Medication Error Disclosure: Ethics and Nursing Practice

Introduction: The Obligation to Report Medication Errors

Although making mistakes may be an inevitable fact of life, when nurses make errors regarding medications, they have an obligation to report those errors. From a deontological ethical perspective, the consequences of the error — whether minor or nonexistent — are irrelevant. The existence of the error is still significant in highlighting some failure, whether in the administering advanced practice nurse's preparation and use of standardized operating procedures or in the procedures themselves. From the standpoint of professional ethics, reporting errors plays 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 institution.

According to Wolf and Hughes (2008), "reporting potentially harmful errors" should encompass all errors, including "those that were intercepted before harm was done, errors that did not cause harm, and near-miss errors," and this 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 an institution's standardized operating procedures as well as issues with the nurse's own actions, that information 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 that govern the behavior of all providers. Patient autonomy is compromised when patients cannot be certain they are receiving the right medication in the correct 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, in order to protect the reputation of the institution; however, greater trust is ultimately fostered through 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 conceal 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 determined by the degree of harm but by the degree of deviation from a set standard. This is a critical aspect of evidence-based medicine: "error is defined as a failure in the process of delivering medical care, without considering the outcome" (Chamberlain et al., 2012, par. 2). It is important to note, however, 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). If a serious error occurs later on and previously unreported minor errors are subsequently revealed, this can result in further legal and public relations fallout for the institution. It is therefore better to fully document any deviations and concerns and to rectify issues promptly.

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. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK2652/