Principles of Law, Accountability and Ethics to a Patient-Prescribing - Report Example

A Critical Application of the Principles of Law, Accountability and Ethics to a Patient-Prescribing Scenario From A Medically-Supervised Practice Word Count: 1,610 (6 pages) A colleague has just finished a consultation/ assessment with a patient/client. The nurse is not a prescriber and requests that you sign the prescription on their behalf. Identify and discuss the legal, accountability and ethical issues for nurse prescribers raised by this request. I. Introduction (72 words) The scenario is that a colleague who is not a prescriber asks to have a pill prescription signed for a patient who needs a contraceptive pill. However, the dilemma is that the prescriber (me) has not seen the patient. Since prescribing medication without seeing the patient has many consequences, I try to discuss all the possible consequences of the situation. This is a critical application of accountability, law, and ethics in practice. II. Accountability (483 words) Prescribing should ideally be done only by people who are authorised to make prescriptions. “The Prescription Pricing Authorities in the UK require confirmation from the NMC of a registrant’s qualification to prescribe and the scope of their prescribing qualification” (“Standards of Proficiency for Nurse and Midwife Prescribers,” 2006, pp. 12). Not all nurse practitioners can make prescriptions and need to be qualified as under the regulations set out by NMC (2006). So prescribing by nurse practitioners is legal, but must be done with great care. After all, one must consider the effects a medication can have on a person. “The people in your care must be able to trust you with their health and well-being” (“The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives,” 2008, pp. 1). Not only that, but giving someone prescriptions for medicine is a task which requires much forethought as well as caution. Contraceptives have the potential to interact with negative side effects. “The administration of medicines….is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner (can now also be an independent…prescriber). It requires thought and the exercise of professional judgment...” (“Standards For Medicines Management,” 2008, pp. 1). This is why accountability is a key factor stemming from the necessity to get the prescription(s) right the first time. If a nurse just asks someone to authorise prescriptions, say a colleague who is authorised to subscribe prescriptions, without having actually seen the patient, then it is the colleague who is accountable for making the prescription. The patient could potentially be pregnant, in which case the nurse would be accountable for providing an inaccurate assessment of the patient. So prescribing on behalf of a colleague makes the prescriber accountable for anything that goes wrong and it is the prescriber against whom action is taken if there’s a legal case. Further, it is not just legally that a prescriber gets bound but also it’s unethical if the prescriber gives prescriptions without really knowing about the situation. Even though it would seem selfish on part of prescriber to not prescribe the medications just because this puts the prescriber accountable but it is better to evaluate the situation before making prescriptions. In spite of the duty that one holds towards a patient a prescriber should take care before signing a prescription unless it’s an emergency. It is absolutely imperative that, ideally, whoever is writing the prescription(s) physically sees the patient. Not only is this a way of keeping other medical personnel professionally responsible for their actions, but it is also the right ethical consideration to take into account—which will be discussed more at length in the triad section. In short, it is important that all factors be taken into consideration when prescribing medication. Next, the legal implications of prescribing medication will now be entertained, taking into account current prescription law. III. Law (571 words) As had been earlier said prescribers are legally bound to their decisions. It is their duty to ensure that the prescriptions do not cause any harm to the patient else the action is taken against the one who signs the prescriptions. Even so there are certain stipulations that are in place, depending upon who is doing the prescribing. “As well as extending independent prescribing responsibilities…prescribing could be passed to another health professional… The necessary legal framework to enable this was subsequently included in the [law]” (“An Outline Framework to Help Allied Health Professional Supplementary Prescribers,” 2004, pp. 8). Even though there are regulations that allow prescribing on behalf of a colleague but there are rules to that as well. The standards make it clear that nurse and midwife prescribers must not prescribe for themselves and should not prescribe for any person with whom they have a close personal or emotional relationship. If the circumstances are exceptional, the prescriber must provide justification for why, at the time, a prescription could not be issued by another independent prescriber. In 2008, a fitness to practise panel removed a nurse from the NMC register for illegally prescribing for her husband, whom she had registered as a temporary patient. The prescriptions conflicted with those he was already prescribed by the GP, thereby endangering his health (NMC 2008e) (“Professional Consideration for Nurse Prescribers,” 2010, pp.58). Therefore, in spite of legally being allowed to sign a prescription for others he should not be closely related to the person. One can always point out that the prescriber was ignorant just because he was close to the colleague and blame it on his lack of sense of duty. Also under the Medicines Act 1968 only certain people are allowed prescription of some medications. It also holds those guilty who allow prescription for medications that they are not appropriate practitioner for. “Legislation only allows doctors, dentists and [nurses] to prescribe [certain] medicines. Pharmacist independent prescribers and nurse independent prescribers cannot lawfully prescribe [certain] medicines[, contraceptives being exempt from this category]” (“RPSGB Law and Ethics Bulletin: Non-Medical Prescribing and Mixing of Medicines in Palliative Care,” 2009, pp. 1). Nurse prescribers, under the Medicines Act of 1968 and the Misuse of Drugs Act of 1971, have a legal “duty of care” to the patient. This means that, in the case that negligence is found, the nurse would be responsible for the prescription written, or if the prescription was not signed properly. The nurse also has the legal duty to provide services that have beneficence and non-maleficence—which are actions done in the best interest of the patient. “A [nurse] prescriber can already prescribe [certain] medicines but only as part of the…plan for an individual patient” (“RPSGB Law and Ethics Bulletin: Prescribing Unlicensed Medicines by Pharmacist and Nurse Independent Prescribers,” 2009, pgh. 1). As with any medical prescriptions, the legal ramifications must be taken into consideration, due to the fact that a patient could sue a hospital, the medical personnel, or the personnel’s cooperating doctor if something were to go awry. Legally speaking, even if the nurse were not to sign the prescription, she could be fined for clinical negligence by not signing the prescription. If the prescription is signed, the nurse carries even more liability because the prescription is valid. As such, each case must be weighed on an individual basis in order to make such a decision, whether or not to prescribe. IV. Ethics (301 words) Ethically speaking, as had been alluded to in the first main topic paragraph, was that it might not be ethically feasible to prescribe medication without having seen the patient in person. “Prescribing safely, effectively, and improving upon the practice of prescribing are three competencies of prescribing effectively” (“An Outline Framework to Help Nurse Prescribers,” 2003, pp. 13). In one’s zest to aid the patient, it is important that—if the prescriber does decide to prescribe for the patient whom has been observed by the nurse—it is up to the prescriber to take all ethical responsibility for one’s actions, having the best interests of the patient at heart. “[One] must not do anything, or allow someone else to do anything, that [one has] good reason to believe will put the health or safety of a [patient] in danger. This includes both [one’s] own actions and those of other people. [One] should [reduce] risk[s]…[by] …following national and local policies” (“Standards of Conduct Performance and Ethics,” 2008, pp. 8). Signing a prescription makes one liable to the consequences that result thereof from the medication. Even though the person might not personally check the patient but should check the reports and other documents related to the patient before signing the prescription. Also, one should ask for the records related to the patient and should check if they have been maintained on a regular basis. Records will also reflect upon the character of the person asking for signing the prescription. At the same time knowledge about the professional record of the colleague should also play a role in signing the prescription. In spite of one should always remember that once the prescription is signed it the one who signs it that becomes liable for any action against the person in case things do go wrong. V. Conclusion (234 words) Every patient’s individual case is different. Therefore, it is important that the nurse prescriber—or whoever it may be—understands that a patient’s health must be considered individually. It’s important not to rely upon the sole observations of a third party—but to actually see the patient oneself in order to maintain standards of accountability, law, and ethics. These considerations must be taken into account because of the sensitive nature of the situation which could have potential to ignite a firestorm. If the wrong type of contraceptive pill were prescribed to the patient—or if the patient had an allergic reaction to the pill, or had some type of reaction due to various medicines being mixed—there would definitely be legal ramifications that might make it difficult for the nurse prescriber to continue making such executive decisions as a prescriber. Nurse prescribing can be done, but the prescriber not only has to be accountable to the cooperating physician, but must also make room for taking into account legal and ethical considerations as well. Since prescribing medications can be highly controversial in the eyes of some patients, it is important to reassure patients that some nurses are just as competent as a medical doctor to accurately prescribe medications. That being said, it is also of premier importance to maintain a professional outlook when prescribing some medication to a patient in any form it is administered. BIBLIOGRAPHY An outline framework to help allied health professional supplementary prescribers. 2004. Online. Available: http://www.npc.co.uk/prescribers/resources/maintain_comp_prescribing.pdf An outline framework to help nurse prescribers. 2003. Online. Available: http://www.npc.co.uk/prescribers/resources/maint_comp_prescribing_nurs.pdf The code: standards of conduct, performance and ethics for nurses and midwives. 2008. Online. Available: http://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/ Guidance for continuing professional development for nurse and midwife prescribers. 2008. Online. Available: http://www.nmc-uk.org/Documents/Guidance/NMC-Guidance-for-CPD-for-nurse-and-midwife-prescribers.pdf Nurse and midwife prescribing off unlicensed medicines. 2010. Online. Available: http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Nurseprescribing/DH_4123003#_2 Professional standards and guidance for pharmacist prescribers. 2007. Online. Available: http://www.psni.org.uk/documents/319/Standards+on+Pharmacy+Prescribing.pdf Record keeping: guidance for nurses and midwives. 2009. Online. Available: http://www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf RPSGB law and ethics bulletin: non-medical prescribing and mixing of medicines in palliative care. 2009. Online. Available: http://palliativedrugs.com/download/081209_RPSGB_LEBpallcare.pdf RPSGB law and ethics bulletin: prescribing unlicensed medicines by pharmacist and nurse independent prescribers. 2009. Online. Available: http://tiny.cc/o02gp Standards for medicines management. 2008. Online. Available: http://www.nmc-uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBooklet.pdf Standards of conduct performance and ethics. 2008. Online. Available: http://www.hpc-uk.org/assets/documents/10002367FINALcopyofSCPEJuly2008.pdf Standards of proficiency for nurse and midwife prescribers. 2006. Online. Available: http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=6942 Read More