Ethical Dilemma Of Medication Error

When I think about an ethical dilemma particularly to nursing, I can’t help but to recall an educational video about a near-fatal medication error. Mike Villeneuve, CEO of Canadian Nurse Association shared his story of a potentially fatal error in the administration of the wrong medication. As we review the story, we will identify the ethical error, the accountability of the nurse, and the action to be taken.

Mike was a new graduate nurse who had just been assigned to the intensive care unit. He explains it was a very fast pace environment and he was only on that unit for about 6 months prior to this incident. Mike had two Patients, Patient A with hyperkalemia and Patient B with Hypokalemia. A physcian had telephoned in an order through the charge nurse at the desk for potassium administration to Patient B. The nurse who took this message relayed it to mike stating the order was for patient A. Mike failed to perform the patients six rights of medication administration because he was in a hurry. Mike proceeded to administer the potassium to the wrong patient and almost cost the patient their life. Mike story can impact the nursing community tremendously in that medication error is a huge ethical dilemma to all nurses across the board.

Since we have identified the ethical dilemma from Mike’s experience as an error in medication administration. We can now identify the correct actions that can be taken by the nursing team, nurse manager, and facility management to reduce another occurrence of this type of error. Medication error can happen within many periods of the patients care. This can include anywhere from an order of the wrong prescription, improper dose, wrong route, or even a monitoring error. One of the actions that should be taken by the nursing team should be to follow the guidelines of the six rights of medication administration. These include the confirmation of the right patient, the right drug, the right dose, the right route, the right time and right documentation.

Performing the six right is the best tool a nurse can utilize to prevent harm to a patient. The first right is to identify the correct patient, and this is done by distinguishing three identifiers such as the clients name, date of birth, and identifying any allergies prior to administration. The next right is to verify the drug order by checking the Medical Administration Record for that specific patient three times. Right three, four, and five will also be specified through the Medical Administration Record of how much of the medication should be given, which rout it should be given, and at what times it should be given. The sixth and final right is to document thoroughly noting medication, time, route of administration and performing assessments.

With a nurse upholding these six rights he or she must use critical thinking to decide whether the ordered medication should be given. Often medication error is caused by a “monitoring error such as failing to take into account patient liver and renal function, failing to document allergy or potential for drug interaction” (Tariq, 2020). Other dilemmas in medication error are contributed by similar drug names, difference in dosage, and lack of pharmacological knowledge. For example, when administering a pediatric dose of digoxin and mistake is made because of the difference in dosage this can be fatal. Pediatric dosage of digoxin has a narrow therapeutic range which can be harmful if there is a miscalculation. As previously noted, medication errors can be caused by many factors, but it is the responsibility of the nurse to catch these before they occur.

The action to be taken by the nurse manager and facility management will depend on the action of the nurse in error. The nurse manager should be notified of any and all administration errors. The nurse manager should then notify the facility management of the occurrence where they will work together on what steps need to be taken. The nurse manager will take the proper steps to identify the cause of the action and what should be changed to prevent another occurrence of this error. The nurse manger will use the proper channels of having the nurse in question fill out the incidence report. The facility manager will review the incident reports and take proper action in the disciplinary process of the nurse in question. These actions should follow the hospital protocol and be addressed to the Board of Nursing.

When errors occur, nurses are deemed as insufficient because of the violation to promote client wellbeing. Quality of care is impacted when errors are made because the safe practice is disrupted by harm to the patient. Referring to the story to Patient A who was given excessive potassium which potentially could have led to a fatality. If not for life saving interventions to treat wrongful administration this patient could have lost their life. Because of this incident quality care was insufficient and harmful to the client. This impacts nurse professionals directly because mistakes that lead to injuries may hold the nurse liable for malpractice, revocation of license, fines, possible jail time, and loss of confidence in skill.

Accountability of a nurse is to take responsibility for their actions, guarantee competency in performed skills, and placing the client’s wellbeing first. Nurses are responsible for their clients and are held to this by what is referred to as Duty of Care. “Duty of care is a legal, ethical and professional obligation to prevent patients from coming to harm, which, if breached, can leave nurses at risk of disciplinary action” (Tineke, et al., 2017). This is the nurse’s responsibility to know the reason they are performing the skill, having the ability to perform the assigned skill, and to carry out what is expected of a nurse know. This includes the reason for ordered medication, ability to carry out order safely, and to perform skill effectively as a member of the nursing team. If an error is made, it is the nurse’s obligation to notify a member of the nursing team as well as the Health Care Provider. The prompt notification can ensure an intervention to treat the mistake as well as find a solution for the reason of error.

As a soon to be graduate nurse the fear of causing harm to a client is very freighting. In a situation in which a member of my nursing team was to perform a medication error. I would respond as an advocate for the client and support the team member. According to “The U.S. Department of Health and Human Services reports that 44,000 to 98,000 deaths may occur annually due to errors in hospitals, ranking medication errors as the highest cause” (Thomas, 2019). As we have gathered form the statistic listed above medication error is prevalent among health care workers.

In this situation I would help the team member treat and stabilize the patient first. Once the patient is stable, I would evaluate the nurse on which steps he or she is going to take next. I would encourage the nurse to notify the health care provider and family of the error because this is the nurse’s duty to tell the truth. Then the nurse will notify the rest of the health care team. This is done to prevent any negative outcomes and reduce further occurrence of this error, Next the nurse should document error, findings, and treatment provided to client to address patient wellbeing. As a nurse I believe supporting the team member to take the right steps is the best way to promote a better outcome. If the team member chose not to take the correct actions, I would be obligated to let my nurse manger know in this situation.

When asked how I would handle a similar situation to a team member versus a friend I would implement the same interventions. Because even though the person in question is my friend, I still have a duty to promote good to the client. I am responsible for the health and wellbeing of others. Choosing to protect a friend could subject me to the same repercussions as my friend. In this situation I would support the team member and friend reassuring them that errors do happen, and that he or she is not alone in this mistake. I would support them in making the right choice to carry out the proper duties to protect the client and to themselves.

The legal and ethical dilemma of medication error violates section 567.8b according to the Oklahoma Board of Nursing Practice Act. The Oklahoma Board of Nursing can take action to suspend or revoke any licenses according to number nine which states anyone who “Is guilty of any act that jeopardizes a patient's life, health or safety as defined in the rules of the Board” (Oklahoma Nurse Practice Act, 2019). The actions the Board of Nursing will take depend on the state of the violation this can include remediation of education or administration penalty. The nurse that is found making this error can also be subjected to be charged with a misdemeanor and a one hundred dollar fine. The Oklahoma Board of Nursing was incorporated to protect the wellbeing of the residence of Oklahoma by making sure any licenses nurse is component to do so. This is where a nurse is held accountable for actions which are upheld by the Nurse Practice Acts.

As a student transitioning to a new graduate nurse I can learn tremendously from Mikes testimony. He made a common mistake that is found to be one of the highest causes of death in the hospital field. Mike disregarded the right patient, the right drug, the right dose, the right route, the right time and right documentation. Because of this mistake he almost caused harm to his patient. Which could have led to death and serious legal action taken against Mike. His story has insight into identifying what actions is right and wrong in the administration of medication among nurses.

The knowledge I have gained from this ethical dilemma has impacted the way I will practice as a soon to be nurse. How I will practice as an accountable member of the nursing team is to take responsibility for my actions. If I were to make error in treatment, I will notify the right individuals of the mistake and take responsibility to correct the error. I will also not take on an assigned skill that I know I am not competent in. This is where I will seek out the proper education on how to perform the skill before ever initiating it. To be an accountable nurse I must always put the client’s wellbeing first and provided the best care possible.

As a nurse I will manage care to the standards of the Oklahoma Board of Nursing, Nurse Practice Acts, and Hospital Protocol. I will uphold the standards of care and manage care accordingly. The insight I have gained from this information has brought a new awareness of this problem in health care. I have learned how to implement the correct actions, identified the issues, violations of act, and my role as a health care team member. I believe this new insight will help me from producing the same ethical dilemma that is prevalent throughout the health care system.

In closing we have uncovered the ethical dilemma particularly to the nursing field. The ethical dilemma of wrongful medication error can be prevented if awareness is made of this problem. Mikes willingness to share the error in administration that he had made has brought attention to this common mistake made in health care. Throughout this paper we have identified the error and established the accountability of a nurse to the wellbeing of the patient. And lastly, we have indicated the action that can be taken to prevent this situation from reoccurring.

References

1. Tariq, R. A. (2020, February 18). “Medication Errors”. Retrieved April 4, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK519065/
2. Thomas, C. M. (2019, March 17). “Your First Mistake as a Nurse”. Retrieved April 4, 2020, from https://www.elitecme.com/resource-center/nursing/your-first-mistake-as-a-nurse/
3. Tineke, Rasmussen, Shayne, Neufeld, Michael, Gerrard, & Ford. (2017, November 1). “Nursing's Duty of Care: From Legal Obligation to Moral Commitment”. Retrieved April 4, 2020, from https://www.questia.com/library/journal/1P4-2036387809/nursing-s-duty-of-care-from-legal-obligation-to-moral
4. Oklahoma Nursing Practice Act. (2019, November 1). “Section 567.8b”. Retrieved April 4, 2020, from https://nursing.ok.gov/
5. Villeneuve, M. (2017, October 30). Near-Fatal Medication Error” [Video File]. Retrieved from https://www.youtube.com/watch?v=MGT8yoAIun4&t=126s