NURS 6521 Week 1 Assignment 2 - Ethical and Legal Implications of Prescribing Drugs

Introduction Each year, more than 100,000 U.S. reports associated with suspected medication errors are received by the U.S. Food and Drug Administration (Centers for Drug Evaluation and Research, 2019). These medication errors can lead to severe adverse effects or result in a patient’s death. To reduce the incidence of the occurrence of medication errors and other medical errors, there are policies and legal frameworks that are put into place to protect both the patient and the provider. The case scenario involves deciding if a terminally ill 85-year-old female should continue INR monitoring. The purpose of this assignment is to explore the ethical and legal implications involved in this scenario and consider how to appropriately respond as a provider. Ethical and Legal Implications The case scenario provided involved many ethical and legal implications. Because of the patient’s cognitive decline, the patient is unable to advocate and participate in her treatment plan safely and effectively. The prescriber should refer to the patient’s advanced directives and consult with a sponsor, guardian, or designated surrogate (these roles are usually assigned to a member of the patient’s family). The family should be educated on the situation and their options for care to aid in advocating for decisions regarding this patient. The decision of continual monitoring of the patient’s INR should be based on evidence-based practice to consider the patient’s safety and comfort and to weigh the risks and benefits of the treatment. Given the patient’s terminal status, monitoring the patient’s INR is increasing her discomfort. It does not have a significant impact on her prognosis or treatment. However, adverse effects related to inadequate or excessive anticoagulation, such as thromboembolic 3 events or serious bleeding, can be reduced by maintaining patients within their prescribed therapeutic range (CMS, n.d.). This would raise concern to the pharmacist regarding the increased risk of blood clots due to the cessation of the patient’s routine INR monitoring. The prescriber is also at risk of being sued if they are negligent in monitoring the patient’s INR. Disclosure and Nondisclosure Strategies Disclosed and nondisclosed factors are essential regarding the end-of-life care of the patient. Despite the physician’s diagnosis of the patient’s terminal status, she continues to take blood thinners due to undergoing a valve replacement 20 years ago. It is important to keep both the patient and her family informed of the risks and benefits of discontinuing the INR monitoring and of other treatment options they can consider. The patient is at increased risk for serious adverse effects related to the medication due to many factors. Her cognitive status is a major factor as she can easily be noncompliant with adhering to the prescribed medication, and she is also at increased risk for falls. If the patient takes her medication incorrectly or falls and is injured, there is an increased risk of bleeding. This could affect the patient negatively and even lead to death. The state’s end-of-life laws should be considered before discontinuing the patient’s INR monitoring. In the state of Alabama, the physician must certify the patient’s terminal diagnosis and the prognosis indicates that the patient has an approximate life expectancy of six months or less (Legal Information Institute, n.d.). Consulting hospice or palliative care should also be considered to aid in the facilitation of the treatment plan. Decision Making As an advanced practice nurse, I would use professional codes of conduct and professional ethics as two strategies to guide my decision-making in this scenario. These strategies will be held to the standards of evidence-based practice and patient safety, comfort,