An estimated 1.5 million “preventable adverse drug events” occur each year in the United States alone; the number of medication errors that did not lead to adverse effects but remained undisclosed is unknown (Jenkins & Vaida, 2007, p. 41). The scenario is this: You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.
Disclosure is an ethical and legal prerogative, showing respect for the patient and a willingness to accept professional responsibility. Consequentialist ethics do not apply to situations like these, because the broader issue is about changing advanced nursing practice and ensuring a culture of safety for all patients. Likewise, disclosure empowers the patient to make informed choices about reactions to the medical error while encouraging the healthcare team to do whatever necessary to reduce errors from occurring in the future. The best strategies for reducing medical errors include ongoing professional training of all staff, correcting organizational culture barriers, and the implementation of a set of specific protocols for medication administration.
Summary
Ethical Issues
Whether or not the patient experienced adverse effects has nothing to do with the ethic of disclosure. Even consequentialist frameworks like utilitarianism can be used to show why disclosure should be normative among advanced practice nurses.
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A utilitarian ethic promotes the greatest good for the greatest number. A culture of safety by definition promotes the greatest good for the greatest number. Therefore, nurses need to practice disclosure as a matter of course in order to participate in, uphold, and be responsible for the culture of safety that promotes ideal patient outcomes.
Deontological ethical frameworks categorically uphold the duty of nurses to provide consistent care under the rubric of guiding ethical principles like patient autonomy, right to knowledge, and nonmaleficence. Non-disclosure is a form of lying or deceit in that it is a deliberate withholding of information from patient about that patient’s own body. Likewise, non-disclosure inhibits the ability of the patient “to make appropriate decisions about the treatment that she needed as a result of the error,” (Sorrell, 2017, p. 1). Advanced practice nurses also operate under the ethical duty to care and to not do harm. Disclosure prevents further harm from occurring: such as the harm that arises out of eroded trust, the harm that arises out of the perpetuation of a culture of deceit in the organization, and the harm that could arise if such errors did actually lead to adverse outcomes. As many as 250,000 deaths per year in the United States are directly due to medication errors—the highest among almost all developed nations (Sorrell, 2017).
Ironically, many nurses report that the “negative….....
Ghazal, L, Saleem, Z. & Amlani, G. (2014). A medical error: to disclose or not disclose. Journal of Clinical Research and Bioethics 5(2):https://www.omicsonline.org/open-access/a-medical-error-to-disclose-or-not-to-disclose-2155-9627-5-174.pdf
Guillod, O. (2013). Medical error disclosure and patient safety. Journal of Public Health Research 2(3): e31.
Leone, D., Lamiani, G., Vegni, E., et al (2015). Error disclosure and family members’ reactions: Does the type of error really matter? Patient Education and Counseling 98(4): 446-452.
McLennan, S.R., Diebold, M., Rich, L.E. et al (2016). Nurses’ perspectives regarding the disclosure of errors to patients: A qualitative study. International Journal of Nursing Studies 54(2016): 16-22.
Sorrell, J.M., (March 7, 2017) "Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare" OJIN: The Online Journal of Issues in NursingVol. 22, No. 2.
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