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.