Type and impact of clinical incidents identified by a voluntary reporting system covering 130 small animal practices in mainland Europe

Medication errors in veterinary anesthesia: a literature review

OBJECTIVE

To provide an overview of medication errors (MEs) in veterinary medicine, with a focus on the perianesthetic period; to compare MEs in veterinary medicine with human anesthesia practice, and to describe factors contributing to the risk of MEs and strategies for error reduction.

DATABASES USED

PubMed and CAB abstracts; search terms: [("patient safety" or "medication error∗") AND veterin∗].

CONCLUSIONS

Human anesthesia is recognized as having a relatively high risk of MEs. In veterinary medicine, MEs were among the most commonly reported medical error. Predisposing factors for MEs in human and veterinary anesthesia include general (e.g. distraction, fatigue, workload, supervision) and specific factors (e.g. requirement for dose calculations when dosing for body mass, using several medications within a short time period and preparing syringes ahead of time). Data on MEs are most commonly collected in self-reporting systems, which very likely underestimate the true incidence, a problem acknowledged in human medicine. Case reports have described a variety of MEs in the perianesthetic period, including prescription, preparation and administration errors. Dogs and cats were the most frequently reported species, with MEs in cats more commonly associated with harmful outcomes compared with dogs. In addition to education and raising awareness, other strategies described for reducing the risk of MEs include behavioral, communication, identification, organizational, engineering and cognitive aids.

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

BACKGROUND

Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing.

METHODS

A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique.

RESULTS

Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events.

LIMITATIONS

The qualitative nature of this study limits the generalisability of the findings.

CONCLUSIONS

Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

Application of systems analysis to safety incident investigations in a single centre using anaesthesia as an example

BACKGROUND

Systems analysis is widely recommended for patient safety investigations in medicine, but the method is poorly described in the veterinary literature.

METHODS

Anaesthetic safety incidents were discussed in debriefs and then reported on standardised forms. Investigators performed informal interviews with team members involved in case management and interrogated clinical records. Finally, incidents were discussed during morbidity and mortality conferences. Systems analysis involved developing a timeline for the case, identifying any care delivery problems (CDPs) that occurred and contributing factors associated with them, and developing control measures to reduce system weaknesses.

RESULTS

From 15 incidents, 32 CDPs were identified. These were categorised into 11 thematic groups. Misdiagnosis (n = 8), human resource allocation (n = 8), failure in planning (n = 6) and technical error (n = 5) were most frequent. Individual factors were identified in 15 (100%), team factors in 12 (80.0%), animal and owner factors in 11 (73.3%), organisation factors in 10 (66.7%), work environmental factors in 10 (66.7%) and task and technology factors in four (26.7%) investigations. Numerous immediate and longer term recommendations were made regarding how to manage systems weaknesses.

LIMITATIONS

Investigations were limited to pre-procedural anaesthetic safety incidents.

CONCLUSIONS

Systems analysis applied to incident investigations can highlight areas for improvement within veterinary healthcare systems.