NURS 6521 WeeK 1 Essay Assignment
Pharmacotherapeutics for Advanced Practice
When looking into the legal and ethical responsibilities an advanced practice nurse (APN) is to adhere to, as a mid-level provider, ensuring safe and effective medication prescribing surely ranks near the top, and is straightforward. However, when the APN considers the cost of the medications, and their potential financial impact on the patient, the ethical path becomes somewhat blurred. On one hand, the higher-priced medication does indeed control the patient’s symptoms to a slightly greater degree; however, on the other hand, the lower-priced medication also controls the patient’s symptoms, though to a lesser degree, and also has a significantly lower financial impact on the patient. In the real world, decisions like this can become troublesome, are not easily navigated, and can often have grate impact on the patient’s ability to stay adherent to the treatment regimen—whether or not the patient has every intention/want to remain in compliance. This writing will endeavor to explore the stakeholders’ ethical and legal implications, disclosure versus nondisclosure according to state laws, strategies available to guide decision making, and minimizing prescribing errors that all lead to making sound prescribing decisions that best benefit the patient.NURS 6521 WeeK 1 Essay Assignment
Ethical and Legal
According to Fowler (2015), the APN’s primary commitment is to the patient, whether it includes one or many, and is accountable/responsible to make decisions that are obligatory towards promoting health and providing optimal care for said patient. When thinking of the scenario of less expensive versus more expensive medications, and the quest for providing the most optimal health benefits, it becomes less a legal implication, as it does an ethical one. When considering the stakeholders in this scenario, which would include the APN prescribing the medication, the pharmacist preparing and dispensing the medication, and the patient with his family taking the medication, either medication, high-cost and low-cost, legally fulfills all obligations in this scenario. However, in terms of ethics, knowingly prescribing the higher-cost medication, though the increased benefits are clearly known by all, instead of the lower-cost one, could most likely create a scenario that would pit the patient and his/her family paying for the costly medication against having enough to provide the basic necessities of daily living—i.e. the rent, food, warmth, etc. In this type of situation, though the lower-cost medication has less efficacy in reducing the patient’s symptoms, the likelihood of adherence to the treatment regimen would invariably be much higher. Ethically speaking, the choice then becomes quite clear as to what would most benefit the patient and his/her family.
Disclosure Versus Nondisclosure
When deciding on how the APN could address whether or not disclosing the cheaper/less-effective option to patient, it is first of paramount importance how one’s own state laws may govern it. According to Virginia Law (2002), all providers shall take prompt action in the event of a medication error or adverse drug reaction, and shall record it in the individual’s medication log. Though this law does not directly govern this type of scenario, it does indirectly stipulate, since the patient is guaranteed the right to have full access to their chart, that the patient be fully informed of drug reactions and medication errors; which failing to alert the patient to a lower-cost medication regimen could be construed as a type of medication error. The implied directive from Virginia Law here is clear, full disclosure of all medication options.NURS 6521 WeeK 1 Essay Assignment
Strategies for Decision Making
The two main strategies that would guide the APN’s decision to disclose the cheaper medication option would include that it would be an egregious violation of ethical standards, and the fact that patient often go without needed medication as a way to cut costs. Providers, of which APN’s are one, are bound by their code of ethics, whether or not they may cause some type of harm to the patient, to fully disclose medical errors (Edwin, 2009). Failing to provide all information is a type of medical error already established. According to How patients reduce their prescription drug costs in the US (2015), a survey uncovered that 7.8% of adults neglected to take their medication as prescribed to reduce costs; which the paper went on further to suggest the percentage to be much higher. So, taking these two points into consideration, the course becomes clear that fully explaining the choices of the differing medications both adheres to ethical codes and ensures greater adherence to the treatment regimen.
Minimizing Errors
According to Rosenthal and Burchum (2018), writing prescriptions involves collaborating with other professionals, ensuring the prescriptions include all the necessary information and are legible, and reviewing all the factors, (including drug-to-drug interactions, allergies, availability, side effects, liver/renal functionality, and even cost) to ensure any medication errors are avoided and the patient receives the best possible care. Clearly, quite a lot of information must be considered before a prescription can be effectively written for a patient. Special attention should also be paid, considering our scenario, to the cost and availability of the drug; whether or not higher-cost versus lower-cost should be prescribed truly depends on whether or not the patient will be able to obtain said medication.
Conclusion
Having explored the minimization of errors, strategies to help decision making, and the obvious ethical obligations of disclosing medication errors, of which failing to disclose cheaper medication regimens is one, we now understand fully the duty of the APN. I would urge any APN to consider this information when deciding a patient’s regimen. For it may very well mean the difference between helping to increase the patient’s health or helping to decline it.NURS 6521 WeeK 1 Essay Assignment
References
Edwin A. (2009). Non-disclosure of medical errors an egregious violation of ethical principles. Ghana medical journal, 43(1), 34–39.
Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, Maryland: American Nurses Association, 2015.
How patients reduce their prescription drug costs in the US. (2015). PharmacoEconomics & Outcomes News, 721(1), 13. https://doi-org.ezp.waldenulibrary.org/10.1007/s40274-015-1888-1
Rosenthal, L., & Burchum, J. (2018). Lehne’s Pharmacotherapeutics for Advanced Practice Providers – E-Book. St. Louis, MO: Elsevier Health Sciences.
Virginia Law. (2002, September 19). 12VAC35-105-780. Medication Errors and Drug Reactions. Retrieved from https://law.lis.virginia.gov/admincode/title12/agency35/chapter105/section780/
NURS 6521 WeeK 1 Essay Assignment