Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: ‘benefiting the patient’, ‘making well-informed decision’, and ‘follow up assessment’ as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.

Medical Interns’ Perceptions about Disclosing Medical Errors

Background. Honest and timely reporting of medical errors is the professional and ethical duty of any physician as it can help the patients and their families to understand the condition and enable the practitioners to prevent the consequences of the error. This study aims to investigate the viewpoints of medical interns regarding medical error disclosure in educational hospitals in Shiraz, Iran. Methods. A researcher-made questionnaire was used for data collection. The survey consisted of questions about the medical error disclosure, the willingness to disclose an error, the interns’ experiences and intentions of reporting the medical error, and two scenarios to assess the students’ response to a medical error. Results. Medical interns believed that a medical error must be reported for the sake of conscience and commitment and prevention of further consequences. The most important cause of not reporting an error was found to be inappropriate communication skills among the students. The results indicated that the willingness to disclose the hypothetical error among females was more than males (R < 0.005), but in practice, there was no difference between males and females (R > 0.005). The willingness to disclose minor and major hypothetical errors had a positive correlation ( P < 0.001 , R = 0.848). Conclusion. More ethical training and education of communication skills would be helpful to persuade physicians to disclose medical errors.

Confessional Approach to Disclosure of Medical Error

Recent literature on the ethics of medical error disclosure acknowledges the feelings of injustice, confusion, and grief patients and their families experience as a result of medical error. Substantially less literature acknowledges the emotional and relational discomfort of the physicians responsible or suggests a meaningful way forward. To address these concerns more fully, I propose a model of medical error disclosure that mirrors the theological and sacramental technique of confession. I use Aquinas’ description of moral acts to show that all medical errors are evil, and some accidental medical errors constitute venial sins; all sin and evil should be confessed. As Aquinas urges confession for sins, here I argue that confession is necessary to restore physicians to the community and to provide a sense of absolution. Even mistakes for which physicians are not morally culpable ought to be confessed in order to heal the physician–patient relationship and to address feelings of professional distress. This paper utilizes an Episcopal theology of confession that affirms verbal admission and responsibility-taking as freeing and relationally restoring acts, arguing that a confessional stance toward medical error both leads to better outcomes in physician–patient relationships and is more compassionate toward physicians who err.

Teaching Empathic Communication to Pediatric Interns: Immediate and 3-Month Impact

Objective: Evaluate pediatric intern self-reported preparedness to Deliver Serious News, Express Empathy, and Medical Error Disclosure after a 1-day simulation based-empathic communication training. Additionally, we sought to evaluate self-reported use of communication skills and describe the clinical scenarios in which the skills were used. Methods: Pediatric interns completed the survey immediately and 3 months after participating in the communication course. Results: Self-reported preparedness to Deliver Serious News, Express Empathy, and Medical Error Disclosure all significantly improved. At 3 months, 73.9% of respondents reported using the skills at least weekly and 62% described the clinical scenarios in which they used skills. These descriptions show an ability to use the skills appropriately, and in some cases apply the skills in advanced, more difficult scenarios. Conclusion: A 1 day simulation-based reflective teaching course for pediatric interns is an effective way to teach empathic communication skills. They feel more prepared to deliver serious news, respond with empathy and disclose a medical error. In addition, the interns value the training as a part of their education and report using the skills in appropriate scenarios at 3 months.

American Pharmacists Attitudes and Behaviors Regarding Medication Error Disclosure

Background: Patient safety places emphasis on full disclosure, transparency, and a commitment to prevent future errors. Studies addressing the disclosure of medication errors in the profession of pharmacy are lacking. Objective: This study examined attitudes and behaviors of American pharmacists regarding medication errors and their disclosure to patients. Methods: A 4-page questionnaire was mailed to a nationwide random sample of 2,002 pharmacists. It included items to assess pharmacists’ knowledge of and experience with medication errors and their disclosure. The data was collected over three months and analyzed using IBM SPSS 22.0. The study received IRB exempt status. Results: The response rate was 12.6% (n = 252). The average pharmacist respondent was a 57-year old (+ 12.1 years), Caucasian (79.8%), male (59.9%), with a BS Pharmacy degree (73.8%), and licensed for 33 years (+ 12.8 years). Most respondents were employed in a hospital (26.4%) or community (31.0 %) setting and held staff (30.9%), manager (29.1%), or clinical staff (20.6%) positions. Respondents reported having been involved in a medication error as a patient (31.0%) or a pharmacist (95.5%). The data suggest that full disclosure is not being achieved by pharmacists. Significant differences in some attitudes and behaviors were uncovered when community pharmacists were compared to their hospital counterparts. Conclusion: There is room for improvement regarding proper medication error disclosure by pharmacists.

Disclosure of Medical Errors: Physicians’ Knowledge, Attitudes and Practices (KAP) in an Oncology Center

Background Between the need for transparency in healthcare, widely promoted by patient’s safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option. We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure.Methods This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made. A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments.Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance. Results Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n=73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value= 0.024).Conclusion Formal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system.