Organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice.

discuss organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice. Students will explore potential effects on patient outcomes and ethical and legal implications for members of the heath care team as a result of illegal behaviors. Students will develop strategies that result in prevention of untoward outcomes that result in a positive practice culture.

Preparing the Discussion
You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers.

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice.

Case Study Questions:

What are the potential ethical and legal implications for each of the following practice members?
Medical assistant
Nurse Practitioner
Medical Director
What strategies would you implement to prevent further episodes of potentially illegal behavior?

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Sample Answer




A medical assistant at an outpatient family practice refills a prescription for a patient without the authorization of the nurse practitioner. The medical assistant has been working at the practice for many years and is well-respected by the other staff members. She is also a close friend of the nurse practitioner.

Potential effects on patient outcomes:

The potential effects of this illegal behavior on patient outcomes are serious. The patient may experience adverse effects from the medication, such as an allergic reaction or an overdose. The patient may also miss out on important medical care if the prescription is not filled correctly.

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Ethical and legal implications for members of the healthcare team:

The medical assistant who refills the prescription is guilty of practicing medicine without a license. She could be sued by the patient for medical malpractice. The nurse practitioner could also be held liable for the medical assistant’s actions, as she is responsible for supervising the medical assistant.

Strategies to prevent untoward outcomes:

There are a number of strategies that can be implemented to prevent untoward outcomes from this type of illegal behavior. These include:

  • Creating clear policies and procedures about who is authorized to refill prescriptions.
  • Providing regular training to staff members on these policies and procedures.
  • Creating a culture of accountability and transparency, where staff members feel comfortable reporting any concerns they have about illegal behavior.
  • Implementing a system for monitoring prescription refills to ensure that they are being filled correctly.

Development of a positive practice culture:

A positive practice culture is one where all staff members feel valued and respected. They feel confident that they can raise concerns without fear of retaliation. They also feel that they are part of a team that is working together to provide the best possible care to patients.

By implementing the strategies outlined above, outpatient family practices can create a positive practice culture that reduces the risk of illegal behavior and protects patient safety.

Additional thoughts:

In addition to the strategies mentioned above, it is also important to have clear communication channels between all members of the healthcare team. This will help to ensure that everyone is aware of the policies and procedures in place, and that any concerns can be raised quickly and easily.

It is also important to have a system in place for dealing with illegal behavior when it does occur. This should include a clear process for investigating the incident, taking disciplinary action as appropriate, and providing support to the affected staff members.

By taking these steps, outpatient family practices can create a culture of safety and respect that will benefit all stakeholders.

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