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9 Fitzgerald Health Education Associates, Inc., April 2015 fhea.com the possibility of Stevens-Johnson syndrome. The jury awarded the patient $525,000 in damages.* WHAT CAN WE LEARN FROM THIS CASE? Consider the whole picture First, primary care providers are responsible for taking into account the patient's complete condition when evaluating and managing a symptom or sign. Any med- ication the patient is taking could be the cause of a side effect, and the psychiatric medication should have been considered as the source of the rash. All practitioners, whether primary care or specialist, must consider the adverse effects of medications prescribed by others if a patient reports a sign or symptom. In this case, the psychiatric NP was neither faulted nor sued. One reason for this was the patient did not communicate complaints about the rash to the psychi- atric NP. The psychiatric NP had prescribed lamotrigine appropriately and if the patient had contacted the psy- chiatric NP about the side effect, it would have been the psychiatric NP's responsibility to deal with the side effect. If the family NP had alerted the psychiatric NP about the rash, then the psychiatric NP would have been responsible for taking action. One could argue that the psychiatric NP was fortu- nate not to be sued inasmuch as she could have been assigned liability in this case because she should have alerted the patient, at the time of prescribing lamotrigine, about the possibility of a Stevens-John- son reaction. The psychiatric NP should have advised her about what to do if a rash developed. Psychiatric NPs prescribing lamotrigine can decrease risks—pro- fessional liability and patient risk—by informing pa- tients of the possibility of a Stevens-Johnson reaction and advising patients to immediately report a rash to the psychiatric NP. Recognize the potential for and presentation of Stevens-Johnson syndrome Second, all NPs should be able to recognize the poten- tial for and presentation of Stevens-Johnson syn- drome, as it can be activated by many medications. More than 100 drugs can cause Stevens-Johnson syn- drome. Some of the most common include: • anti-gout medications, such as allopurinol • pain medications such as acetaminophen, ibupro- fen, and naproxen sodium • antibiotics such as penicillins, sulfonamides, beta- lactams, and cephalosporins • anticonvulsants such as lamotrigine, carbamazepine, phenytoin, phenobarbital, and valproic acid C ontinued from page 7 Avoiding Malpractice: A Case Analysis Continued on page 11 Figure 3. The bilateral erythematous conjunctival membranes are attributed to Stevens-Johnson syndrome in a 19 year-old. Photo credit: CDC/Council on Dental Therapeutics, ADA; Robert E. Sumpter Psychiatric NPs prescribing lamotrigine can decrease risks—professional liability and patient risk—by informing patients of the possibility of a Stevens-Johnson reaction and advising patients to immediately report a rash to the psychiatric NP.