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"There's a major difference between covering up and not volunteering information after a mistake," says Dr. Prager. "Covering up is an act of wrongdoing that is always unethical, while there are shades and nuances to the question of whether to reveal an innocuous mistake to the patient if no harm ensued."
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A large proportion of medication errors are not reported, for many reasons. A major reason is embarrassment or fear of punishment from colleagues, employers, regulatory agencies, or patients and their families.
Research has shown that nurses are responsible for intercepting between 50% and 80% of potential medication errors before they reach the patient in the prescription, transcription and dispensing stages of the process. The administration stage is the most vulnerable to error because this is where there are fewer system checks and balances.
Ethical issues related to medical errors can be categorized around four ethical principles: autonomy and right to self-determination; beneficence and nonmaleficence; disclosure and right to knowledge; and veracity (Bonney, 2014). Each of these principles will be discussed below. Autonomy and Right to Self Determination
The widespread use of electronic health records has helped avert errors at the ordering and transcribing stages, but these errors still persist, and studies have found a high rate of medication administration errors in both the inpatient and outpatient settings.
While many doctors under the guise of concern for patient welfare do not disclose medical error, such behaviour is not ethically justified. The fiduciary nature of the doctor-patient is such that the doctor is ethically obligated to disclose medical errors to patients.
Large physician organizations, such as the American Medical Association in their general Code of Medical Ethics,15 state that physicians need to inform patients about medical errors so that patients can understand the error and participate in informed decision making about subsequent management of their health care.
Ethical issues. Several ethical issues can occur as a result of medication errors. These issues, harm to patients, whether to disclose the error, erosion of trust, and impact on the quality of patient care, are not mutually exclusive. Harm to patients is self-evident.
Becoming romantically involved with patients or family members of a patient. Cherry-picking patients. Breaching patient confidentiality (violating HIPAA regulations) Joking about patients or acting inappropriately while a patient is under anesthesia.
This ethical principle has been reinforced by practical lessons learned from errors; especially when an adverse event causes serious harm or even death, there is an ethical and moral obligation to disclose information.
Recommendations suggest that the disclosure be made soon after the mistake occurs. 36 Typically, patients do not expect a medical mistake to occur. Hence, the disclosure timing is important to consider, as are general precautions and best practices surrounding disclosure of all bad news.
Several ethical issues may arise as a result of medication errors: harm to patients, whether to disclose the error, erosion of trust, and impact on quality care. Nurses' appropriate ethical responses to medication errors need to be supported.
An "error theory of ethics" is the view that the ordinary user of moral language is typically making claims that involve a mistake. The concepts of ethics introduce a mistaken, erroneous, way of thinking of the world or of conducting practical reasoning.
Medication Errors (medical error) Law is a subset of Medical Malpractice law which can result in severe and permanent injury or death. These types of errors can occur at any point during the process of selecting, prescribing and dispensing medications.
adjective. lacking moral principles; unwilling to adhere to proper rules of conduct. not in accord with the standards of a profession: She treated patients outside the area of her training, and the appropriate medical organization punished her unethical behavior.
Unethical behavior can be defined as actions that are against social norms or acts that are considered unacceptable to the public. Ethical behavior is the complete opposite of unethical behavior. Ethical behavior follows the majority of social norms and such actions are acceptable to the public.
An unknown percentage of physicians and others rendering health care services do so unethically, with a wide variety of abuses such as: practising without the proper educational qualifications; practising without required licences and registrations; over-charging; negligence; erroneous, unwarranted or uncertain ...
A medication error is an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication. An adverse drug event (ADE) is defined as harm experienced by a patient as a result of exposure to a medication.
Transcribing: in a paper-based system, an intermediary (a clerk in the hospital setting, or a pharmacist or pharmacy technician in the outpatient setting) must read and interpret the prescription correctly.
The Institute for Safe Medication Practices maintains a list of high-alert medications—medications that can cause significant patient harm if used in error. These include medications that have dangerous adverse effects, but also include look-alike and sound-alike medications: those that have similar names and physical appearance but completely different pharmaceutical properties . The Beers criteria, which define certain classes of medications as potentially inappropriate for geriatric patients, have traditionally been used to assess medication safety. However, the newer STOPP criteria (Screening Tool of Older Person's inappropriate Prescriptions) have been shown to more accurately predict ADEs than the Beers criteria and are therefore likely a better measure of prescribing safety in elderly patients.
If a clinician prescribes an incorrect dose of heparin, that would be considered a medication error (even if a pharmacist detected the mistake before the dose was dispensed). If the incorrect dose was dispensed and administered but the patient experienced no clinical consequences, that would be a potential ADE.
Other well-documented patient-specific risk factors include limited health literacy and numeracy (the ability to use arithmetic operations for daily tasks).
The widespread use of electronic health records has helped avert errors at the ordering and transcribing stages, but these errors still persist, and studies have found a high rate of medication administration errors in both the inpatient and outpatient settings.
For example, the intravenous anticoagulant heparin is considered one of the highest-risk medications used in the inpatient setting. Safe use of heparin requires weight-based dosing and frequent monitoring of tests of the blood's clotting ability, in order to avoid either bleeding complications (if the dose is too high) or clotting risks (if the dose is inadequate). If a clinician prescribes an incorrect dose of heparin, that would be considered a medication error (even if a pharmacist detected the mistake before the dose was dispensed). If the incorrect dose was dispensed and administered but the patient experienced no clinical consequences, that would be a potential ADE. If an excessively large dose was administered, the overdose was detected by abnormal lab results, but the patient experienced a bleeding complication due to clinicians failing to respond appropriately, that would be considered an ameliorable ADE (that is, earlier detection could have reduced the level of harm the patient experienced).
A major reason is embarrassment or fear of punishment from colleagues, employers, regulatory agencies, or patients and their families. Because of this fear, only about 5% of potentially life-threatening errors are reported. 4, 42 Other errors are not reported because they seem unimportant or inconsequential or because they were intercepted before the patient was harmed—an attitude of “no harm, no foul.” 4, 43, 44 When an error is discovered by the person who committed it, the typical action is to ignore it and not report it. When an error is discovered by someone else, it often goes unreported because of fear of retribution from the person who committed the error , especially when that person is a physician or someone in authority. Even when the mistake can be traced to the person prescribing the medication, an error not intercepted by a nurse may end up being blamed on the nurse who administered the medication. 45
Traditionally, medication errors have been attributed to mistakes by individual clinicians (physicians, nurses, pharmacists) or by patients. Even though individuals are often responsible for making these errors, this “blame-seeking” approach does not consider the chain of events that may have led to the error, and it fails to address the root cause and most important reason for most medication errors—systems failures. 1, 4
A culture of safety encourages nonpunitive reporting of medication errors and near misses; it also addresses systems factors that contribute to medication errors. 56 More complete, accurate, and timely surveillance of medication errors and ADEs will lead to better understanding of the risks and benefits of medication therapies.
Medication errors have been estimated to occur at a rate of five per 100 medication administrations, but only seven in 100 medication errors have the potential to cause patient injury, and only one in 100 actually results in injury. 2, 10 In hospital settings, the number of ADEs has been reported to vary from about one error per patient per day 20 to about 6.5 events per 100 nonobstetric admissions. 2 One study found that inpatient ADEs are more common in teaching hospitals than in community hospitals, but this was most likely because ADEs are more commonly detected and reported in teaching hospitals. 17 Within the hospital, ADEs occur more frequently in the ICU. 2
Reports of ADEs in the outpatient setting range from three to 50 ADEs per 1,000 adult patients. 22–24
Examples of systems and organizational failures that can lead to medication errors and ADEs include the following: 1 inaccessibility of patient information, such as information about the patient’s health status, illnesses, laboratory test results, current medications, or known drug allergies 2 insufficient knowledge about a drug, such as proper dosing or drug–drug interactions 3 handwritten orders that are illegible, misspelled, abbreviated, incorrect, or incomplete 4 failures in the administration of a drug, such as giving drugs at the incorrect time or by an incorrect route, giving drugs other than those prescribed, or giving drugs to the wrong patient 4, 27, 28
Medication errors are defined as the preventable inappropriate use of medications. These errors can occur at any point in the process: ordering, transcribing, dispensing, administering, or monitoring medications.
You immediately experience a physical and psychological stress response. Your blood pressure and pulse rate go up, your muscles tense and you are overcome by disbelief, panic, fear, anger and shame.
Unintentionally harming of a patient through a medication error is devastating because it is in complete conflict with our nursing goal of caring and helping. Here are six things nurses need to know if they commit a medication error: 1. Medication errors happen all the time. Human error is a fact of life and mistakes with medication are ...
Nurses have always played a major role in preventing medication errors. Research has shown that nurses are responsible for intercepting between 50% and 80% of potential medication errors before they reach the patient in the prescription, transcription and dispensing stages of the process.
Studies have shown that, besides increasing hospital stays and inpatient expenses, medication errors cause more than 7,000 deaths annually in the United States.
Should you not report the incident and the patient dies or suffers permanent disability from your mistake you will have to live with the guilt for the rest of your life. A cover-up may also be discovered and do more harm to your reputation, and possibly your career than that the mistake you made.
The administration stage is the most vulnerable to error because this is where there are fewer system checks and balances. In the hospital setting most medication is administered by a single nurse with the result that nurses’ errors are those most likely to reach the patient.
Be sure to stay with facts only. Avoid personal views, defensiveness, making excuses, lying or trying to shift blame. As you will most likely be an emotional wreck at this stage, it might be a good idea to ask a close colleague to help you with the report.
Several ethical issues may arise as a result of medication errors: harm to patients, whether to disclose the error, erosion of trust, and impact on quality care. Nurses' appropriate ethical responses to medication errors need to be supported.
Errors in health care are receiving much attention today, although committing such errors is not a new phenomenon. Nurses are taught procedures so that they are less likely to make mistakes. Yet nurses do make errors. Although many types of errors can and do occur in the health care setting, this article focuses on a discussion of medication errors and related ethical implications. Several ethical issues may arise as a result of medication errors: harm to patients, whether to disclose the error, erosion of trust, and impact on quality care. Nurses' appropriate ethical responses to medication errors need to be supported. Changing the health care system will help nurses to promote patient welfare, lessen the chance of harm, and reduce the likelihood of medication errors occurring.
Ethical issues related to medical errors can be categorized around four ethical principles: autonomy and right to self-determination; beneficence and nonmaleficence; disclosure and right to knowledge; and veracity ( Bonney, 2014 ). Each of these principles will be discussed below.
Medical errors are not typically caused by a negligent or incompetent healthcare professional. Instead they are often the result of a breakdown in processes that guide delivery of patient care ( Bonney, 2014 ).
Concepts of autonomy and right to self determination acknowledge patients’ rights to make their own choices and to take actions based on their personal views and perceived benefits. Healthcare providers have an ethical obligation to inform patients about their ongoing plan of care , including if a medical error has occurred. If Sarah had not informed others of her error, Mrs. May would not have been able to make appropriate decisions about the treatment that she needed as a result of the error. Healthcare providers are also obligated to assist patients in making decisions, as the physician did in his care of Mrs. May. The physician’s honest discussion with Mrs. May about the medication error and potential adverse effects helped her to maintain trust in those caring for her and follow their instructions for treatment so that she could minimize harm from the error.
Students in the Advanced Clinical Nursing class that I taught were assigned to write a paradigm case--a story that reflected an ethical dilemma that they had experienced in their clinical practice. It was made clear that they needed to write something they could share with others, as we would set aside class time to read their stories aloud. With 22 students gathered in a circle in the classroom, Sarah * prefaced the reading of her story by confiding that she had read it to her husband before class. He asked her whether she really thought she should share the story openly. She replied, “Yes.”
Sharing Stories of Errors. Encourage students and practitioners to tell their stories of medical errors, rather than hiding errors out of fear, and to listen to stories from others. Knowing how others have handled mistakes, or wish they had handled them, can help other staff prevent and/or manage healthcare errors.
Research is needed that incorporates disciplinary perspectives of professionals in healthcare, law, communication, and ethics to help healthcare providers understand and implement ethical practices for prevention and management of medical errors.
Healthcare providers have an ethical obligation to disclose information that patients need for informed decision making. The patient’s bill of rights calls for full disclosure of a medical error ( Ghazal, Saleem, & Ariani, 2014 ). Fortunately, in Sarah’s situation healthcare providers disclosed the information needed to help Mrs. May make decisions about her care, thus respecting her autonomy and decreasing the potential for harm. Every institution needs clear and detailed policies for disclosure of information about medical errors.