NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
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Scenario 1:
As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.
Scenario 2:
A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
Scenario 3:
You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.
Scenario 4:
During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
To prepare:

• – Review Chapter 1 of the Arcangelo and Peterson text, as      well as articles from the American Nurses Association, Anderson and      Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
• – Select one of the four scenarios listed above.
• – Consider the ethical and legal implications of the      scenario for all stakeholders involved such as the prescriber, pharmacist,      patient, and the patient’s family.
• – Think about two strategies that you, as an advanced      practice nurse, would use to guide your ethically and legally responsible      decision-making in this scenario. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.

With these thoughts in mind:
Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
– This work should have Introduction and conclusion
– This work should have at 3 to 5current references (Year 2012 and up)
– Use at least 2 references from class Learning Resources
The following Resources are not acceptable:
1. Wikipedia
2. Cdc.gov- nonhealthcare professionals section
3. Webmd.com
4. Mayoclinic.com
Required Readings
**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 1, “Issues for the      Practitioner in Drug Therapy” (pp. 3–14)
  This chapter introduces issues relating to drug therapy such as adverse      drug events and medication adherence. It also explores drug safety, the      practitioner’s role and responsibilities in prescribing, and prescription      writing. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
• Chapter 59, “The Economics      of Pharmacotherapeutics” (pp. 1009-1018)
  This chapter analyzes the costs of drug therapy to health care systems and      society and explores practice guideline compliance and current issues in      medical care.
• Chapter 60, “Integrative Approaches to      Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
  This chapter examines issues in individual patient cases. It explores      concepts relating to evaluation, drug selection, patient education, and      alternative treatment options. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.

**Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.
Note: Retrieved from the Walden Library databases.
This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.
**Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
Note: Retrieved from the Walden Library databases.
This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.
**American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html
NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.
**Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from https://americannursetoday.com/medication-errors-dont-let-them-happen-to-you/
This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.
**Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
**Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
**Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf
This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
**Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www.medscape.com/viewarticle/440315
**Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm
NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012).  Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
Consider the following scenario:
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.
To prepare:
·        Consider the ethical implications of disclosure and nondisclosure.
·        Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
·        Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.
·        Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.
To complete:
Write a 2- to 3- page paper that addresses the following:
1.      Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your stat(OHIO).
2.      Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.
3.      Explain the process of writing prescriptions including strategies to minimize medication errors.
 

Readings

·        Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
o   Chapter 1, “Issues for the Practitioner in Drug Therapy” (pp. 2–14)
This chapter introduces issues relating to drug therapy such as adverse drug events and medication adherence. It also explores drug safety, the practitioner’s role and responsibilities in prescribing, and prescription writing.
o   Chapter 59, “The Economics of Pharmacotherapeutics” (pp. 918–927). NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
This chapter analyzes the costs of drug therapy to health care systems and society and explores practice guideline compliance and current issues in medical care.
o   Chapter 60, “Integrative Approaches to Pharmacotherapy—A Look at Complex Cases” (pp. 928–939)
This chapter examines issues in individual patient cases. It explores concepts relating to evaluation, drug selection, patient education, and alternative treatment options.
Due to the importance of ethical and legal considerations in advanced practice nursing, several resources have been provided for your reference.
·        Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.
Retrieved from the Walden Library databases.
This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.
·        Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.
Retrieved from the Walden Library databases. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.
·        American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html
This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.
·        Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from
http://www.americannursetoday.com/assets/0/434/436/440/6276/6334/6350/6356/8b8dac76-6061-4521-8b43-d0928ef8de07.pdf
This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.
·        Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
·        Drug Enforcement Administration. (2006.). Practitioner’s manual. Retrieved from
http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
·        Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
·        Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf
This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.

·        Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www.medscape.com/viewarticle/440315
·        Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from
http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures.
·        Drug Enforcement Administration. (n.d.). Registration. Retrieved August 23, 2012, from
http://www.deadiversion.usdoj.gov/Registration.html. NURS 6521 Essay Assignment Papers – Ethics and Legalities of Medication Error Disclosures
 

Biotechnology is the use of microbes to make practical products.  The top three justifications for manipulating the genomes of cells are:
1. to eliminate undesirable phenotypic traits in humans, animals, plants and microbes.
2. to combine the beneficial traits of two or more organisms to create a new more valuable organism.
3. to create cells that synthesize products humans need.
Recombinant DNA technology employs a number to tools and techniques to isolate genes and insert them into cells grown in culture. The following are five tools of recombinant DNA technology and examples of application of the tools.
Mutagens are physical and chemical agents that produce mutation.  Some mutations are beneficial, so creating a large number of mutations increases the probability of discovering a beneficial mutation. For example the fungus Penicillium may be mutated to syntheisize a more effective antibiotic. Mutagens include uv radiation and ionizing radiation. Mueller first demonstrated the effects of X rays on Drosophilia, establishing cause and effect between radiation and genetic changes manifested in phenotypic changes.  Chemical mutagens in bacteria may be carcinogenic in humans.  The Ames test utilizes bacteria to test for mutagenic activity, and identify chemicals that may induce cell changes that lead to cancer. Ethidium bromide which may be used to visualize DNA on gel, is also a mutagen because it disrupts base pairing.
1. Explain and describe one physical and one chemical mutagen and its application.
Reverse transcriptase  synthesizes cDNA from mRNA, which is the reverse of information flow as depicted in the central dogma of molecular biology, i.e.  DNA is transcribed to RNA which is translated to peptides. Cells may have millions of copies of mRNA, so being able to synthesize the complementary DNA reveals the gene that is being expressed. In addition, cDNA contains no introns because of processing in the eukaryotic transcription, so that cDNA may be inserted into a prokaryotic cell and may be translated into the corresponding peptide.
2. Explain how reverse transcriptase differs from RNA polymerase.  Give one example of an application of reverse transcriptase in recombinant DNA technology.
Synthetic nucleic acids are synthesized in vitro using enzymes from cells. Currently there are machines that syntheized DNA or RNA by having the sequence of bases entered tthrough a keyborad.
3.  If each letter of the keyboard represents a base in DNA, how many keys does the keyboard require? How does this means of DNA synthesis differ from DNA replication in the cell?
Synthetic nucleic acids were used to elucidate the genetic code, create genes for specific proteins, synthesize probes to locate genes in a genome, to synthesize antisense nucleic acids and to make PCR primers.
4. What is the genetic code, how might a synthetic nucleotide be used to determine which amino acid corrresponds to which codon?
5. Give an example of a probe with a flourescent tag that will be used to locate a gene associated with an aggressive form of breast cancer.
Restiction enzymes cut dsDNA at restriction sites, or palindromes. Examples of restriction enzymes are EcoRI and HindIII.  There are hundreds of restriction enzymes isolated from bacteria and used to cut DNA at predictable sites.  One type of restriction enzyme cuts dsDNA to make blunt ends and the other type creates sticky ends.
6. Compare and contrast blunt and sticky ends, and give one example of each type of restriction enzyme.
Vectors insert DNA into a new cell so that the cell acquires a new phenotype.   Vectors are pieces of DNA that are small enough to manipulate in a lab, survive inside the new cell, contain a recognizalbe genetic marker and carry the gene regions necessary to ensure the gene is transcribed and translated.   Examples of vectors are plasmids, viruses and transposons.
7. Explain one risk of a viral vector that inserts itself into a necessary gene and causes a mutation.
Gene library is a collection of cells or viruses, in which each member carries a portion of a given organism’s genome.  Gene libraries provide a ready
Techniques of recombinant DNA technology include the polymerase chaing reaction (PCR)  developed by Cary Mullis.  PCR has three steps that are repeated while the same sample of primers, target gene, taq polymerase and nucleotides are cycled through three different temperatures in a microfuge tube. Gel electrophoresis separated fragments of molecules by size, shape and charge.  DNA microarrays are able to monitor thousands of genes on one plate. Applications of these techniques include diagnostics or vaccine design.
8. Explain how a subunit vaccine is designed using  genes from a pathogen and a viral vector? p502-504.
One proposed way to stop the spread of arboviruses by mosquitoes is to vaccinate the mosquito.  This type of vaccine is a transmission blocking vaccine (TBV).  One typeof TBV vaccinates the human so that a blood meal from a vaccinated human would prevent the mosquito from being infected.  Another strategy is to use the gene drive known as Crispr-Cas9 which would edit the mosquito genome to confer resistance to diseases mosquitoes transmit to humans, and is very targeted.  This requires wild type mosquitoes to mate with lab mosquitoes that have been genetically modified.  Some data would indicate the lab mosquitoes are not competitve with wild type males.
9. Explain one advantage and one disadvantage of the TBV approach for controlling the spread of arboviruses.
10. Does the public have any control over the use of gene drives to alter species in the ecosystem for public health concerns?