💊Pharmacology for Nurses Unit 3 – Ethics and Safety in Pharmacology

Key Ethical Principles in Pharmacology

• Autonomy involves respecting patients' right to make informed decisions about their treatment and medication use
• Beneficence focuses on promoting the well-being of patients and ensuring that the benefits of a medication outweigh its risks
• Non-maleficence emphasizes the importance of avoiding harm to patients when prescribing and administering medications
  • This principle is often associated with the phrase "first, do no harm" (primum non nocere)
• Justice addresses the fair and equitable distribution of healthcare resources, including access to medications
• Veracity requires healthcare professionals to be truthful and honest in their communication with patients about medications and treatment options
• Confidentiality involves protecting patients' personal and medical information, including details about their medication use
• Fidelity encompasses the duty of healthcare professionals to act in the best interests of their patients and maintain their trust
• Accountability holds healthcare professionals responsible for their actions and decisions related to medication management

Safety Fundamentals in Drug Administration

• Adhere to the "5 Rights" of medication administration: right patient, right drug, right dose, right route, and right time
• Double-check medication orders and labels to ensure accuracy and prevent errors
• Use two patient identifiers (name and date of birth) before administering medications
• Assess patients for allergies and potential drug interactions before administering medications
• Follow proper hand hygiene protocols to minimize the risk of infection during medication administration
• Educate patients about their medications, including proper use, potential side effects, and any precautions they should take
  • Provide written and verbal instructions to ensure patient understanding
• Document medication administration accurately and completely in the patient's medical record
• Monitor patients closely for adverse reactions or side effects after administering medications and report any concerns promptly

Common Ethical Dilemmas in Nursing Practice

• Allocation of scarce resources, such as deciding which patients should receive limited supplies of a medication during shortages
• End-of-life care decisions, including the use of pain medications and sedatives for terminally ill patients
• Balancing patient autonomy with the need to promote their well-being when patients refuse recommended medications
• Addressing conflicts between patient preferences and family wishes regarding medication use
• Managing situations where patients request medications that are not medically indicated or potentially harmful
• Navigating the use of placebo treatments in clinical practice and research
• Dealing with the influence of pharmaceutical companies on prescribing practices and potential conflicts of interest
• Ensuring equitable access to medications for disadvantaged or marginalized populations

Medication Errors: Prevention and Reporting

• Implement a culture of safety that encourages open communication and learning from errors
• Use standardized medication ordering and administration protocols to reduce the risk of errors
• Employ technology, such as barcode scanning and electronic medication administration records (eMARs), to minimize human error
• Educate healthcare professionals about common types of medication errors and strategies for prevention
  • Examples include dosing errors, wrong drug errors, and omission errors
• Encourage the use of medication reconciliation to ensure accurate and up-to-date medication lists for patients
• Establish clear policies and procedures for reporting medication errors, near misses, and adverse drug events
• Analyze medication error data to identify trends and develop targeted interventions for improvement
• Foster a non-punitive environment that promotes reporting and learning from errors to enhance patient safety

Patient Rights and Informed Consent

• Respect patients' right to make informed decisions about their medication use and treatment options
• Provide patients with clear, accurate, and understandable information about the benefits, risks, and alternatives to proposed medications
• Obtain informed consent from patients before initiating medication therapy, ensuring they understand the purpose, potential side effects, and expected outcomes
• Accommodate patients' cultural, linguistic, and literacy needs when providing medication information and obtaining consent
• Recognize patients' right to refuse medication and work collaboratively to explore alternative treatment options
• Protect patients' privacy and confidentiality when discussing medication use and treatment plans
• Involve patients in shared decision-making processes regarding their medication therapy, considering their values, preferences, and goals
• Continuously assess patients' understanding of their medications and address any questions or concerns they may have

Legal Aspects of Pharmacology in Nursing

• Adhere to federal and state laws governing the prescribing, dispensing, and administration of medications
  • Examples include the Controlled Substances Act and the Food, Drug, and Cosmetic Act
• Maintain a current understanding of the legal scope of practice for nurses in relation to medication management
• Document medication-related activities accurately and completely in the patient's medical record to ensure legal compliance
• Obtain and verify medication orders from authorized prescribers before administering medications
• Follow proper procedures for the storage, handling, and disposal of medications, especially controlled substances
• Report any suspected drug diversion or abuse by healthcare professionals or patients to the appropriate authorities
• Participate in ongoing education and training to stay current with legal requirements and best practices in medication management
• Collaborate with other healthcare professionals, such as pharmacists and physicians, to ensure legal compliance and patient safety

Cultural Considerations in Drug Therapy

• Recognize that cultural beliefs, values, and practices can influence patients' attitudes towards medications and treatment adherence
• Assess patients' cultural background and incorporate this information into medication therapy planning and patient education
• Address language barriers by using professional interpreters or translated materials when providing medication information to patients with limited English proficiency
• Consider the potential impact of traditional or alternative therapies on medication use and safety, and discuss these openly with patients
• Tailor medication education and instructions to patients' cultural norms and health literacy levels to promote understanding and adherence
• Respect patients' religious or spiritual beliefs that may affect their medication use, such as fasting practices or dietary restrictions
• Engage family members or support systems in medication education and decision-making processes when culturally appropriate and with patient consent
• Continuously develop cultural competence through education, self-reflection, and exposure to diverse patient populations

Ethical Decision-Making Models for Nurses

• Familiarize yourself with common ethical decision-making models, such as the Four-Quadrant Approach and the MORAL model, to guide practice
• Identify the ethical dilemma or issue at hand, gathering relevant facts and considering the perspectives of all involved parties
• Analyze the situation using ethical principles, professional codes of conduct, and legal guidelines to determine potential courses of action
• Evaluate the benefits, risks, and consequences of each option, considering the impact on the patient, family, healthcare team, and society
• Make a decision based on the analysis and evaluation, selecting the course of action that best aligns with ethical principles and patient well-being
• Implement the chosen course of action, communicating the decision and rationale to the patient, family, and healthcare team as appropriate
• Reflect on the decision-making process and outcomes, identifying areas for improvement and learning opportunities
• Seek guidance from ethics committees, professional organizations, or colleagues when facing complex or unresolved ethical dilemmas in medication management