Page 7 - APP Collaboration - Assessing the Risk (Part Two)

SVMIC Advanced Practice Provider Collaboration: Assessing the Risk

Mrs. Jones was 77 years old, a diabetic, and on dialysis.
Mrs. Jones presented for examination of suspicious spots

on her arms and legs. These lesions were diagnosed as
precancerous and NP Smith performed cryosurgery on

these spots, including the left arm, which bore a shunt.
Post-procedure, NP Smith prescribed Hylatopic Plus

Cream for Mrs. Jones to apply to other actinic keratoses,
not to the treated areas. The treatment on the right arm

healed normally, but the treatment to the left arm did not
heal and began to ulcerate. Mrs. Jones’ husband alleged

he attempted to contact ABC’s office but received no
return call. ABC Dermatology’s records show that Mrs.

Jones missed several follow-up appointments.

It turns out that, Mrs. Jones and her husband applied the

cream to the wounds, rather than to the keratoses. Due to
the same, Mrs. Jones’ wounds progressively began to get

worse. Mrs. Jones continued her treatment with her
primary care physician, an emergency room, and a wound

care center. The wounds continued to deteriorate and
three months later, she returned to ABC Dermatology. At

this time, the wounds were open and non-healing on her
left arm. She was referred to a plastic surgeon, Dr. Adams.

Mrs. Jones stated that Dr. Adams agreed that the nurse
practitioner should never have used cryotherapy on that

limb because of the shunt. Ultimately, Mrs. Jones’ wounds
required extensive surgery and skin-grafting procedures

performed at a local hospital. After a lawsuit was filed, it
was discovered that the NP did not have updated protocols

and had no method of consultation with the collaborating
physician, who likewise did not conduct regular review of

patient records.

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