Pharmacology in Nursing: Medication Errors, Ethical Principles, and Legislation

This article discusses the importance of pharmacology in nursing practice with a focus on medication errors, ethical principles, and legislation. A case study analysis is included to provide a real-life example of the consequences of negligence in medication administration. The article highlights the significance of effective documentation, training, and continuing education for nursing professionals to maintain nursing standards and ethics.

Running head: PHARMACOLOGY IN NURSING
Pharmacology in nursing practise
Name of the student
University name
Author’s note

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Table of Contents
Introduction................................................................................................................................2
Medication errors.......................................................................................................................2
Ethical principles........................................................................................................................3
Legislation..................................................................................................................................5
Conclusion..................................................................................................................................7
References..................................................................................................................................8

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Introduction
The current assignment deals with the aspect of pharmacology in nursing. The study
here focuses upon an actual clinical scenario where the medicine administration and safety
and guidelines have been violated. The assignment further divides the drug into various
schedules as based upon some of these specifications the drug needs to be administered to the
patient. The medicine administration is further guided by a number of ethical principles and
legislations.
Medication errors
The current study is based upon the case study of Mrs. T who was a 74 year old
woman admitted to the psychogeriatric ward with psychotic stress or trauma. She was
administered a number a wrong medication owing to the negligence of the nurse. This
resulted in lethal health consequences within the patient. The patient had a past history of
depression, cholecystectomy, ischaecmic heart along with recurrent urosepsis. The patient
had also undergone aortic valve replacement in the year 2008 due to synocopal episodes.
Since the surgery, the patient had also experienced deteriorating health conditions such as
poor appetite, significant weight loss, reduced mobility and lethargy. The patient family had
mentioned that much of her deteriorating health conditions could be attributed to the presence
of depression in the patient and hence she required immediate intervention strategies. In the
psychogeriatric ward Mrs. was commenced on mirtazapine which was increased to 15 mg
after a week. The patient was to be transferred from the psychogeriatric unit to the psychiatric
hospital for the treatment of her major depression. However, before the transfer the nursing
professionals attending to Mrs. T had to ensure that she was provided with the required
medication doses so that later she does not miss them during the transfer process. It was seen
that instead of miratzapine the patient was provided with nitrazepam 15 mg, which was a

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sedative belonging to the benzodiazepine class of medications. The provision of the
medications resulted in development of low pressure in the patient. The patient later died
from septic shock and aspiration pneumonia on admission to the intensive care unit. The
sedative effects of the drug caused the patient to aspirate gastric contents leading to septic
shock. Hence, there was a clear negligence on the part of the nursing professionals, as they
had put the medication on wrong medication. The high dosage of the sedative caused the
patient to aspire her gastric contents leading to septic shock, which further triggered
multiorgan failure in the patient resulting in instant death (Hanson, 2016). The incident
clearly pointed towards a gap in communication between the nursing professionals. The
nurses responsible for looking after Mrs. T had administered her wrong medicine. The
incident though followed by a fellow nurse, who thought it to be the other name for the same
drug and failed to consult with her colleague. Therefore, both the nurses failed to check the
procedure which was followed with the patient effectively. Hence, there clearly a breach of
ethics on the part of the nurses, which further deteriorated the condition of the patient. The
nurses had also disclosed the error and documented the same in the hospital record (Brown,
Edwards, Seaton & Buckley, 2017). The negligence depicted by the nurses resulted in the
death of the patient. Hence, professional nursing standards and ethics had been violated over
here.
Ethical principles
The clinical negligence could be further described based upon a number of ethical
principles. Some of which had been enlisted over here such as veracity and non-maleficience.
Both of these could be pondered upon over here in order to understand the gaps in the nursing
care and support services delivered to Mrs. T.

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Veracity could be described as the condition of truth telling and is justified by the
respect for persons and providing them with sufficient autonomy (Latimer, Hewitt,
Stanbrough & McAndrew, 2017). For the current assignment, focus needs to be shifted to the
aspect of truth telling. As mentioned by Buckley, Stasa, Cashin, Stuart & Dunn (2015), the
principle of veracity is violated by omission or deliberate holding back of crucial
information. This is particularly important within the healthcare context, as misleading of
pivotal information can endanger the life of the patient. As supported by Birks et al. (2018),
exchange of true to the fact information can prevent the occurrence of untoward incidences.
As argued by Hewitt, Tower & Latimer (2015), the veracity also refers to being honest in
one’s professional interactions. The veracity also refers to maintaining the standards of
documentation, effective regulatory reporting and compliance monitoring (Martiniano et al.,
2016). In this respect, the nursing professionals had mismanaged the entire procedure to be
followed with the patient. The lack in effective compliance monitoring further gave way to
the untoward incident (Gammie, Lu & Baba, 2015). There could be a number of causes
behind the negligent behaviours depicted by the nurses. It could be due to lack of training or
compassionate fatigue within the nurse.
The other ethical principle which could be discussed over here is non-maleficience.
The aspect of non-malefiecience in nursing means causing the least harm to the patient with a
purpose of bringing out the best possible outcome (Christensen, Craft, Wirihana & Gordon,
2015). The nursing professionals are supposed to work as per the principle of non-
maleficience, where the treatments should be delivered in a way which minimizes the harm to
the patient (Hayes, Jackson, Davidson & Power, 2015). This could be discussed with respect
to the current situation where both the nurses had shown negligence in taking the records and
dealing with the patient. The patient here Mrs. T was suffering from acute form of depression
and had to be admitted for following up her treatment. She was suggested a new medication

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were she was supposed to take mirtazapine instead of sertarline. However, nursing
professionals who were following up the treatment of Mrs. T had put her under the wrong
medication instead, where she was out on a strong sedative nitarzepam. The treatment was
conducted in hasty manner which resulted in the death of the patient. Therefore, both the
nursing ethical principles were clearly violated over here.
The nursing principles were not at all followed in this case as both the nurses had
shown negligence in following the medication pattern. The fellow nurse failed to discuss or
report the error to her peer thinking that the same medication under different generic name
had been provided the patient. Inefficiency was also shown in the documentation and the
follow up process. Hence, there was a clear breach of the nursing ethics in the case study.
Legislation
The significance of drug legislation has been discussed over here. The drug
legislations consist of the effective guidelines regarding the medication patterns and the exact
doses based on which the medicines need to be administered to the patient. As mentioned by
Hewitt, Tower & Latimer (2015), under no circumstances unsupervised medication could be
suggested to the patient. The storage, supply of medicines is governed by drug and medicines
legislation (Birks et al., 2018). Some of the legislations which could be highlighted over here
are -Poisons and therapeutic goods act, 1966, Poisons therapeutic goods regulation, 2002.
With regards to the current scenario, some of the effective drugs regulations could be
discussed over here which are health regulation, 1966, which sets out requirements for
endorsements holders concerning storage, record keeping and sales of schedules drugs and
poisons. As per the health regulation, the record keeping should be done effectively regarding
the administration of the drugs. This helps in the prevention of administration of wrong
medicines or wrong medication doses to the patient.

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In this respect, some of the regulations mentioned in the Australian schedule of
medicines have been listed over here. Some of these are schedule 2, 3, 4, 8 and so on. The
schedule 2 covers pharmacy medicine, under which psychological drugs with high potential
for abuse have been reported such as hydromoprohone, nethadone, meperidine etc. The
schedule 4 covers prescription only medicine such as diazepam, mizadolam etc and has low
potential for abuse compared to schedule 3 drugs which include Ephedrine, Apomorphine etc.
The schedule 8 covers controlled drug which have high potential for abuse and addiction.
Some of the examples are – Buprenorphine, Alprazolam, Amfetamine etc. The schedule 3
covers the highly addictive medicines and could only be prescribed under the consent of a
pharmacist only. The nursing professional attending to the care concern of Mrs. T needed to
ensure that proper doses of the right medication were provided to the patient. As mentioned
by Gammie, Lu & Babar (2015), following the six right of nursing can prevent the
occurrence of the untoward accidents in an acute clinical setup. The six rights could be
mentioned as follows- right medication, right dose, right time, right patient, and right route.
Additionally, the nursing ethics had not been followed over here which led to a further
worsening of the situation.
The patient Mrs, T was also provided with a number of medicines such as panadol osteo and
enbdone. Endone consist of the generic name oxycodone and was listed under schedule 8 of
the drugs and medicines. Panadol osteo contained the generic name osteovan and belonged to
schedule 2 as per the Australian drugs and medicine.
The patient Mrs. T was provided nitrezepam which belonged to schedule 4 of the
Australian medicines and drugs and was a prescription drug only. Therefore, unsupervised
doses of the medication could lead to further heath risks in the patient. The mitrazapine
belonged to the schedule 1 of the Australian medicines and drugs and is considered to be low
risk drugs (Hibbert & Sutton, 2017). They belong to the paracetamol class of drugs and could

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be stored under normal conditions. On the other hand, before administration of a schedule 2
drug the nurse should have checked the proper disclaimers alongside consulting a physician
attending to the patient, as it would have helped in the prevention of untoward health risk to
the patient.
Conclusion
Therefore, focusing upon the clinical scenario and the nursing ethics one could say
that effective documentation along with provision of sufficient training to the nursing
professionals could have helped in the occurrence of such untoward incident. Additionally,
the provision of nursing continuing education can also help in ensuring that the nursing
standards and ethics are maintained in right place.

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References
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Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical
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Buckley, T., Stasa, H., Cashin, A., Stuart, M., & Dunn, S. V. (2015). Sources of information
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practitioners in Australia. Journal of the American Association of Nurse
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