Medication Errors: Ethical and Legal Issues in Nursing Practice

Medication Errors: Ethical and legal issues in nursing practice

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Medication Errors: Ethical and legal issues in nursing practice

A medication error is a preventable event of inappropriate medical prescription that a patient receives from a healthcare facility by their physician or pharmacist. A medication error can also occur as a result of over-the-counter self-medication from a pharmacist to an ailing individual without a proper prescription from a professional physician.  These medical errors occur in many ways; prescribing mistakes, patients complain errors, medication administration errors, monitoring errors, wrong dosage errors and improper dosage errors. National Institute of Medicine (IOM), estimated that 44,000 to 98,000 people die each year from such medical mistakes in U.S hospitals alone.

Betsy Lehman, a 39year old mother of two and a renowned health reporter, was diagnosed with breast cancer in September 1993. What followed was a hospital admission for her third round of cyclophosphamide, a chemotherapy agent at the renown Dana – Farber cancer institute in Boston. Being in its first phase of a cancer treatment clinical trial, Betsy was one of the first patients in the trial where the medication doses were administered in higher doses than usual to wipe out the cancer cells. She was also undergoing a bone marrow transplant to assist in the restoration of her immune system and blood-forming cells.

Betsy received a prescription order from her physician of 1,000mg per square meter of body surface area, to be administered daily for four days which totaled to 4000mg/m². After reading the trial report, the attending physician noted down the prescription as 4000mg/m² ×4days.

The dosing went unnoticed, and Betsy died on December 3, 1993. The medication error was later discovered after ten weeks of her death when her treatment data was first entered into the clinical trials system. (Bohmer,2003; Bohmer & Winslow,1999)

The attending physician and resident nurses, in this case, did not consult any further on the prescription order they received from Betsy’s physician on the chemotherapy medication. Being in phase 1, they ought to have communicated with the physician on the dosage they were required to administer without making any assumptions as to what it read. The nurses failed to assess and document the condition of the patient and the dosage she received while she was in the chemotherapy sessions as required by the nursing standards of practice. Why the attending nurses waited for two and a half months to enter Betsy’s treatment information to the cancer trial’s system is still a matter of contention legally and ethically, and it shows the hospital’s negligence in caring for the patients they received.  

Legally, the victim of medication errors is required by law to sue the hospital for damages and negligence. These lawsuits have cost the hospitals a lot of money amounting to billions just because of a minor reading and writing error that could have been avoided if the right protocols were followed. The physicians in the Betsy Lehman’s case were reported to the state’s Board of Medicine and as a result of it, three pharmacists and sixteen nurses were reprimanded for a mishap they could have avoided if only they had enquired about the unclear nature of the prescription.

Ethically, the hospital that administered the chemotherapy treatment is an essential part of the care of the patients that were treated there. In Betsy Lehman’s case, administering the cyclophosphamide in high dosage was very important for her recovery. The hospital staff followed this standard policy and did everything they could to stabilize Betsy’s condition when she came into admission in the facility.

Medication errors occur regularly in hospital settings and should not be taken lightly. From the healthcare professionals’ perspective, errors happen because of the lack of crucial therapeutic staff training on procedures to take in such cases where they receive an order that they do not understand. Some of the attending nurses and physicians have very little drug knowledge and experience with the drugs administered on the patient. Also, a patient might come to the hospital, and they do not have the medical history and end up treating an ailment without clear backgrounds of their medication and allergies which also could lead to medication errors. Poor communication between the healthcare staff and the patients is the most significant factor that leads to these occurrences. Talking to the patients and clearly noting down what they feel without assumptions would go a long way in preventing catastrophic damages related to medication errors.