Running head: DISCLOSURE 1

Disclosure or Non-Disclosure

Tameka Joy-Hawkins

Walden University

Advance Pharmacology

NURS:6512 Section 10

Dr. Janet Gutner

June 10, 2018

Introduction
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In today's healthcare system medical mishaps like medication errors are common.

Statistics have shown on a yearly average there are approximately one million medication error

occurrences. Many of these errors are harmless but some have resulted in an adverse drug event.

The Institute of Medicine (IOM) has reported approximately 770,000 injuries or death yearly

because of adverse drug event secondary to a medication error (Moghaddasi, Sajadi, &

Amanzadeh, 2016).

Medical errors do not automatically indicate the quality of care provided is subpar. The

medication error merely suggests a mishap has occurred, this mishap can occur at any given time

along the journey; from prescribing of the medication to the patient receiving the medication

(Medication Errors, 2017). The purpose of this paper is to discuss disclosure or non-disclosure of

medication errors per Georgia laws and identifying strategies to help prevent or reduce

medication errors occurrence.

Disclose or Nondisclosed

Medication mishap can be categorized into four groups of adverse drug reaction;

Potential, Preventable, Ameliorable, and Nonpreventable adverse drug reactions. Potential

adverse drug reaction is a potential medical error intercepted prior to reaching the patient.

Preventable adverse drug reaction is errors which reach the patient and result in harm.

Ameliorable adverse drug reaction occurs when the patient experienced harm secondary to a

medication error that was not completely avoidable but could be mitigated. The non-preventable

adverse reaction occurs when the medication appropriately prescribed results in an adverse

reaction. Half of the adverse drug reaction are either preventable or nonpreventable (Medication

Errors, 2017).

As suggested in the written scenario, the advanced practice nurse created a medical error

prescribing a medication, however, the patient was unaware of the medication discrepancy. This
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medication error can be characterized as a preventable adverse drug reaction. The scenario does

not suggest the patient was harm from this error. As the provider, the medication error will need

to be disclosed, by legal and ethical standards. In the state of Georgia, all medical errors

including near misses are reported as indicated in statute OCCGA. §§ 31-7-130 to 31-7-133,

also known as Georgia's Peer Review Law. As stated in the law, all medical errors are reported to

two separate agencies. The two reporting agencies are the Partnership for Health and

Accountability (PHA) program created in 2000 by the Georgia Hospital Association and

Department of Human Resources (DHR) founded 1972 (Georgia Medical Errors, n.d.). Joint

Commission on Accreditation of Healthcare Organization (JCAHO) will be the third agency to

report a medication error if the error results in severe injury or death of the patient, all other

types of medication error can be reported by the organization voluntary (Joint Commission,

2017).

Initially, PHA was a voluntary agency for reporting of medical occurrence, became a

mandatory agency for reporting in 2001 by the Georgia Department of Community Health

(DCH). Georgia DCH required participation of all hospitals as a requirement to continuing

servicing Medicaid and Medicare members. PHA utilizes a peer to peer view system, which

allows for an unbiased platform for reporting, studying, and learning. PHA review team will

examine the process, the outcome, the medication intend use, the patient safety issue, the medical

event, and the reporting of the incident. Once the information is collected and analyze, a detail

reported is provided to the institution. PHA different from DHR in the type of medical errors

reported. PHA requires reporting of all incidents including near misses, whereas DHR does not.

DHR is the department of regulations for all hospital within the Georgia. DHR agency provides

mandatory criteria and guidelines for reporting of all medical incidents. (Georgia Medical Errors,

n. d.).
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Along with the two mandatory report agencies, the prescriber will need to inform their

delegated physician. In the state of Georgia, an APRN must have a supervising doctor, also

known as a delegating physician. In the state of Georgia, if an APRN has authority to prescribed

he or she must have a nursing protocol agreement with the supervising doctor as described in GA

statue OCCGA 43-34-25. APRN who do not have authority to prescribe can only call in orders

under the physician name as indicated in OCCGA 43-34-23 (Georgia Medical, n.d.).

Informing the patient of a medication error is the provider’s legal and moral obligation. As a

provider our number one priority is duty is to care and prevent harm to the patient. Even though

this medication mishap has shown no imminent adverse effects to the patient, the provider still

needs to inform the patient of what has occurred. As the provider, the patient and I would have a

face to face visit to discuss the medication error. I would inform the patient of the medication

error and my plan to ensure the patient is not affected tremendously by the error. I would

educate the patient on the potential side effect or adverse drug reaction that may occur, and the

action plan if an adverse reaction or side effect does occur. The patient will be informed how to

report any side effects or adverse reactions. Disclosing of the medication error provides a

moment of learning for the provider and the patient. Hopefully, this disclosure will not affect the

patient-provider relationship, it may strengthen the relationship secondary to the provider being

transparent with the patient. The reporting of medication errors helps to improve the patient

safety. Research has shown reporting of medication errors help to prevent future errors, which

helps to decrease healthcare cost. The disclosing of medication errors has shown to enhance the

patient’s trust for the physician and healthcare system, also decreasing the risk of a lawsuit

because of the transparency of the physician and the healthcare system (Ghazal, Saleem, &

Amlan, 2014).
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Reduction Strategies

The Institute of Medicine (IOM), and other research has suggested approximately twenty-

five percent of all medication-related injuries were preventable errors. IOM has recommended

the increase utilization of electronic prescribing (e-prescribing). Research has shown

computerized provider order entry (CPOE) system as one way to reduce medication errors and

patient harm. With the increased usage of CPOE, the numbers of medication errors indicated via

poor handwriting or incorrect transcribing have prevented approximately 17 million or more

medication errors seen yearly (Computerized, 2017).

Many of the CPOE systems utilized in today's healthcare system include software

application and function like drug dosing support, alerts about harmful interactions, and clinical

decision support (CDSS), which may further reduce and prevent other common medication

errors. Typically, a CDSS system will indicate or default to suggest standard values for drug

doses, routes of administration, and frequency. There are some high tech CDSS systems offering

guidelines on drug safety features, like checking for drug allergies or drug-drug or even drug–

laboratory by indicated or suggesting specialty e testing or lab monitoring as a safety measure

when prescribing specific medications. For example, a warning for a provider to order and

review kidney function level prior to prescribing a medication with a potential risk of

nephrotoxicity. Research has shown CDSS can improve adherence to guidelines for diagnostic

imaging and testing, reducing the misuse diagnostic testing (Computerized, 2017).

Summary

As a healthcare provider we try our best to protect our patients from harm, however, they

may be a chance a medication error like the one described in this scenario can occur. Disclosing
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of a medical error can be a vehicle for learning for everyone involved. From this collaboration,

recommendation and new guidelines can be developed, overall improving and strengthen the

quality of care for the patient. Disclosing of the medical error is a hard task, however, as a

member of the healthcare profession, it is our duty to be morally honest and responsible in

practice, which occurs when a provider disclosed an error. Disclosing allows for more

transparency and a better relationship between the patient and the healthcare system.

References

Computerized Provider Order Entry. (2017, June). Retrieved June 7, 2018, from

https://psnet.ahrq.gov/primers/primer/6/computerized-provider-order-entry
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Facts about patient safety. (2017, March 30). Retrieved June 7, 2018, from https://www.joint

commission.org/facts_about_patient_safety/

GEORGIA COMPOSITE MEDICAL BOARD. (n.d.). Retrieved June 7, 2018, from

https://medicalboard.georgia.gov/sites/medicalboard.georgia.gov/files/imported/GCMB/Fil

es/FAQs NP May 2010.

GEORGIA –Public and Private Policy Medical Errors and Patient Safety. (n.d.). Retrieved June 6,

2018, from http://qups.org/med_errors.php?c=individual_state&s=11&t=all

Ghazal, L., Saleem, Z., & Amlani, G. (2014, February 8). A Medical Error: To Disclose or Not ...

- Open Access Journals. Retrieved June 7, 2018, from https://www.omicsonline.org/open-

access/a-medical-error-to-disclose-or-not-to-disclose-2155-9627-5

Medication Errors. (2017, June). Retrieved June 6, 2018, from

https://psnet.ahrq.gov/primers/primer/23/medication-errors

Moghaddasi H, Sajadi S, Amanzadeh M. The effect of a well-designed computerized physician

order entry on medication error reduction. J Health Man & Info. 2016;3(4):127-131.