NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Sample Answer for NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing Included After Question

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? 

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. 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. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond. 

Scenario 1: 

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult. 

Scenario 2: 

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

Scenario 3: 

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident. 

Scenario 4: 

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life. 

To prepare: 
Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Ladd and Hoyt (2016), the Drug Enforcement Administration, and Sabatino et al (2017). 
Select one of the four scenarios listed above. 
Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the 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. 

With these thoughts in mind: 

By Day 3 

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario. 

By Day 6 

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different scenario than you did, in one or more of the following ways: 

Suggest additional ethical and legal implications for all stakeholders in your colleagues’ scenarios. 
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. 
Validate an idea with your own experience and additional research. 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Submission and Grading Information 
Grading Criteria  

Responsibilities are given to him on whom trust rests. Responsibility is always a sign of trust.
—James Cash Penney  

Nurses have been rated the most trusted professionals in the United States (CDC, 2012). With this trust comes a critical responsibility to maintain ethical and legal practices in order to preserve patient safety when treating patients and prescribing drugs. Since the scope of practice for advanced practice nurses is broadening, you will likely encounter new and complex ethical challenges in your clinical settings. 

This week, you explore ethical and legal implications of prescribing drugs including disclosure, nondisclosure, and prescriptive authority. You also examine the process of writing prescriptions to avoid prescription drug errors. 

Learning Objectives 

By the end of this week, students will: 

Evaluate ethical and legal implications related to prescribing drugs 
Analyze ethical and legal practices of prescribing drugs 
Evaluate ethical and legal implications of disclosure and nondisclosure 
Analyze the process of writing prescriptions to avoid medication errors 
Understand and apply key terms, concepts, and principles related to ethical and legal aspects of prescribing 

Photo Credit: erhui1979/DigitalVision Vectors/Getty Images 

NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. 

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below. 

Required Readings 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Chapter 1, “Issues for the Practitioner in Drug Therapy” (pp. 3–14)
This chapter introduces issues relating to drug therapy such as adverse drug events and medication adherence. It also explores drug safety, the practitioner’s role and responsibilities in prescribing, and prescription writing.  

Chapter 59, “The Economics of Pharmacotherapeutics” (pp. 1009-1018)
This chapter analyzes the costs of drug therapy to health care systems and society and explores practice guideline compliance and current issues in medical care.  

Chapter 60, “Integrative Approaches to Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
This chapter examines issues in individual patient cases. It explores concepts relating to evaluation, drug selection, patient education, and alternative treatment options.  

Due to the importance of ethical and legal considerations in advanced practice nursing, several resources have been provided for your reference. 

Sabatino, J.A., Pruchnicki, M.C., Sevin, A.M., Barker, E., & Green, C.G. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students.  

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. 

Note: Retrieved from the Walden Library databases. 

A Sample Answer For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Scenario # 1: As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult. 

            When prescribing medication for anyone it is important to check multiple times that the medication is prescribed correctly.  Prescribing for children can be complicated because their dosages are not usually standard doses.  Medication for children is usually prescribed based on the child’s weight in kilograms.  As the prescriber you have to be attentive and knowledgeable about the medication prescribed, “it is the prescriber’s responsibility to calculate the dose and write the correct dose, and not depend on the pharmacist to calculate the dose” (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p.9).  The pharmacist should be looked at as an additional check who would hopefully catch any medication errors before a prescription is filled and given to the patient.  However, the liability with medication errors will fall back on the prescriber because they are first responsible for their patient.  The pharmacist can also make mistakes which would ultimately fall back on the prescriber if it has to be explained in a court of law. 

 If I made a medication error when prescribing medication to the five years old or any patient it is my ethical duty to make the parent or legal guardian (since the error was on a minor) aware of the medication error.  If the child has not yet taken the medication, I would need to contact the pharmacy to stop the medication from being filled and contact the parents to inform them of the mistake and stop them from giving the medication to the child.  In the instance that the child was already given the medication, I would need to instruct the person caring for the child on the proper instructions to prevent further harm which could be monitoring the child to seeking immediate treatment for the child.  

            Not only is it unethical to not inform the parents of the medication error it is a violation of the patient’s bill of rights to be notified of medication errors.  In Maryland, medication errors must be reported to the appropriate agency.  The six rights to medication administration must be followed (right person, right medication, right dose, right time, right method/route, right charting/documentation).  Not following any of these six rights could be considered a medication error. Patients want to know when a medical error has been made, “the patient’s bill of rights also demands to have full disclosure of an error” (Ghazal, Saleem, & Amlani, 2014, p.1).  When patient’s feel wronged they are more inclined to file lawsuits, “insufficient provider-patient communication after an error motivates patients to file lawsuits” (Hannawa & Shigemto, 2016,p.29).  

Strategies 

            As an APN it is important to maintain the trust of the population that we serve.  Not being honest about how we practice will reflect poorly on us and whoever we may work for.  The first strategy I would use is the triple check system when prescribing the medication.  I would want to make sure that the medication order is correct before it is given to the patient to avoid error.  In the case that an error was made I would provide full disclosure, “disclosure of error to the patient will enhance the trust in physician and prevent lawsuit on the hospital” (Ghazal, Saleem, & Amlani, 2014, p.1). After the error, I would follow up with the patient, assess the damage determine if the patient needs immediate attention or monitoring and prescribe the correct the error.  No one wants to make mistakes when prescribing medication being truthful about the incident will help maintain the respect of the provider.  

Reference: 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). 

Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Hannawa, A. F., Shigemoto, Y., & Little, T. D. (2016). Medical errors: Disclosure styles, 

interpersonal forgiveness, and outcomes. Social Science & Medicine, 156, 29–38. https://doi-org.ezp.waldenulibrary.org/10.1016/j.socscimed.2016.03.026 

Saleem, L. G. (2014). A Medical Error: To Disclose or Not to Disclose. Journal of Clinical  

Research & Bioethics,05(02). doi:10.4172/2155-9627.1000174 

A Sample Answer 2 For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

               Scenario two was chosen for this discussion. In this scenario, a friend calls and asks the APRN to prescribe a medication for her. The APRN has the autonomy; however, does not have the friend’s medical history. The prescription is written anyways. 

Legal and Ethical Implications 

               Legally, in the writer’s state of Florida, APRNs are required to have protocols that are written with an MD, DO, or dentists in order to diagnose, treat, order diagnostic tests, treat patients, and order physical and occupational therapies (Kaplan, 2016). Prescribing this medication can cause the writer to be outside of practice standards depending on the condition the friend is attempting to treat. The friend would not have knowledge of the standards established by the APRN and their supervising physician, placing the APRN in danger of not being legally compliant. 

               The ethical implication in this scenario is focused on the lack of patient information during the prescriptive process. Studies have shown high incidences of prescribing errors occurring at the primary care provider’s office and the occurrence is usually during the prescriptive process (Sabatino, et al., 2017). When prescribing a medication, it is imperative to have a clinical indication for the medication being prescribed (Arcangelo, Peterson, & Reinhold, 2017). Some medications are utilized for off-label use and some medications are used to treat multiple disorders. 

 One example of a medication used to treat multiple diagnoses is Bupropion also known as Wellbutrin. This medication can be used to treat depression and is utilized for smoking cessation (Connective Rx, 2018). There have been incidences in the writer’s practice where the medication list has been utilized to determine the past medical history, which can be an inaccurate guess in the case of Bupropion. The other ethical concern is the need to prescribe the appropriate medication based on the medical history or possible contraindications. The lack of information about the patient will increase the likelihood of the medication error during prescribing.  For example, the PDR indicates the need for dosage adjustment with the prescription of Bupropion with individuals with renal or hepatic insufficiency (Connective Rx, 2018). It is also contraindicated for patients with alcoholism, anorexia nervosa, brain tumor, bulimia nervosa, diabetes mellitus, hypoglycemia, hyponatremia, hypoxemia,  obesity treatment, seizure disorder, seizures, stroke, substance abuse (Connective Rx, 2018) to name a few. At this juncture, patient safety and appropriate clinical indication becomes a problem. 

Two Strategies for Decision-Making 

               The two strategies that would be utilized to navigate the interaction with the friend and help with the decision-making process would be to educate the patient safety concern and the need to ensure it is the appropriate drug and dosage for the friend. The education provided to the friend would be to explain the possible food and drug interactions (and drug-drug) that can occur with the medication in question. Explanation of the possible adverse effects that can occur due to the lack of information on the health history would help the friend understand the processes that have been put into place to ensure his/her safety. The other strategy would be to determine if the drug is really appropriate for the friend based on an assessment. Without a health history, it would not be possible to determine if it is truly the correct medication for the indicated condition. 

Conclusion 

               In conclusion, the above-mentioned scenario requires exploration of legal and ethical considerations when making a decision. Legally, in Florida, there are certain standards that have been established with APRNs that have to be followed. Ethically, there are a lot of patient safety concerns that can potentially cost the friend her life or result in an inaccurate diagnosis. Education about dangers of prescribing without the appropriate indications would be one strategy. The second one would be to assess the patient to determine the appropriate treatment for the condition in question. 

References 

Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins. 

Connective Rx. (2018). Wellbutrin. Retrieved from PDR: https://www.pdr.net/drug-summary/Wellbutrin-bupropion-hydrochloride-237.5886 

Kaplan, L. (2016). Florida NPs advocate for controlled substance prescriptive authority. The Nurse Practitioner, 14-16. 

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C., & Porter, K. (2017). Improving prescribing practives: A pharmacist-led educational intervention for nurse practitioner students. Journal of the American Association of NPs, 248-254. 

A Sample Answer 3 For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

Scenario: Your sister’s friend, and your acquaintance, Elena calls you Monday afternoon stating that she tweaked her knee over the weekend, and while  

she can put weight on it, she is in tremendous pain despite around the clock acetaminophen, elevation, and icing. She has an appointment scheduled with  

her primary care provider on Friday for an evaluation, but they are unable to get her in any sooner. She is sure that she took ketorolac for a previous injury 

and that it worked miracles for her; Elena asks for a prescription to hold her over until she can see her primary care provider. You ask her a few questions  

to include allergies, history of asthma, and stomach ulcers.  These answers are negative, she is young and appears healthy, and you reluctantly issue her a  

5- day prescription for ketorolac. 

     Antibiotics, antihistamines, and contraception are the most commonly prescribed medications to provider family, friends, and self (Cowgill, 2015),  

though it is easy to see how the scenario described could occur. Practitioners prescribing for friends or families may neglect to address sensitive portions of  

the medical history (Bird, 2016). Because a thorough medical history was not obtained, which is a common cause of prescribing errors (Arcangelo,  

Peterson, Wilbur, & Reinhold, 2017), you are unaware of Elena’s lithium use for diagnosed bipolar disorder.  

     Lithium remains the mainstay of pharmacological treatment of bipolar disorder because of its effectiveness in reducing suicide during the depressive  

cycle. Lithium’s “narrow therapeutic window” necessitates frequent monitoring to prevent toxicity (Ayano, 2016, para. 4). There are many theories as to  

the biochemical mechanism of lithium that stabilizes mood to include alteration of metabolism of catecholamines and serotonin and that its similarities to  

sodium, potassium, calcium, and magnesium can alter ion pumps in cell membranes (Ayano, 2016). Ayano also states that lithium is wholly absorbed, not  

protein bound (which means available) and excreted primarily by the kidneys with a 70-80% reabsorption rate in the proximal tubule. Small changes in  

reabsorption or excretion of lithium by the kidney can quickly alter the serum levels leading to potential toxicity. 

     Ketorolac is a non-steroidal anti-inflammatory (NSAID) indicated for short-term acute pain and is contraindicated for those with asthma, concurring  

NSAID use, history of GI bleed or ulceration, decreased renal function, and suspected or known cerebrovascular bleeding; bioavailability is 100 percent, is 

highly bound to serum proteins and is believed to relieve pain by inhibition of prostaglandin synthesis (Roche, n.d.). Ketorolac is metabolized by the liver, 

but like lithium, it is primarily excreted by the kidneys (Ayano, 2016 & Roche, n.d.). The concern with the simultaneous use of these two drugs is that  

ketorolac, like most NSAIDs, can reduce the amount of lithium cleared, or excreted, by the kidneys increasing serum lithium levels leading to potential  

toxicity (Ayano, 2016 & Roche, n.d.). 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical approach  

     (4th ed.). Philadelphia, PA: Wolters Kluwer. 

Ayano, G. (2016). Bipolar disorders and lithium: Pharmacokinetics, pharmacodynamics, therapeutic effects and indications of Lithium: Review of articles. 

     Austin Journal of Psychiatry and Behavioral Sciences, 3(2), 1-8. Retrieved from http://austinpublishinggroup.com/psychiatry-behavioral- 

     sciences/download.php?file=fulltext/ajpbs-v3-id1053.pdf 

Bird, S. (2016). The pitfalls of prescribing for family and friends. Australian Prescriber, 2016(39), 11-13. https://doi.org/10.18773/austprescr.2016.002 

Cowgill, C. (2015). Ethical obligations and self-regulation: APRN perspective. Retrieved from  

     epubs.democraticprinting.com/article/ETHICAL_OBLIGATIONS-AND-SELF-REGULATION%3A-APRN- 

     ERSPECTIVE/2271998/2732831article.html 

Roche. (n.d.). Toradol. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019645s019lbl.pdf 

A Sample Answer 4 For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Scenario 3: 

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident. 

Ethical and Legal Implications for the Prescriber 

            In scenario 3 of this week, there are several ethical and legal implications for all involved, therefore, the ethical thing to do in this case is to report what happened. The Iowa Board of Nursing is the regulatory agency for licensed practical nurses, registered nurses, and nurse practitioner’s (NPs) in the state of Iowa. Disciplinary actions the Board may impose upon the prescriber in this scenario include but are not limited to citation and warning, 

civil penalty/fine, continuing education, probation with conditions, suspension, and revocation (Iowa Board of Nursing, n.d.a). For one to have their license reinstated, a submission of an application for reinstatement of licensure and a written letter stating “why the circumstances that led to your encumbered license have been resolved, evidence to support that, and why it would be in the best interest of the Board to reinstate your license,” must be completed (Iowa Board of Nursing, n.d.a, para 2). If these items are deemed complete, the prescriber may have to appear in person at a Board meeting hearing. 

Pharmacist 

The Iowa Prescription Monitoring Program (PMP) allows pharmacists and other prescribers access to information regarding their patients’ use of Schedule II, III, and IV controlled substances (Iowa Board of Nursing, n.d.b.). If the patient goes to the same pharmacy for this prescribed narcotic, it would not be unreasonable for the pharmacist to request the patient’s use of Scheduled drugs from the electronic database. This database may reveal the number of prescriptions filled each year and signs of excessive pharmacy-shopping or doctor-shopping for controlled substances. If the pharmacist notices a pattern of excess prescription for the narcotic for this patient or that he has been to several other pharmacies for the same prescription, he has an ethical duty to report it to the Iowa Board of Pharmacy. According to Chapter 124.509: Education and research- The board and the department, subject to approval and direction of the governor, shall carry out educational programs designed to prevent and deter misuse and abuse of controlled substances…Determine patterns of misuse and abuse of controlled substances and the social effects thereof (Iowa Board of Pharmacy, n.d.a., p. 45). If a pharmacist violates any provision of the controlled substances Act or rules relating to that Act, it is grounds for licensure discipline (Iowa Board of Pharmacy, n.d.b.) 

Patient             
The consequence for the patient may be that their care at that office or by the providers of the practice may be terminated. There are several reasons an NP may decide to terminate a patient’s care, for example, inappropriate or disruptive behavior from the patient such as physically or verbally assaulting a provider or staff member. A practice may also terminate care when the patient’s provider leaves the practice, and the current providers are at capacity and unable to accommodate the patient. Another reason may be repeated failure to show up for scheduled appointments or paying their medical bills, although some states may prohibit the termination of care due to lack of payment. Another common reason to terminate care is a breach in a patient-provider agreement surrounding controlled substances or failure to follow recommended treatment plans. While there are many reasons to terminate a patient’s care, there are also unacceptable reasons for care termination such as those based on age, gender, race, religious beliefs, or sexual orientation (Wright, 2017). 
  

Strategies for Decision Making 

            The strategies I would use to guide my decision making in this scenario is the American Nurses Association (ANA) Code of Ethics for nurses, the Iowa Board of Nurses, and the Iowa Legislature laws. The ANA Code of Ethics (2015), Provision 2.2 discusses the conflict of interest for nurses. “Nurses address such conflicts in ways that ensure patient safety and that promote the patient’s best interest while preserving the professional integrity of the nurse and supporting interprofessional collaboration… Nurses in all roles must identify, and whenever possible, avoid conflicts of interest” (p. 5). The prescribing NP did not avoid conflicts of interest by prescribing her husband, who is not a patient of hers, narcotics. It is also my duty as well as it was the prescribers to preserve the professional integrity of our profession. Furthermore, the Code of Ethics states in Provision 3.5 that a “nurse must be alert to and take all appropriate action in all instances of incompetent, unethical, illegal or impaired practice or actions that place the rights or best interest of the patient in jeopardy” (ANA, 2015, p. 12).  

            Another key point to consider is the prescribing NPs specialty. If the prescribing NP works in an ophthalmology clinic, it would not be appropriate for the prescription of narcotics. According to the Iowa Board of Nursing (2018), registration as a practitioner with the Federal Drug Enforcement Administration and the Board of Pharmacy Examiners permits the Advanced Registered Nurse Practitioner to prescribe controlled substances within the practitioner’s recognized specialty, in which this scenario does not. And lastly, for an advanced registered nurse practitioner, prescribing, dispensing, administering or distributing drugs to individuals who are not patients or are outside the licensee’s specialty area is prohibited (The Iowa Legislature, n.d.). 

  References 

American Nurses Association. (2015). Code of ethics for nurses: With interpreted statements. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ 

Iowa Board of Nursing. (2018). Advanced registered nurse practitioner: Role and scope. Retrieved from https://nursing.iowa.gov/practice/advanced-registered-nurse-practitioner-role-scope 

Iowa Board of Nursing. (n.d.a). Enforcement FAQs. Retrieved from https://nursing.iowa.gov/enforcement/enforcement-faqs 

Iowa Board of Nursing. (n.d.b). Iowa Prescription Monitoring Program (PMP). Retrieved from https://nursing.iowa.gov/practice/arnp-role-scope/iowa-prescription-monitoring-program-pmp 

Iowa Board of Pharmacy. (n.d.a). Rules/Laws. Chapter 124. Retrieved from https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.124.pdf 

Iowa Board of Pharmacy. (n.d.b). Rules/Laws. Chapter 155A. Retrieved from https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.155a.pdf 

The Iowa Legislature. (n.d.). Grounds for discipline. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/01-06-2016.655.4.6.pdf 

Wright, W. (2017). Terminating a patient from care. Nurse Practitioner, 42(11), 53-55. Retrieved from the Walden Library database. 

A Sample Answer 5 For the Assignment: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing
Title: NURS 6521 Week 2: Ethical and Legal Aspects of Prescribing

As prescribing practitioners, we have a responsibility to abide by the legal and ethical aspects of prescribing medications. The practitioner has the responsibility of formulating one or more diagnosis and treatment plans after a detailed history is obtained and a physical examination is performed (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In the scenario number one, the provider appeared to diagnose correctly the child’s pathology, but failed to appropriately prescribe the correct dose for the patient’s age. This case scenario is describing a medical error and actions must be taken as soon as the provider discovered the mistake. 

The Provider 

Ethical issues regarding medical errors according to Bonnie (2014), as cited by Sorrell (2017), can be grouped according to four principles: 

1-      Autonomy and Right to self Determination: the patients’ right to make their own choices and to act based in their own beliefs, personal views, and perceived benefits. Also, established the providers obligation to report the medical error. In this case the 5 years old child may have not been informed, but his legal guardians, in this case the patient’s parents, were supposed to be notified in spite of any consequences the provider may have faced. 

2-      Beneficence and Non-Maleficence: This principle guided providers to do what is right to his patients and to avoid harm. The ordering provider should have taken the necessary steps co correct the error as soon as he became aware of the mistake. 

3-      Disclosure and Right to Know: This principle describes the provider’s obligation to disclose information the patients need to make informed decision making. In this case, informing the parents about the mistake may have de creased the damages caused by and overdose. 

4-      Veracity: This principle calls for all medical providers to always be honest and disclose accurate information. This helps build trust with patients and families. 

Disclosure of a medical error is still an ethical dilemma. One of the reasons they may not report the mistake is because of fear of being sued by the patient or the patient’s family. Many physicians do not disclose errors because they are afraid of being held liable. They fear than an apology be taken as an admission of guilt or liability. But, according to Guilloid (2013) many injured patients merely seek an explanation and hope for an apology rather than strive for financial compensation. 

The Pharmacist 

Multiple ethical and legal aspects surround this medical professional as well. Some of these ethical principles are similar to the ones for Medical Doctors and Nurse practitioners. Non-Maleficence, Beneficence, Honesty, Justice, Empathy and Excellence, Cooperation, and Respect for Patient’s Dignity and Autonomy are some of the principles that guide this profession (Salari, et al., 2013). The pharmacist should have