Reference no: EM133508760

Case: Diagnosis-related allegations represent a significant area of liability for nurse practitioners (NPs). Diagnosis-related allegations can stem from factors such as the NP's failure to order appropriate diagnostic tests to establish a diagnosis, failure to obtain a complete patient and family history and thorough patient physical assessment, and/or a lack of sound documentation supporting the decision-making process of the treating NP. This case study involves a nurse practitioner (NP) who was working in an urgent care clinic. Summary This case study involves an NP working in an urgent care clinic in a rural, wooded area of the South. In the summer, a 3-year-old male patient presented to the clinic with fever, nausea, and rashes on his wrists and ankles. At this initial visit, the patient was evaluated by another provider working at the urgent care clinic. The other healthcare provider prescribed Amoxicillin and advised the patient's parent to return to the clinic if there was no improvement.

The patient's fever and rash continued to worsen over the next day, so the patient's parent brought him back for reassessment. The NP assessed the patient and diagnosed him with hand, foot, and mouth disease due to the rashes on the patient's wrists and ankles. At the time of this visit, the rashes had spread to his palms and the soles of his feet. The NP also concluded that the patient appeared to be having an adverse reaction to the Amoxicillin. The NP advised the patient's parent to stop administering the Amoxicillin and informed the parent that the virus would clear up on its own in a few days.

The patient's condition deteriorated over the next several days, eventually requiring hospitalization and treatment for seizure activity, cardiac dysfunction, and respiratory compromise which required intubation. During the patient's hospitalization, laboratory testing revealed that the patient was suffering from Rocky Mountain spotted fever (RMSF). The patient was treated with antibiotics and was able to be discharged from the hospital after 10 days. Two years after the patient was discharged, the patient's parents filed a lawsuit against the NP, the other healthcare provider who initially evaluated and treated the patient, and the urgent care clinic.

By the time the lawsuit was initiated, the NP no longer worked for the urgent care clinic, and the clinic's professional liability insurance coverage no longer extended to the NP. However, the NP had individual coverage through NSO. Risk Management Comments The NP failed to review documentation from the patient's visit to the urgent care clinic two days earlier, which would have revealed that the patient had recently sustained a tick bite. Defense experts opined that the NP should have been aware of the risk of RMSF, especially in young children, due to the following:

• The NP practiced in one of the five states responsible for >60% of cases of RMSF.

• The patient presented during the summer months, when tick bites are more common, and transmission of RMSF is high. The NP also failed to document a comprehensive history and physical of the patient, as well as her rationale for concluding that the patient was having an allergic reaction to the Amoxicillin. Due to the low likelihood of a defense verdict if the case proceeded to trial, the NP agreed to the defense recommendation to offer to settle the case. Resolution Two and a half years after the lawsuit was filed, the parties agreed to a settlement. The claim resolved with a total incurred of greater than $160,000. After the lawsuit was settled, the settlement payment was reported to the State Board of Nursing (SBON), as required by law. The SBON investigated the NP's conduct, and ultimately ordered the NP to complete 20 hours of continuing education courses and pay a $500 fine. The total costs incurred to defend the NP in the SBON matter exceeded $6,300.

Question: Based on your readings of the malpractice summary report - what additional recommendations would you have for the nurses involved in these cases to avoid any further litigation?