advance practice nursing ethics disclosure

Introduction An estimated 1.5 million “preventable adverse drug events” occur each year in the United States alone; the number of medication errors that did not lead to adverse effects but remained undisclosed is unknown (Jenkins & Vaida, 2007, p. 41). The scenario is this: You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

Disclosure is an ethical and legal prerogative, showing respect for the patient and a willingness to accept professional responsibility. Consequentialist ethics do not apply to situations like these, because the broader issue is about changing advanced nursing practice and ensuring a culture of safety for all patients. Likewise, disclosure empowers the patient to make informed choices about reactions to the medical error while encouraging the healthcare team to do whatever necessary to reduce errors from occurring in the future.

The best strategies for reducing medical errors include ongoing professional training of all staff, correcting organizational culture barriers, and the implementation of a set of specific protocols for medication administration. Summary Ethical Issues Whether or not the patient experienced adverse effects has nothing to do with the ethic of disclosure. Even consequentialist frameworks like utilitarianism can be used to show why disclosure should be normative among advanced practice nurses. A utilitarian ethic promotes the greatest good for the greatest number.

A culture of safety by definition promotes the greatest good for the greatest number. Therefore, nurses need to practice disclosure as a matter of course in order to participate in, uphold, and be responsible for the culture of safety that promotes ideal patient outcomes. Deontological ethical frameworks categorically uphold the duty of nurses to provide consistent care under the rubric of guiding ethical principles like patient autonomy, right to knowledge, and nonmaleficence.

Non-disclosure is a form of lying or deceit in that it is a deliberate withholding of information from patient about that patient’s own body. Likewise, non-disclosure inhibits the ability of the patient “to make appropriate decisions about the treatment that she needed as a result of the error,” (Sorrell, 2017, p. 1). Advanced practice nurses also operate under the ethical duty to care and to not do harm.

Disclosure prevents further harm from occurring: such as the harm that arises out of eroded trust, the harm that arises out of the perpetuation of a culture of deceit in the organization, and the harm that could arise if such errors did actually lead to adverse outcomes. As many as 250,000 deaths per year in the United States are directly due to medication errors—the highest among almost all developed nations (Sorrell, 2017).

Ironically, many nurses report that the “negative emotions” patients express when a medication error is disclosed is one of the reasons for choosing not to disclose (Leone, Lamiani, Vegni, et al, 2015, p. 446). Nurses who choose not to disclose because of patient “negative emotions” may be confusing monmaleficence with egoism. Causing anger, fear, or whatever “negative emotions” may arise in the patience does not qualify as maleficence, but refusing to offer pertinent information about patient healthcare is.

Legal Issues Two types of laws address medication errors: apology laws and disclosure laws. Apology laws generally insulate the nurse and/or the organization from litigation, whereas disclosure laws are typically invoked when there has been a critical incident. Both types of laws vary by state. Most states in the United States have in place disclosure laws that apply to “specific circumstances” only but not to cases like these in which no adverse reaction occurred (Guillod, 2013, p. e31).

One of the barriers to enacting both apology laws and disclosure laws is the fear of litigation and related financial or reputational repercussions. Apology laws may in fact be linked to fewer risks of litigation; Ghazal, Saleem & Amlani (2014) claim, “disclosure of errors has reduced the chances of lawsuits cases on hospital or on physician,” (p. 1).

Even when apology or disclosure laws do not pertain to the situation, healthcare organizations should have higher standards of patient care that include mandatory medication error disclosure for the purposes of maintaining a culture of safety. Recommendations Creating a culture of safety is the key component of reducing medication errors, and responding to errors in an ethical manner. Administering medication is a more complex procedure than it may seem, involving collaboration with multiple members of the medical team as well as issues involving patient awareness and compliance.

Poor handwriting on prescriptions is only one of the many problems that can lead to medication errors; other practices that need to be changed include avoiding problematic abbreviations, being certain to double-check for similar medication names, robust identification of high-risk drugs in particular, standardizing units of measurement, and verification of patient-specific identifiers and conditions (Jenkins & Vaida, 2007). The introduction of electronic health records is not a panacea, even though technology can be used to prevent some types of medication errors from occurring.

Ultimately, though, medication errors are most often related to culture, training, and education, effectively “the result of a breakdown in processes that guide delivery of patient care,” (Sorrell, 2017, p. 1). Patient education in how to take the medication is important, but staff training programs are also essential for promoting.