Ethical Dilemmas in Responding to Nursing Medication Errors
It is well documented that medication errors made by nurses are among the most prevalent but also the most preventable types of adverse patient incidents that occur in health care settings today. The impact of these medication errors is also severe and even life-threatening, and the potential for an increase in the numbers and frequencies of medication errors has been compounded in recent months as the ongoing Covid-19 pandemic continues to stretch medical resources and health care personnel to their limits. When medication errors are discovered, though, some type of patient incident report is typically required to be made to appropriate authorities and the consequences of these adverse drug events can also be severe for the nursing personnel who are responsible (Escriva et al., 2021). Against this backdrop, it is clear that there are some profound ethical dilemmas involved in responding to nursing medication errors. The purpose of this paper is to provide a review of the literature to identify the ethical dilemma and how it affects nursing practice at present. In addition, a discussion concerning the main moral issues that are raised in these situations and relevant bioethical principles as they relate to the ethical dilemma is followed by the authors personal views about this which are based on personal, group, and societal moralities. Finally, a description of that values relationship with the morality of a group or society with which the author is currently living is followed by a summary of the research and important findings in the conclusion.
Review and Discussion
Given the enormous numbers of the wide array of drugs that are administered to Americans in different ways each year, it is little wonder that huma errors occur from time to time, but the implications of these errors can be profoundly severe and even life-threatening. The most recent estimates indicate that more than 7 million people (perhaps even more due to unreported cases as discussed further below) are harmed as a result of medication errors each year, and the economic costs of these errors exceeds $21 billion. In addition, the various types of adverse effects of medication errors add between 1.7 and 4.6 patient days to inpatient care each year (da Silva & Krishnamurthy, 2018).
The adverse drug effects that are caused by medication errors include 1) allergic reactions, 2) a wide range of other side effects, and 3) the overmedication of patients (Medication safety, 2021). Furthermore, the potential for these and other types of adverse effects from medication errors has been exacerbated by the growing numbers of prescription medicines that American take each as well as the devastating effects from the ongoing Covid-19 pandemic which has completely filled ICU beds across the country in recent months. Taken together, nurses who are on the frontlines of patient care are confronted with a daunting enterprise in providing the highest quality care possible, including the decisions as to whether to report medication errors that are caused by other nurses and the ethical dilemmas posed by these decisions are discussed further below
What is the ethical dilemma? How does the dilemma affect nursing?
Medication errors are likely seriously underreported due to the dilemma of the responsible nurse being "written up and these reports could potentially lead to their termination. It is reasonable to posit that the vast majority of unreported medication errors did not cause any substantive harm to patients and the decision to overlook these incidents can easily be rationalized by both the nurse responsible as well as whomever discovered it as well. For instance, according to a study by Sorrell (2017):
Nurses working in long-term care noted that participants had different definitions of what constitutes harm with a medical error; their perceptions of harm influenced whether they reported the error. Because of busy working conditions, these nurses prioritized which errors to report. One participant stated, If its caused no harm, its no big deal! (emphasis added) (p. 2)
In other words, because patient incident reporting about medication errors can have career-altering implications, many nurses likely have second thoughts concerning whether to report...
…can also adversely affect patients future encounters with health care providers which can even be based on a single, isolated episode. Given the trust that is instilled in professional nurses by the vast majority of patients in the United States, this personal value is particularly relevant for the purposes of this discussion as it relates to the larger American society as noted below.Describe that values relationship with the morality of a group or society you are currently living
America society in general places a high priority on consumers being able to absolutely trust certain occupations such as law enforcement authorities, first responders, firefighters and even lawyers to consistently perform their jobs in ways that protect them from harm. Indeed, scarcely a day goes by without headlines reporting yet another high-profile instance of this trust being violated by people in these and similarly situated occupations, and the cumulative effect of these violations can likewise have dire consequences for Americans who may learn to distrust the very people whom they need to help them during emergent situations. When it comes to trusting health care professionals to do the right thing even when something wrong was done is therefore an integral part of the morality calculus whn it comes to the decision-making process for reporting or not reporting medication errors (Erlen, 2011).
Conclusion
The research was consistent in showing that the medication error reporting process is frequently fraught with ethical dilemmas that defy easy resolution. Like many other complex problems, these ethical dilemmas were shown to exist along a continuum that serves as a de facto framework that is used by nurses to guide their decisions concerning whether to report medication errors or not, with many nurses viewing harmless medication errors as no big deal which do not require reporting due in large part to the adverse effects this can have on nursing careers. Fortunately, besides the relevant bioethical principles that can be used to guide this process, individual moral values can also help nurses make the right ethical decision despite the complexity of the…
References
Brady, A.-M., Malone, A.-M., & Fleming, S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17(6), 679–697.
da Silva, B. A. & Krishnamurthy, M. (2018). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of Community Hospital Internal Medicine Perspectives, 6(4), 10-15.
Erlen, J. A. (2011). Medication errors: ethical implications. Orthopedic Nursing, 20(4), 82–85.
Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Services Research, 19(1), 640.
Medication safety. (2021). U.S. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/medicationsafety/basics.html.
Pedley, L. (2002). Medication errors and ethical nursing practice. Perspectives, 26(2), 10–13.
Perm, J. (2018). Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients. The Permanente Journal, 22, 1-10.
Sorrell, J.M. (2017, March 7). Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2), 1-7.
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