A nurse who administered Botox to a patient without taking relevant safety precautions, leaving her with an infection and abscesses on her face, has been made subject to a conditions of practice order.

Joanne Lisa Kilpatrick, a community practitioner nurse who is also trained in aesthetic procedures, was found to have her fitness to practice impaired at a Nursing and Midwifery Council misconduct hearing earlier this month.

Kilpatrick was initially charged with 18 breaches of the nurse’s code - which included attempting to squeeze an abscess on a patient’s face after it became infected - and 10 of those charges were proven.

These included:

  • using a cardboard box as a table for her instruments during the procedure
  • failing to provide adequate consultation prior to the procedures
  • failing to provide advice regarding side effects of treatments
  • not seeking written consent prior to the procedures
  • not providing adequate post procedure advice
  • failing to adequately document an appointment
  • attempting to squeeze an abscess when it was not appropriate to do so 
  • allowing/encouraging a patient to use out of date antibiotics
  • allowing/encouraging a patient to increase her dose on Flucloxacillin
  • failing to obtain professional indemnity insurance in place to cover the treatment of the patient

The charges arose from events which took places while Ms Kilpatrick, who was employed as a health visitor for Virgin Care and was also self-employed as an aesthetics treatment nurse, was undertaking cosmetic procedures at a patient’s home between May and October 2016.

The misconduct panel heard that Ms Kilpatrick, from Poulton-le-Fylde, attended a patient’s home on several occasions to administer Botox and dermal fillers to the patient, and her daughter.

At an appointment in October, Ms Kilpatrick failed to adhere to infection control procedures and pre and post treatment consultation, used the same syringe to administer dermal filler to the patient and her daughter, and used a cardboard box as a table, while failing to perform the injections in a sterile environment.

Following this appointment, the patient experienced bruising and swelling to her face, and when she contacted Ms Kilpatrick for advice, she was advised that she may need to take antibiotics to treat a potential infection.

The panel heard that Ms Kilpatrick allowed/encouraged the patient to take expired antibiotics while she was waiting for new antibiotics to be prescribed, and Ms Kilpatrick advised the patient to increase the dose of the new antibiotics.

Later in October 2016 the patient attended A&E at Blackpool Victoria Hospital and was diagnosed with cellulitis and prescribed with antibiotics, steroids and painkillers.

But following that hospital visit, Ms Kilpatrick visited the patient again to review her symptoms and while at her home, attempted to drain the infection by squeezing an abscess which had formed on her face.

The panel viewed video footage of this incident and were informed by a professional witness that "attempting to squeeze out the purulent matter could have forced the infection deeper into the skin, thus spreading it further".

On that same evening, the patient was forced to return to Blackpool Hospital and was then referred to the Maxillo-Facial unit at Royal Preston Hospital.

She was admitted for two days for intravenous antibiotics and required further courses of antibiotics for persistent abscesses throughout 2017, suffering severe pain and emotional distress.

The patient commenced legal proceedings against Ms Kilpatrick in July 2017, and Ms Kilpatrick was found not to have professional indemnity insurance for her aesthetics treatment at the time covered by the charges.

Evidence submitted to the hearing from Ms Kilpatrick, who was not in attendance for the proceedings, read: "I allowed my cosmetic insurance to lapse... I realise this was not appropriate as having insurance would have protected both myself and [the patient]... I realise I should have made sure my insurance covered me."

Upon completion of the hearing, the panel found Ms Kilpatrick’s actions fell significantly short of the standards expected of a registered nurse, amounted to a breach of the nurse’s code, and amounted to misconduct.

A report from the misconduct hearing stated: “Having regard to all the above, the panel was satisfied that Ms Kilpatrick’s fitness to practise is currently impaired.

“The panel has considered this case very carefully and has decided to make a conditions of practice order for a period of 12 months.

“The effect of this order is that Ms Kilpatrick’s name on the NMC register will show that she is subject to a conditions of practice order and anyone who enquires about her registration will be informed of this order.”

Ms Kilpatrick must now, among other conditions, limit her nursing practice to one employer, which must not be an agency, and must not carry out any aesthetic procedures.

She will still be able to practice as a registered community nurse.

A review hearing will be held before the 12-month conditions of practice order expires.

An interim order for 18 months has also been made to mitigate for the 28 days Ms Kilpatrick has to make an appeal against the panel’s decision.