The Ethics and Legalities of Medication Error Disclosure

Medication Error Disclosure: Ethical Implications
Although making mistakes may be an inevitable fact of life, when nurses make errors in regards to medications, they have an obligation to report the error. From a deontological ethical perspective, the fact that the consequences of the error were minor or nonexistent is irrelevant. The existence of error is still significant in highlighting some failure, either in the administering advance practice nurse’s preparation and use of standardized operating procedures, or the procedures themselves. From the point-of-view of professional ethics, reporting errors has a vital role in preventing future errors from occurring. This should be at the forefront of the nurse’s mind, not protecting her own reputation or that of the institutions’ reputation.
According to Wolf & Hughes (2008), “reporting potentially harmful errors” should encompass all errors including “that were intercepted before harm was done, errors that did not cause harm, and near-miss errors is as important as reporting the ones that do harm patients” (par.2). The individual who commits the error is seldom, for self-interested reasons, the best person to determine whether an error is serious or not. When intercepted errors reveal critical deficits in the institution’s standardized operating procedures as well as issues with the nurse’s own actions, this can be used to prevent more serious consequences from occurring later.
Ethical and Legal Implications of Disclosure and Nondisclosure
Reporting all errors is consistent with the core principles of medical ethics which govern the behavior of all providers. Patient autonomy is compromised when they cannot be certain if they are being given the right medication in the right dosage. Additionally, “Fidelity, beneficence, and nonmaleficence are all principles that orient reporting and disclosure policies” (Wolf & Hughes, 2008, par.8). Providers are often under pressure not to disclose errors that have no immediate repercussions to protect the reputation of the institution but greater trust is ultimately fostered when there is an honest relationship between provider and patient. The principle of doing what is best for the patient and doing no harm is not congruent with attempting to cover up errors. The idea that the provider knows best in terms of what the patient should or should not know is profoundly paternalistic and runs counter to the principles of modern Western medicine (Chamberlain et al., 2012).
In traditional medical parlance, it should be noted that the definition of error is not accorded based upon the degree of harm, but the degree of deviation from a set standard. This is a critical aspect of evidence-based medicine, that “error is defined as a failure in the process of delivering medical care, without considering the outcome” (Chamberlain et al., 2012, par.2). But it is important to note that a single provider alone cannot change institutional reporting policies. Many institutions have inadequate channels through which to report errors such as “the lack of standard definitions, gaining easy access to databases, and the associated cost of electronic applications” (Wolf & Hughes, 2008, par.15). But if a serious error occurs later on, and minor errors that went reported are later revealed, this can result in further legal and public relations fallout for the institution. It is better to fully document any deviations and concerns to rectify the issue.
Advanced Practice Nurse: What I Would Do
If I made an insignificant error in reporting a patient’s prescription, I would immediately report the error through my institution’s reporting channels and consult with the patient. I would wish to speak personally to the patient and explain how the error occurred and what steps were being taken to ensure that it would not occur again. Personal communication can have a great, positive effect in reducing the likelihood of the patient bringing legal action against the institution. The provider should also communicate the risks the patient was under; if minimal, this should provide some comfort. Reassurance is important but so is ensuring that the error becomes a learning opportunity for the nurse and the institution. I would also discuss with my supervisor how to prevent future problems from occurring and any continuing education or other steps which might be required to do so.
Minimizing Medication Errors
As noted by Sorrell (2017), despite the common perception that medical errors are rooted in provider incompetence, this is seldom the case. Usually, inadequate standardized operating procedures and miscommunication are the root of errors. Often errors are revelatory of deeper problems beyond that of the individual. Nurses that are overtired and overstressed may be more apt to make errors. This can be due to understaffing. A lack of patient literacy can also cause them to misinterpret unclear instructions. Nurses should be aware how best to communicate with their patients and how to identify if patients do not understand what they are asking (for example, if a patient has an allergy or is taking over-the-counter medications that might make the prescription contraindicated).
Incomplete recordkeeping can result in omissions of important patient information, such as allergies and contraindicated treatments with existing medications. Using electronic records can be important to ensure the nurse has all evidence at her disposal. Orders should be in “clear and consistent formats,” and displayed prominently near patients in a hospital (Sorrell, 2017, par.5). Accessing medical records should be part of routine safety precautions when administering medications (Sorrell, 2017). Having checklists that nurses must check off when prescribing is also useful to ensure that nurses do not miss critical steps when interacting with patients.


References
Chamberlain, C., Koniaris, L., Wu, A., & Pawlik T. (2012). Disclosure of “nonharmful” medical
errors and other events duty to disclose. Archives of Surgery, 147(3):282–286.
doi:10.1001/archsurg.2011.1005
Sorrell, J.M. (2017). Ethics: Ethical issues with medical errors: Shaping a culture of safety in
Healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2).
DOI: 10.3912/OJIN.Vol22No02EthCol01
Wolf, Z. & Hughes, R. (2008). Error reporting and disclosure. NIH. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK2652/