Medical errors in the healthcare systems have posed many ethical and legal consequences for the stakeholders involved. These have produced unwarranted pain for patients and a financial burden to families, prescribers, pharmacists, and even hospital management. The effects of treatment faults are dilemmas about disclosure and non-disclosure, which often result in moral dilemmas and criminal repercussions. In Maryland, it is a requirement that all therapeutic mistakes are revealed to patients to avoid harm and injury. To circumvent potential lawsuits, it is important to understand the available guidelines on medical errors, particular state laws regarding medical faults admission, and possible strategies for minimizing the errors.
Ethical and Legal Implications of Disclosure and Non-Disclosure in Maryland
In Maryland, under the legislation, COMAR 10.07.06 subsection two, outlines the duty to notify patients. The legislation stipulates that patients and their family members must be notified about any adverse events that occur during their medical treatments and can cause serious harm or death (Maryland Department of Health, n.d.). Notably, under Maryland’s medical legislation, non-disclosure of medical faults can lead to several legal and ethical consequences. According to Koller et al. (2016), it is imperative to acknowledge preventable medical mistakes that might be a source of severe healthcare complications for patients. Besides, the Maryland health department requires a thorough investigation of the roots of the medical inaccuracies through root cause analysis (RCA) as indicated in COMAR 10.07.06 subsection four, which ensures that all possible causes of errors are eliminated in the future (Maryland Department of Health, n.d.). Therefore, it is an ethical obligation of the healthcare providers to disclose medical mistakes and provide investigations into the root causes to avoid potential present and future harm to the patients.
Adults of the right mental capacity and aptitude are competent in making informed decisions regarding their medical care. The principle of autonomy demands that healthcare providers seek the patient’s consent when recommending treatment plans. In this sense, the diseased must be involved in all the management models proposed to them to comprehend how the treatment methods affect them. Maryland department of health also highlights in the patient’s safety regulation COMAR 10.07.06 subsection three that all medical errors must be revealed to the Office of Health Care Quality immediately to ascertain tracking of the slips and possible rectification of the medical mistakes (Maryland Department of Health, n.d.). However, releasing such information goes against the principle of confidentiality as a third party is involved. Conversely, Ghodousi et al. (2018) argue that confidentiality promotes patients’ self-reliance in medical procedures and acts to avert legal conflicts, though with several ethical implications. Importantly, working within the state’s laws is paramount as the regulations and protocols are created to guide the healthcare providers.
What I Would Do as the Advanced Practice Nurse in the Scenario
The choice to disclose information or not depends on an individual’s ability to accept their mistake and account for their wrongdoing. Tigard (2019) argues that it would help the medical health systems to recount a person’s responsibility and blame for medical errors. Particularly, expressions of trustworthiness through displaying guilt and penitence are keys to the process of unveiling liabilities to patients and their proxies. Though admission of guilt can have undesirable mental repercussions on the healthcare providers, accounting for mistakes and showing an expression of regret allow the patients and their families to cultivate beyond the clinical faults (Tigard, 2019). However, according to Fortunato et al. (2017), “nocebo effects” may arise when medical errors ascend from the patient’s negative prospects. Informed consent and observation of the principle of autonomy may violate the notion of “primum non nocere,” given that medical error disclosure may lead to more adverse effects (Fortunato et al., 2017). Therefore, I will evaluate the possibility of harm to the patient when faced with the dilemma of whether to disclose or not to disclose the medical errors before taking any actions.
Process of Writing Prescriptions and Strategies to Minimize Medication Errors
Writing prescriptions encompasses important guidelines that physicians must consider. For instance, there are particular components to include in a treatment process and drugs formulations. According to Maxwell (2020), drugs instructions standards require that the information be enclosed in the instruction of medications to a patient. All directions for drug usage must use a precise and simple dialect so that a patient could read and comprehend with ease (Maxwell, 2020). Besides, when prescribing, it is important to note the medications in clear writing, stating the frequency and amount at which the patient should use them. Moreover, the formula should contain the projected days that the sick person can take the drugs. However, other information incorporated depends on the treatment guidelines and regulations of the state.
Advanced technology and improved electronic software in prescriptions can help lower medical inaccuracies. Zadeh and Tremblay (2016) established that e-prescribing improves the quality of medical care by elevating the effectiveness of proposed medications. Additionally, e-prescribing lowers the rates of medical errors and minimizes patients’ medical costs by reducing adverse events (Zadeh & Tremblay, 2016). Therefore, technology is an essential method of decreasing medical fallacies, thus, lowering healthcare costs.
In the state of Maryland, patient safety during medical adverse events comes first. The state directive stresses that all medical mistakes are divulged to the patients and their families because healthcare providers have the duty to notify the victims. However, in the event of ethical and legal implications, a nurse’s judgment guided by the principle of “primum non nocere” supersedes all other regulations. In this regard, such strategies as e-prescribing ensure a reduction in medical errors.
Fortunato, J. T., Wasserman, J. A., & Menkes, D. L. (2017). When respecting autonomy is harmful: A clinically useful approach to the nocebo effect. The American Journal of Bioethics, 17(6), 36−42.
Ghodousi, A., Abedzadeh, M., Ketabi, M., Zarean, P., & Zarean, P. (2018). Adherence to confidentiality principles from the viewpoint of Iranian dental students: A multicenter study. European Journal of Dental Education, 22(1), 88−93.
Koller, D., Rummens, A., Le Pouesard, M., Espin, S., Friedman, J., Coffey, M., & Kenneally, N. (2016). Patient disclosure of medical errors in paediatrics: A systematic literature review. Paediatrics & Child Health, 21(4), 32−38.
Maryland Department of Health. (n.d.). Patient safety program. Web.
Maxwell, S. R. J. (2020). Writing prescriptions: How to avoid common errors. Medicine, 48(7), 472−477.
Tigard, D. W. (2019). Taking the blame: Appropriate responses to medical error. Journal of Medical Ethics, 45(2), 101−105.
Zadeh, P. E., & Tremblay, M. C. (2016). A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Research in Social and Administrative Pharmacy, 12(1), 1−19.