Writing Question
I HAVE TO REPLY TO THIS POST.
In this case, the patient is a 12-year-old male brought into a walk-in clinic by his parents for a six-centimeter laceration above his right knee. According to the charting, the nurse practitioner cleansed the site, used a numbing agent and sutured the wound using nylon sutures. Upon discharge, the patient was sent home with a prescription for Augmentin, although the medical record stated he was allergic to penicillin. There was no documentation in the medical record to show that the provider irrigated the wound or educated on wound care but the provider did document to follow up in 7-10 days for suture removal. Since the patient developed a rash from the antibiotic while at home, the mother of the patient only gave one dose of the antibiotic that was prescribed and admits to not calling the clinic for a new antibiotic. Two days after the encounter, the patient was seen at the hospital and admitted for cellulitis, possibly due to MRSA and was given intravenous antibiotics. The patient eventually required multiple procedures including debridement’s and fasciotomies leading to the final diagnosis of necrotizing fasciitis. The patient deteriorated and went into a comatose state with recurrent uncontrolled seizures. The patient recovered but there is now impaired movement in his right leg, and the patient had to relearn simple activities of daily living.
Identify the area that went wrong.
There were many things that went wrong in this case. The biggest issues involved lack of documentation on wound irrigation prior to laceration repair or discharge teaching regarding after care for the suture site on the leg to avoid infection. According to Fernandez & Bernhardsen (2018) “recommendations by wound care experts range from 25 to 100 mL of irrigation fluid per centimeter of laceration” to prevent post-repair wound infections (p. 48). Another important component of the testimony stated that the sutures were too tight to promote proper wound healing and the wrong antibiotic being ordered for the patient contributed to the risk of developing necrotizing fasciitis.
- What are the ways to avoid malpractice?
To avoid these adverse events, medical practitioners need to ensure that they thoroughly educate patients for at home care for wounds and document the encounter in entirety. Also important to ensure that staff are properly trained in performing procedures such as laceration repairs and comprehensive documentation in real time. Medical providers need to ensure that they have detailed medical records with proper documentation that accurately capture the visit including procedures, and follow-up care as well as justification for decision-making.
Reflect on the malpractice issue and discuss opportunities to avoid malpractice issues in the future.
- The importance of patient education and making sure that not only the patient but the family involved understands the importance of medication compliance and after care for skin wounds. Also with any mediation, using the “5 rights” should be a standard of practice. Another important component to avoid malpractice issues is proper documentation of patient-related discussions and clinical information in a timely manner. This not only protects the provider but protects the patient from developing adverse reactions.
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