the motivation, knowledge, and skills to disclose an error they have made appropriately and effectively to the patient, without fear of litigation or being reported to the public registry. Healthcare providers have an ethical obligation to disclose their responsibility to patient in a manner that they communicate honestly, show respect, and provide further medical care. 

Additionally, they have a duty to self to maintain a sense of duty and accountability, integrity, and a desire to empathize as well as do the right thing in their profession. They too have a duty to share the lessons they have learned, strengthen trust and serve as role model. Nurses have an ethical obligation to their community to enhance the health of future patients and nurture a doctor–patient relationship, and thus help patients understand complex causes of errors (Hannawa et al., 2013). Disclosing errors to patients enhances a sense of relief after disclosing an error to the healthcare provider. 

Studies have shown that patients are less likely to seek litigation if a healthcare giver shows themselves to be nonverbally involved during an error disclosure. Healthcare workers should disclose the information and in the process offer an apology to the patient to avoid legal action. This stems from the legal protection in the framework of the recently advanced apology laws, since patients have repeatedly identified providers’ failure to apologize as one of the main reasons for filing a law suit (Hannawa et al., 2013).

With respect to autonomy, patients need to have full access to all information related to their health and medical care. Non-maleficence dictates that the healthcare giver’s obligation not to injure or harm patients and to refrain from actions that would harm them. This makes subsequent nondisclosure conduct maleficent. Disclosure of errors that are based on the ethical principle of non-maleficence have to facilitate transparent reporting to the institution, and effectively and appropriately communicate with the patient or the patient’s family in order to prevent any additional avoidable harm (Martinez et al., 2014).

Beneficence is a moral principle in disclosure of information that requires that one has to help others by preventing harm, removing it, and doing the general good. It therefore requires the practitioner to balance the benefits against risks and costs (Martinez et al., 2014). Moreover, the inherent inequitable distribution of power in the provider-patient relationship is susceptible to the ethical principle of justice. Healthcare givers have the power to prescribe medications, describe patients as noncompliant, and refer to failures as complications.

The practitioners may abuse this power thus hiding the information to avoid confrontation and disclosure of medical errors. Practitioners should use the principle of justice to disclose medication error information to patients or their families. Legally, patients and healthcare providers are required to respect the law, though there might arise conflicts between legal and ethical standards. Legal standards demand that disclosure of errors be made, although the ethically recommended disclosure content is not sufficiently defined and protected by the law (Martinez et al., 2014). Apologies, though may be a reason for a patient not seeking legal redress, it may also be used as evidence of negligence against the practicing nurse. 

Legal justice to the patient requires fair and appropriate restitution when harm is caused to them by error. Moreover, the patient has a right to know about their entitlements as well as the financial costs that emanate from the medication error needs to be covered by the registered nurse.

The Process of Writing Prescriptions and Strategies to Minimize Medication Errors

The process involves noting the name of prescribing practitioner as well as the name and strength of medication. Moreover, the quantity of the drug in both textual and numeric formats is noted with directions for use. The healthcare practitioner also dates the prescription with the month written in textual letters and signature on the day of it is issued.

Strategies used to reduce medication errors, include a review of medication orders by healthcare givers. Moreover, clinical decision support systems also play a crucial role in decreasing drug toxicity thereby reducing medication errors. Additionally, medication prescription should be computerized as a patient safety strategy (Martinez et al., 2014). Hospitals should implement a computerized provider order entry with decision support to assist in reducing medication errors in hospitalized young patients and should include provide weight and age based dosage decision support thus giving mechanisms to alert healthcare givers on any potential under-dosing or overdosing. 

Moreover, safety principles should assist the development of safety systems by standardizing the prescription process thus creating independent checks for key steps in the process, and learning from mistakes when they occur. All prescriptions must be legible and written in black ink, with a brief notation of purpose, unless deemed inappropriate. The caregiver should sign their name as if it were a legal document and should not pre-sign a blank prescription. The caregiver should not loan their prescription pads to anyone and should contact the pharmacy immediately in case of its misplacement.

 

Leave a Reply