When should the drug not be prescribed?
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
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.
Scenario 2:
A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.
Scenario 3:
You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.
Scenario 4:
During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.
To prepare:
- – Review Chapter 1 of the Arcangelo and Peterson text, as well as articles from the American Nurses Association, Anderson and Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
- – Select one of the four scenarios listed above.
- – Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.
- – Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario.
- Chapter 1, “Issues for the Practitioner in Drug Therapy” (pp. 3–14) This chapter introduces issues relating to drug therapy such as adverse drug events and medication adherence. It also explores drug safety, the practitioner’s role and responsibilities in prescribing, and prescription writing.
- Chapter 59, “The Economics of Pharmacotherapeutics” (pp. 1009-1018) This chapter analyzes the costs of drug therapy to health care systems and society and explores practice guideline compliance and current issues in medical care.
- Chapter 60, “Integrative Approaches to Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036) This chapter examines issues in individual patient cases. It explores concepts relating to evaluation, drug selection, patient education, and alternative treatment options.