Ethical Decision-Making

As the CNO in the scenario, defend your decision to disclose the incident to the media. How does this decision influence value-based healthcare? What risks might you encounter? What impact might this decision have on you personally and professionally?

Medication errors occur even in the best hospitals and affect an estimated 2-14% of patients per year (Hammoudi et al., 2017).  As CNO, deontological ethics would guide my decision to disclose the incident to the media. There is a moral obligation to do what is right and openly admit our shortcomings as an organization. Medication errors affect all involved. The family may feel anger or distrust. The patient may experience additional injuries or even death. Clinicians can experience guilt, embarrassment, and self-doubt. Finally, the organization can potentially experience increased costs due to prolonged hospitalizations and additional treatments, negative influences on their reputation, and low patient satisfaction scores that may affect their reimbursements.

At a regional health consortium, fellow CNOs remark that they would not disclose such an incident to the media. Provide two justifications for withholding disclosure of the error to the public. How does this decision influence value-based healthcare?

Many nurses are reluctant to report medication errors due to the response of the administration and potential disciplinary action or job loss. Nurses also fail to report errors due to fear the patient, family, or physician will think poorly of their abilities (Allari, 2017).  In a value-based environment where the cost of care is based on outcomes, an organization can risk not being reimbursed for care if a patients’ condition is deemed avoidable. If the medication error is not disclosed to the public their reputation within the community may be protected, but their system remains broken.

Imagine you are the patient’s family. How would you want the issue to be handled by the CNO? Explain your rationale.

As I was thinking about my response to this question, I reflected on the well-known case of Josie King, the 18-month old that died while admitted to Hopkins. I have watched lectures given by her mother Sorrell King and was inspired and in awe of her response to this horrific event. I would want the CNO to disclose the incident to me with honesty and I would hope that my response would be similar to Sorrell’s. After the incident, the medical team involved met with the Kings. George Dover, as the head of the Childrens’ Center, took responsibility, apologized, and promised to get investigate what happened. In reviewing Josie’s case, her death was not attributed to one mistake; it was due to a broken system. Since Josie’s death, the Sorrells and Hopkins have been working together to fix the broken system. Their united, transparent efforts have established various safety programs including the Pediatric Patient Safety Program, The Patient Safety Group, and Rapid Response Teams to prevent this tragedy from happening again. Without disclosure, the process could not be critically examined and changed which means it may be repeated.

Allari, R. S., Ismaile, S., & Househ, M. (2017). Professional values among female nursing students in Saudi Arabia. Studies in Health Technology and Informatics238, 231–234.

Anderson, J. G., & Abrahamson, K. (2017). Your health care may kill you: Medical errors. Studies in Health Technology and Informatics234, 13–17.

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2017). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences32(3), 1038–1046.

Rubin R. (2018). How value-based medicare payments exacerbate health care disparities. JAMA. 319(10):968–970. doi:10.1001/jama.2018.0240


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