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Hawker WTG, Singh A, DeForge T, Mankin KT, Giuffrida MA, Weese JS. Attitudes towards surgical safety checklists among American College of Veterinary Surgeons diplomates. Vet Surg 2024. [PMID: 38817076 DOI: 10.1111/vsu.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/01/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation. STUDY DESIGN Qualitative online research survey. SAMPLE POPULATION A total of 1282 current ACVS diplomates. METHODS An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs. RESULTS Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [8.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake. CONCLUSION Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs. CLINICAL SIGNIFICANCE Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.
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Affiliation(s)
| | - Ameet Singh
- The Ontario Veterinary College, Guelph, Ontario, Canada
| | - Teagan DeForge
- The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Michelle A Giuffrida
- The University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - J Scott Weese
- The Ontario Veterinary College, Guelph, Ontario, Canada
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Pinho RH, Nasr-Esfahani M, Pang DSJ. Medication errors in veterinary anesthesia: a literature review. Vet Anaesth Analg 2024; 51:203-226. [PMID: 38570267 DOI: 10.1016/j.vaa.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Renata H Pinho
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.
| | - Maryam Nasr-Esfahani
- University of Calgary, Cumming School of Medicine, Department of Obstetrics and Gynecology, Alberta Health Services, Calgary, AB, Canada
| | - Daniel S J Pang
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montreal, PQ, Canada
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Goh WT, Drew J. Stifle arthrodesis in a feline pelvic limb amputee. JFMS Open Rep 2024; 10:20551169231217837. [PMID: 38223301 PMCID: PMC10785732 DOI: 10.1177/20551169231217837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Case summary A domestic shorthair cat presented to the Animal Referral Hospital (Brisbane, Australia) after having the left pelvic limb incorrectly amputated. The cat was unable to ambulate on the remaining right pelvic limb due to a chronically subluxated stifle. A stifle arthrodesis was performed on the right pelvic limb to manage the injury. Follow-up radiographs performed 5 months postoperatively demonstrated stifle arthrodesis with no detectable complications. The owner reported that aside from some difficulties in toileting, the cat had a good quality of life and was capable of performing the majority of daily activities. Stifle arthrodesis in a feline pelvic limb amputee appears to be a viable treatment option. After a period of rehabilitation and adaptation, the cat in the case report has been able to lead a near-normal lifestyle. Relevance and novel information To the authors' knowledge, this is the first report of the outcome and complications associated with stifle arthrodesis in a feline pelvic limb amputee. This is also the first report of stifle arthrodesis in a cat using the bilateral plating technique.
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Affiliation(s)
- Wei Tze Goh
- College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Jarrod Drew
- Animal Referral Hospital, Sinnamon Park, QLD, Australia
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Glenn OJ, Faux I, Pratschke KM, Bowlt Blacklock KL. Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system. Vet Surg 2024; 53:184-193. [PMID: 37597218 DOI: 10.1111/vsu.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection. STUDY DESIGN Prospective, cohort study. ANIMALS Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital. METHODS Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians. RESULTS Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined "SSI" or "No SSI" from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. "No SSI" was diagnosed in responses not meeting criterion 1, and "SSI" in responses meeting criteria 1 and 2. "Inconclusive" responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only. CONCLUSION Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection. CLINICAL SIGNIFICANCE Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.
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Affiliation(s)
- Owen J Glenn
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Ian Faux
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Kathryn M Pratschke
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
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McMillan M. Implementing surgical safety checklists in veterinary medicine: where do we currently stand? Vet Rec 2023; 193:279-281. [PMID: 37800493 DOI: 10.1002/vetr.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
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Hill J, Irwin-Porter G, Buckley LA. Surgical safety checklists in UK veterinary practice: Current implementation and attitudes towards their use. Vet Rec 2023; 192:e2484. [PMID: 36607140 DOI: 10.1002/vetr.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Surgical safety checklist (SSC) use benefits veterinary patients, but endorsement and implementation are essential for these benefits to be observed. METHODS A cross-sectional survey assessed UK veterinary professionals' attitudes towards and usage of SSCs and identified factors associated with poorer attitude or failure to use SSCs. RESULTS Of 513 respondents, 70% used SSCs. Of these, 87.1% used SSCs for every surgical procedure, 19.1% adapted SSCs for different procedures and 61.1% had a standard operating procedure detailing how to use SSCs. Attitudes towards SSC use were favourable, with increased positive attitude associated with employing at least one registered veterinary nurse with a post-qualifying qualification (p < 0.001), current SSC use (p < 0.001), undertaking self-directed reading (p = 0.033) or completing SSC-relevant post-qualification continuing professional development (p = 0.005). Factors associated with veterinary practices not using SSCs included Practice Standards Scheme (PSS) non-membership (odds ratio [OR] 2.0, 1.1-3.4), no RCVS hospital status (OR 1.9, 1.1-3.5) or being a mixed first-opinion veterinary practice (OR 2.4, 1.2-5.0). LIMITATIONS Study limitations include sampling methodology and non-validated attitudinal scale usage. CONCLUSION Most respondents used SSCs. Familiarity, education and the RCVS PSS were associated with improved uptake and attitudes, but mixed practice was associated with reduced usage.
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Affiliation(s)
- Jessica Hill
- Bristol Veterinary School, University of Bristol, Langford, UK
- Paragon Veterinary Referrals, Wakefield, UK
| | | | - Louise A Buckley
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
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Simpson SE, Zersen KM. Incidence and type of peripheral intravenous catheter complications documented in hospitalised dogs. J Small Anim Pract 2023; 64:130-135. [PMID: 36442837 DOI: 10.1111/jsap.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the incidence and type of peripheral intravenous catheter complications in hospitalised dogs. METHODS A prospective, observational trial was performed. Peripheral intravenous catheters were monitored for complications. Complications were documented and classified as extravasation, phlebitis, dislodgement, occlusion and line breakage. If phlebitis was present, the Visual Infusion Phlebitis Scale was used to assign a grade (0 to 5). Fisher's exact test was used to compare the type of complications between the critical care unit and the intermediate care unit. A univariate logistic model was used to compare the incidence of complications between the critical care unit and the intermediate care unit and adjusted odds ratios were used to compare the groups. RESULTS The incidence of peripheral intravenous catheter complications was 24.2% in the Critical Care Unit and 13.1% in the Intermediate Care Unit, with an overall incidence of 19.9%. Phlebitis was the most common peripheral intravenous catheter complication in the Critical Care Unit, and line breakage was the most common complication in the Intermediate Care Unit. Length of hospitalisation and weight had a significant effect on the likelihood of complication. In a multivariable logistic regression model, the odds of a peripheral intravenous catheter complication was not significantly higher in CCU than IMCU, accounting for length of hospitalisation and weight (adjusted odds ratio, 1.84; 95% confidence interval, 0.98 to 3.48). CLINICAL SIGNIFICANCE Peripheral intravenous catheter complications are common in hospitalised dogs and may result in an increased expense for owners, failure to deliver prescribed treatments, venous depletion (lack of peripheral vessels for intravenous catheter placement) and pain experienced by the patient. Techniques to reduce peripheral intravenous catheter complications should be further evaluated and may include the use of peripheral intravenous catheter placement and maintenance checklists, use of force-activated separation devices, or patient sedation.
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Affiliation(s)
- S E Simpson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - K M Zersen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, 80523, USA
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McMillan MW. Surgical time-out procedures: a single centre audit of standardised surgical communications. J Small Anim Pract 2023; 64:69-77. [PMID: 36418012 DOI: 10.1111/jsap.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess deviation from a standardised structure of surgical time-out procedures in a multidisciplinary referral hospital. MATERIALS AND METHODS An observational process audit was performed on a convenience sample of surgical cases. A fly-on-the-wall observer assessed surgical time-out procedures in real-time. Pre-induction and recovery checklists were not assessed. Observations were recorded on standardised reporting forms including a checklist and free text. Analysis was performed using a validated framework of four conceptual domains: the purpose, occasion, audience and content of the communication. Field notes were taken to allow retrospective verification of assessments. Observations were compared to a predefined standardised surgical time-out procedure structure. RESULTS Twenty surgical time-out procedures were observed from a mixture of procedure types. Although all were performed at the specified time and place, only eight (40%) were considered to have fully achieved their purpose with potentially important sections of the communication being omitted in the others. Individuals were not ready for communication to begin in 14 (70%) and distractions occurred in 11 surgical time-out procedures (55%). In seven surgical time-out procedures (35%) superfluous information was communicated. CLINICAL SIGNIFICANCE In a busy operating theatre environment, surgical time-out procedures may not be performed as they are intended. Communication during surgical time-out procedures should be audited to highlight opportunities for improvement.
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Affiliation(s)
- M W McMillan
- The Ralph Veterinary Referral Centre, Fourth Avenue, Marlow, Buckinghamshire, UK
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Davidow EB, Owen T, Rishniw M. Knowledge and attitudes towards surgical safety checklists: a survey of veterinary professionals. J Am Vet Med Assoc 2023; 261:1-9. [PMID: 36626287 DOI: 10.2460/javma.22.09.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the knowledge and use of safe surgical checklists (SSCs) and surgical safety practices (SSPs) in different sectors of veterinary medicine. SAMPLE 1,235 small animal veterinarians who perform surgery in the United States and Canada. PROCEDURES An online survey was distributed to veterinarians through social media platforms, specialty listservs, and the Veterinary Information Network. Respondents provided information regarding their role, practice type, as well as knowledge, attitudes, and use of SSCs. Respondents also provided information about performance of SSPs including team introductions; confirmation of antibiotic prophylaxis, patient identity, procedure to be performed; and confirmation of completion of all procedures. RESULTS A greater proportion of Diplomates of the American College of Veterinary Surgeons (49/77 [64%]) reported using an SSC than other veterinarians (257/1157 [22%]; P < .0001). A greater proportion of veterinarians working in university and multispecialty hospitals reported using a SSC (71/142 [50%]) than in other practice settings (235/1092 [22%]; P < .0001). Use of a SSC correlated with consistent performance of surgical safety practices listed above (P < .0001). Primary care veterinarians commonly reported not using a SSC because they did not know about them (359/590 [61%]). Of the 507 respondents who had ever used a SSC, 333 (66%) believed the checklist had prevented an error or complication. CLINICAL RELEVANCE Despite widespread knowledge and adoption of SSC use in human medicine, knowledge and use of SSCs is lacking in primary care veterinary practice. Checklist use has previously been shown to decrease post operative complications and in this study was correlated with increased use of SSPs that decreased complications.
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Affiliation(s)
- Elizabeth B Davidow
- 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
| | - Tina Owen
- 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
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10
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Daly ML. The case for quality improvement in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2023; 33:11-15. [PMID: 36478111 DOI: 10.1111/vec.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Meredith L Daly
- Associate Editor, Journal of Veterinary Emergency and Critical Care
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11
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Hauber E, Alef M. [A multifactorial risk index for evaluation of anesthetic risk in dogs: the LeiV-Risk-Index]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:249-260. [PMID: 35700968 DOI: 10.1055/a-1839-5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The Leipzig Veterinary Risk-Index - "LeiV-Risk-Index" is a multifactorial risk index developed to enable an improved objective assessment of the anesthetic risk in dogs. The scoring system is based on 10 risk factors affecting perioperative mortality. The aim of this study was to evaluate the applicability of the LeiV-Risk-Index and its risk factors as well as to perform a direct comparison with the ASA-classification. MATERIAL AND METHODS An online survey was conducted among veterinarians working in small animal medicine throughout Germany. Participants received a questionnaire containing information on 15 selected patients. They were asked to classify the patients according to the LeiV-Risk-Index and ASA-classification and to answer several questions concerning their professional background. The results were statistically analyzed considering the consistency among veterinarians of rating the different patients by using Fleiss'-Kappa. The correlation of LeiV-Risk-Index and ASA-classification was calculated. RESULTS The consistency of all assigned LeiV-risk classes between participants was moderate (κ = 0.55) and higher than classification by ASA (κ = 0.33). On average, 3 different LeiV-risk classes and 4 different ASA-classes were assigned for one patient. There was a positive correlation between LeiV-risk class and increasing ASA-class. No effect of gender or clinical experience of the veterinarian could be demonstrated on ranking patients. There was also no effect of how confident veterinarians felt in applying the LeiV-Risk-Index. CONCLUSION UND CLINICAL RELEVANCE The LeiV-Risk-Index is the first index available in veterinary medicine for assessing anesthetic risk that is based on objective risk criteria and whose objectivity exceeds that of the ASA classification. Anesthetic patients can thus be evaluated more consistently in veterinary medicine as well. Utility and practicability were positively received by 95 % of the participants. Further revision of individual risk criteria needs to be reconsidered.
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Affiliation(s)
- Elke Hauber
- Klinik für Kleintiere, Abteilung für Anästhesiologie und Intensivmedizin, Veterinärmedizinische Fakultät der Universität Leipzig
| | - Michaele Alef
- Klinik für Kleintiere, Abteilung für Anästhesiologie und Intensivmedizin, Veterinärmedizinische Fakultät der Universität Leipzig
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Simpson SE, Zersen KM. Fewer peripheral intravenous catheter complications in hospitalized dogs when force-activated separation devices are used versus not used in a randomized controlled clinical trial. J Am Vet Med Assoc 2022; 260:1657-1662. [DOI: 10.2460/javma.22.03.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To determine whether the use of a force-activated separation device (FASD) lowers the incidence risk of peripheral intravenous catheter (PIVC) complications in hospitalized dogs.
ANIMALS
367 dogs that were hospitalized and received IV fluids between January 11 and March 25, 2021.
PROCEDURES
A prospective, randomized controlled clinical trial was performed. Dogs hospitalized and receiving IV fluids for at least 24 hours were randomized to the FASD group or control group. PIVCs were placed following a standardized protocol. Dogs in the FASD group had the FASD device attached to their PIVC according to manufacturer instructions. For both groups, all PIVC complications were documented, and each complication was classified as extravasation, phlebitis, dislodgement, occlusion, or line breakage.
RESULTS
Results from 367 dogs (FASD group = 180, control group = 187) underwent analysis. The proportion of PIVC complications was significantly (P = .004) lower for the FASD group (8.9% [16/180]) versus the control group (24.6% [46/187]). Following adjustment for differences in hospitalization time, the odds of a dog in the FASD group having a PIVC complication was approximately one-third the odds of those in the control group (OR, 0.33; 95% CI, 0.17 to 0.63; P = .001).
CLINICAL RELEVANCE
Results indicated that the use of a FASD in hospitalized dogs receiving IV fluids is warranted to lower the incidence of PIVC complications and may also limit patient discomfort, owner expense, and staff time devoted to managing PIVC complications. Further research investigating its use in cats and other species should be considered.
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Affiliation(s)
- Sydney E. Simpson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Kristin M. Zersen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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Blackie K. Learning from patient safety event reporting in veterinary practice. Vet Rec 2022; 191:71-73. [PMID: 35866944 DOI: 10.1002/vetr.2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Development and implementation of veterinary anesthesia medical quality standards for primary care. Vet Anaesth Analg 2022; 49:233-242. [DOI: 10.1016/j.vaa.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/07/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
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Bennie CJM, Daniels JB, Rao S, Rosychuk RAW, Schissler JR. Efficacy of a quaternary ammonium compound in reducing coagulase-positive staphylococcal colony counts in veterinary dermatology exam rooms following two cleaning instruction protocols. Vet Dermatol 2022; 33:185-e52. [PMID: 35080083 DOI: 10.1111/vde.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nosocomial meticillin-resistant (MR) staphylococcal infections are of global concern. Veterinary dermatology exam room surfaces may be a reservoir given the commonness of staphylococcal pyoderma. HYPOTHESIS/OBJECTIVES First, efficacy of exam room surface decontamination using a quaternary ammonium compound was assessed after use of two different cleaning instruction protocols. Second, coagulase-positive staphylococcal (CoPS) colony counts were assessed after use of rooms by dogs with pyoderma, and then after cleaning and disinfection. METHODS AND MATERIALS In Part I, 10 room surfaces were tagged with a discreet fluorescent dye, Glo Germ, to assess the efficacy of surface cleaning between two Virex II 256-based cleaning protocols. In Part II, CoPS colonies were quantified via 3M Staph Express System. Ten standardised room surfaces were sampled after use by a dog with staphylococcal pyoderma, and immediately after a detailed cleaning and disinfection protocol. RESULTS A total of 24 of 100 and 81 of 100 surfaces were completely cleaned by the general and detailed protocols, respectively. The mean number of surfaces adequately cleaned was higher with the detailed protocol (P = 0.003). The detailed protocol reduced CoPS colony counts of eight surfaces (P < 0.01), and not chairs (P = 0.055). No CoPS were isolated from the exam table under a table mat. CONCLUSIONS AND CLINICAL RELEVANCE Detailed exam room cleaning and disinfection protocols are recommended to minimise contamination of veterinary exam room surfaces with staphylococci. The appropriate disinfection of chairs necessitates further study.
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Affiliation(s)
- Callum J M Bennie
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Joshua B Daniels
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 200 West Lake Street, Fort Collins, CO, 80523, USA
| | - Sangeeta Rao
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Rod A W Rosychuk
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Jennifer R Schissler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, 80523, USA
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Russell E, Mossop L, Forbes E, Oxtoby C. Uncovering the 'messy details' of veterinary communication: An analysis of communication problems in cases of alleged professional negligence. Vet Rec 2021; 190:e1068. [PMID: 34821386 DOI: 10.1002/vetr.1068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/13/2021] [Accepted: 10/03/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Communication failure is reported as a cause of error in veterinary practice and has been associated with complaints and litigation. Evidence describing the types and nature of communication problems is lacking. This limits our ability to mitigate the risk poor communication poses. METHODS This study used a mixed methods approach to explore the frequency and types of communication problems present in settled cases of alleged veterinary professional negligence. Thematic analysis was conducted on written documents associated with 100 such cases involving canine patients. Interpretation was informed by human factors thinking and communication theory. Results were triangulated with findings from a focus group with the Veterinary Defence Society claims consultants and with healthcare literature on communication failures. RESULTS Communication problems played a contributory role in 80% of the cases examined. The analysis highlighted features of problematic communication in veterinary practice that are underrepresented in the current literature. These include the prominence of communication problems within veterinary teams, the impact of communication on the safety of care and also the interdependence of communication events with the context, system and environment in which they occur. CONCLUSIONS These results suggest that communication is a collective competency. Effective communication is something veterinary systems, rather than individuals alone, achieve. There is a need to consider the team and organisational contexts in which communication occurs to ensure individual communication skills can be translated into communication practices that support the delivery of high-quality, safe veterinary care for the benefits of clinicians, owners and patients.
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Affiliation(s)
- Elly Russell
- School of Health and Social Care, University of Lincoln - Brayford Campus, Lincoln, UK
| | - Liz Mossop
- Vice Chancellors Office, University of Lincoln - Brayford Campus, Lincoln, UK
| | - Ellie Forbes
- School of Health and Social Care, University of Lincoln - Brayford Campus, Lincoln, UK
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de Carellán Mateo AG, Casamián-Sorrosal D. The perioperative management of small animals with previously implanted pacemakers undergoing anaesthesia. Vet Anaesth Analg 2021; 49:7-17. [PMID: 34916163 DOI: 10.1016/j.vaa.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/26/2020] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is little information in the veterinary literature about the perioperative management of small animal patients with previously implanted pacemakers undergoing elective or emergency non-cardiac procedures. The purpose of this article is to review the current literature with regard to human patients, with previously implanted pacemakers, undergoing general anaesthesia. Using this and the current information on pacemakers and anaesthesia in dogs and cats, we provide recommendations for small animal patients in this situation. DATABASES USED Google Scholar, PubMed and CAB Abstracts using and interlinking and narrowing the search terms: "dog", "cat", "small animals", "anaesthesia", "pacemaker", "perioperative", "transvenous pacing", "temporary pacing". Scientific reports and human and small animal studies from the reference lists of the retrieved papers were reviewed. In addition, related human and veterinary cardiology and anaesthesia textbooks were also included to create a narrative review of the subject. CONCLUSIONS The best perioperative care for these animals comes from a multidisciplinary approach involving the anaesthetist, cardiologist, surgeon and intensive care unit team. When such an approach is not feasible, the anaesthetist should be familiar with pacemaker technology and how to avoid perioperative complications such as electromagnetic interference, lead damage and reprogramming of the device. The preanaesthetic assessment should be thorough. Information regarding the indication for pacemaker placement, complications during the procedure, location, type and programming of the pacemaker should be readily available. The anaesthetic management of these veterinary patients aims to preserve cardiovascular function while avoiding hypotension, and backup pacing should be available during the perioperative period. Further prospective studies are needed to describe the best perioperative care in small animals with a previously implanted pacemaker.
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Affiliation(s)
- Alejandra García de Carellán Mateo
- Anaesthesia and Analgesia Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain.
| | - Domingo Casamián-Sorrosal
- Cardiology and Interventional Cardiology Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain
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18
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Crosse KR. Pre-surgical hand preparation in veterinary practice. N Z Vet J 2021; 70:69-78. [PMID: 34586948 DOI: 10.1080/00480169.2021.1987348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users' compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of pre-surgical hand preparation for veterinarians in all types of practice.
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Affiliation(s)
- K R Crosse
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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19
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Communicating Patient Quality and Safety in Your Hospital. Vet Clin North Am Small Anim Pract 2021; 51:1111-1123. [PMID: 34226075 DOI: 10.1016/j.cvsm.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Discussing medical quality starts with defining quality. Human health care publications identify safety, timeliness, efficiency, effectiveness, equity, and patient centeredness as important components of medical quality. Safety is foremost as medical errors are a leading cause of patient death. Studies examining patient outcomes have found that culture is critical. Cultures that emphasize communication, open discussion, and continuous improvement lead to improved patient survival and decreased medical errors. Leadership, training, staff meetings, and processes for gathering input all contribute to a culture of safety. Discussing medical errors with clients is difficult but can be made more manageable with a 6-step process.
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20
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Thieman Mankin KM, Jeffery ND, Kerwin SC. The impact of a surgical checklist on surgical outcomes in an academic institution. Vet Surg 2021; 50:848-857. [PMID: 33797097 DOI: 10.1111/vsu.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/15/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of a surgical checklist (SC) on morbidities and compliance with safety measures. STUDY DESIGN Before-and-after-intervention study. SAMPLE POPULATION Three thousand two hundred eighty-six dogs: 1375 dogs pre-SC and 1911 post-SC. METHODS Completion of safety measures and occurrence of morbidity and/or mortality during hospitalization and up to death or 30-days postoperatively were recorded. RESULTS Safety measures were more frequently completed post-SC, including oral confirmation of patient identity (467/1177 [40%] vs. 1911/1911 [100%]) and oral confirmation of surgical site (568/1175 [48%] vs. 1911/1911 [100%]). In addition, duration of anesthesia decreased from 241 to 232 min (t = 2.824; p = .005); a greater proportion of animals that were intended to receive antibiotics did so prior to incision (1142/1316 [86.8%] vs. 1656/1845 [89.8%] [χ2 = 6.70, p = .01]); and fewer dogs had unplanned return to the OR (32/1065 [3.0%], vs. 21/1472 [1.4%]) (χ2 = 7.52, p = .006). No difference in surgical site infection (adjusted odds ratio 1.02 [95%CI: 0.63-1.66]); morbidity, (adjusted odds ratio 1.00 [95%CI: 0.77-1.29]); or death within 30 days (adjusted odds ratio 1.15 [95%CI: 0.72-1.83]) was detected on multivariable logistic regression analysis. The checklist prevented one wrong-site surgery. CONCLUSION Implementation of the checklist at our institution led to a decrease in anesthesia duration, increased administration of planned perioperative antibiotics before incision, increased completion of safety measures, and decreased unexpected return to the OR. IMPACT Despite the lack of effect on morbidities, the use of SC is recommended to improve compliance with safety measures and potentially prevent rare catastrophic events.
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Affiliation(s)
- Kelley M Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Nicholas D Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Sharon C Kerwin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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21
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Miloro R, Higgins J, Phipps WB. Retained artery forceps causing acute intestinal strangulation two years following abdominal surgery in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Renato Miloro
- Fitzpatrick Referrals Halfway Lane, Eashing Godalming UK
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22
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Hawker WTG, Singh A, Gibson TWG, Giuffrida MA, Weese JS. Use of a surgical safety checklist after implementation in an academic veterinary hospital. Vet Surg 2020; 50:393-401. [PMID: 33378549 DOI: 10.1111/vsu.13561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/06/2020] [Accepted: 11/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN Voluntary online survey and retrospective study. SAMPLE POPULATION All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.
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Affiliation(s)
- William T G Hawker
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas W G Gibson
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | | | - J Scott Weese
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Välkki KJ, Thomson KH, Grönthal TSC, Junnila JJT, Rantala MHJ, Laitinen-Vapaavuori OM, Mölsä SH. Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs. Acta Vet Scand 2020; 62:53. [PMID: 32943076 PMCID: PMC7495856 DOI: 10.1186/s13028-020-00545-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Surgical site infections (SSI) are associated with increased morbidity and mortality. To lower the incidence of SSI, antimicrobial prophylaxis is given 30–60 min before certain types of surgeries in both human and veterinary patients. However, due to the increasing concern of antimicrobial resistance, the benefit of antimicrobial prophylaxis in clean orthopaedic and neurosurgeries warrants investigation. The aims of this retrospective cross-sectional study were to review the rate of SSI and evaluate the compliance with antimicrobial guidelines in dogs at a veterinary teaching hospital in 2012–2016. In addition, possible risk factors for SSI were assessed. Results Nearly all dogs (377/406; 92.9%) received antimicrobial prophylaxis. Twenty-nine dogs (7.1%) did not receive any antimicrobials and only four (1.1%) received postoperative antimicrobials. The compliance with in-house and national protocols was excellent regarding the choice of prophylactic antimicrobial (cefazolin), but there was room for improvement in the timing of prophylaxis administration. Follow-up data was available for 89.4% (363/406) of the dogs. Mean follow-up time was 464 days (range: 3–2600 days). The overall SSI rate was 6.3%: in orthopaedic surgeries it was 6.7%, and in neurosurgeries it was 4.2%. The lowest SSI rates (0%) were seen in extracapsular repair of cranial cruciate ligament rupture, ulnar ostectomy, femoral head and neck excision, arthrotomy and coxofemoral luxation repair. The highest SSI rate (25.0%) was seen in arthrodesis. Omission of antimicrobials did not increase the risk for SSI (P = 0.56; OR 1.7; CI95% 0.4–5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; CI95% 1.4–57.9) and higher body temperature (P = 0.03; OR 1.69; CI95% 1.0–2.7; mean difference + 0.4 °C compared to dogs without SSI). Conclusions Antimicrobial prophylaxis without postoperative antimicrobials is sufficient to maintain the overall rate of SSI at a level similar to published data in canine clean orthopedic and neurosurgeries.
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Affiliation(s)
- Mickey Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Wakefield, UK
| | - Sophie Adamantos
- Paragon Veterinary Referrals, Paragon Business Village, Wakefield, UK
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25
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Kilbane H, Oxtoby C, Tivers MS. Staff attitudes to and compliance with the use of a surgical safety checklist. J Small Anim Pract 2020; 61:332-337. [PMID: 32175603 DOI: 10.1111/jsap.13131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate staff attitudes to the use of a surgical safety checklist in a small animal operating room and to gain insight into barriers to use. MATERIALS AND METHODS A questionnaire was designed and used to assess attitudes of 36 operating room personnel to the checklist. The checklist was retrospectively audited on 984 patients over an 8-month period to investigate compliance. RESULTS Responses were obtained from 100% of operating room personnel. Attitudes to the checklist were positive, with 83.4% agreeing that it improved teamwork and 100% agreed that the checklist improved patient safety, reduced error and was best practice. Most personnel (94%) believed that a completed checklist was used for every procedure. Several barriers were highlighted, including issues of hierarchy and team-working and lack of training. 984 checklists were used during the study period with 83 (8.4%) being fully completed. CLINICAL SIGNIFICANCE Surgical safety checklists have potential to improve patient safety in veterinary operating rooms. However, appropriate design and implementation are critical and surgeons should endeavour to support checklist use.
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Affiliation(s)
- H Kilbane
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, UK
| | - C Oxtoby
- The Veterinary Defence Society, 4 Haig Court, Parkgate Industrial Estate, Knutsford, Cheshire, WA168XZ, UK
| | - M S Tivers
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, UK
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26
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Langdon G, Hoet AE, Stull JW. Fluorescent tagging for environmental surface cleaning surveillance in a veterinary hospital. J Small Anim Pract 2019; 61:121-126. [PMID: 31777093 DOI: 10.1111/jsap.13090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/19/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the use of fluorescent tagging for environmental surface cleaning surveillance in a small animal veterinary hospital and identify factors associated with tag removal. MATERIALS AND METHODS Over 5.5 weeks, a commercial fluorescent dye (Glo Germ) was used to tag (mark) surfaces in a small animal veterinary teaching hospital. Twenty-four hours after tagging, cleaning was assessed with a black light (UV-A source). Surfaces were recorded as cleaned based on complete removal of fluorescent tagging at assessment. Proportions cleaned were calculated overall and by predictors (i.e. surface location/type, primary nature of surface contact - animal/human, week of study). RESULTS A total of 4984 surfaces were tagged and assessed. Overall cleaning was 50%. Cleaning varied by surface/object (range: 2 to 100%) and hospital location (4 to 78%). Surfaces designated as having primarily animal contact were cleaned more frequently than those with primarily human contact (75%, 42%; P<0.001). Cleaning varied over the study period (range by week: 45 to 54%;); a significant trend was not identified. CLINICAL SIGNIFICANCE Key surfaces in the small animal veterinary practice environment are unlikely to be adequately cleaned, posing a concern for animal and human health. Commercial products can be effectively used to asses environmental cleaning with findings used to target clinic-specific barriers to improve cleaning and reduce hospital-associated infections.
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Affiliation(s)
- G Langdon
- College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - A E Hoet
- College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA.,Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, 43210, USA
| | - J W Stull
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, 43210, USA
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27
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Hardefeldt LY, Crabb HK, Bailey KE, Johnstone T, Gilkerson JR, Billman-Jacobe H, Browning GF. Appraisal of the Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery in dogs and cats. Aust Vet J 2019; 97:316-322. [PMID: 31286484 DOI: 10.1111/avj.12848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/03/2023]
Abstract
The Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery on dogs and cats are evidence-based guidelines for veterinary practitioners. Validation of these guidelines is necessary to ensure quality and implementability. Two validated tools, used for medical guideline appraisal, were chosen to assess the guidelines. The terminology from the GuideLine Implementability Appraisal (GLIA) and the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) were adapted for use by veterinarians. A two-phase evaluation approach was conducted. In the first phase of the evaluation, the GLIA tool was used by two specialist veterinary surgeons in clinical practice. The results of this phase were then used to modify the guidelines. In the second phase, the AGREE II tool was used by 6 general practitioners and 6 specialists to appraise the guidelines. In phase 1, the specialist surgeons either agreed or strongly agreed that the guidelines were executable, decidable, valid and novel, and that the guidelines would fit within the process of care. The surgeons were neutral on flexibility and measurability. Additional clarity around one common surgical procedure was added to the guidelines, after which the surgeons agreed that the guidelines were sufficiently flexible. In phase 2, 12 veterinarians completed the assessment using the AGREE II tool. In all sections the scaled domain score was greater than 70%. The overall quality of the guidelines was given a global scaled score of 76%. This assessment has demonstrated that the guidelines for antimicrobial prophylaxis for companion animal surgery are valid and appear implementable.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - H K Crabb
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - T Johnstone
- Translational Research and Animal Clinical Trial Study Group (TRACTS), U-Vet Animal Hospital Werribee, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Hwy, Werribee, 3030, Victoria, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
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28
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Ward J, McLaughlin A, Burzette R, Keene B. The effect of a surgical safety checklist on complication rates associated with permanent transvenous pacemaker implantation in dogs. J Vet Cardiol 2019; 22:72-83. [DOI: 10.1016/j.jvc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/09/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Wallis J, Fletcher D, Bentley A, Ludders J. Medical Errors Cause Harm in Veterinary Hospitals. Front Vet Sci 2019; 6:12. [PMID: 30805349 PMCID: PMC6370638 DOI: 10.3389/fvets.2019.00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Medical errors are a leading cause of mortality in human medicine. In contrast, errors in veterinary medicine are rarely discussed, and there is little known about their nature and frequency. This study aimed to evaluate the type and severity of medical errors reported in three veterinary hospitals. The voluntary online incident reporting systems of a small animal teaching hospital, large animal teaching hospital, and small animal multi-specialty practice were reviewed. Reports were included if they were entered between February 2015 and March 2018, and involved an incident pertaining to patient safety. The reporting systems classified errors into the following categories: drug, iatrogenic, system, communication, lab, oversight, staff, or equipment errors. In addition, all incidents were classified as resulting in either a near miss, harmless hit, adverse incident, or unsafe condition. Adverse incidents were further evaluated retrospectively for error severity. A total of 560 incident reports were included for analysis. Drug errors were the most frequently reported in all three hospitals, followed by failures of communication. Errors most commonly reached patients without causing harm (45%); however, 15% of all incidents resulted in patient harm. Eight percent of patients harmed suffered permanent morbidity or death. A higher proportion of adverse incidents were reported in the small animal teaching hospital than in the other two practice settings. This study demonstrates that medical errors have a substantial impact on veterinary patients. Establishing that drug and communication errors are most frequent in a variety of hospitals is the first step toward interventions to improve patient safety and outcomes in veterinary medicine.
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Affiliation(s)
- Jessica Wallis
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Daniel Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Adrienne Bentley
- Cornell University Veterinary Specialists, Stamford, CT, United States
| | - John Ludders
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Stull JW, Bjorvik E, Bub J, Dvorak G, Petersen C, Troyer HL. 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines*. J Am Anim Hosp Assoc 2018; 54:297-326. [DOI: 10.5326/jaaha-ms-6903] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
A veterinary team’s best work can be undone by a breach in infection control, prevention, and biosecurity (ICPB). Such a breach, in the practice or home-care setting, can lead to medical, social, and financial impacts on patients, clients, and staff, as well as damage the reputation of the hospital. To mitigate these negative outcomes, the AAHA ICPB Guidelines Task Force believes that hospital teams should improve upon their current efforts by limiting pathogen exposure from entering or being transmitted throughout the hospital population and using surveillance methods to detect any new entry of a pathogen into the practice. To support these recommendations, these practice-oriented guidelines include step-by-step instructions to upgrade ICPB efforts in any hospital, including recommendations on the following: establishing an infection control practitioner to coordinate and implement the ICPB program; developing evidence-based standard operating procedures related to tasks performed frequently by the veterinary team (hand hygiene, cleaning and disinfection, phone triage, etc.); assessing the facility’s ICPB strengths and areas of improvement; creating a staff education and training plan; cataloging client education material specific for use in the practice; implementing a surveillance program; and maintaining a compliance evaluation program. Practices with few or no ICPB protocols should be encouraged to take small steps. Creating visible evidence that these protocols are consistently implemented within the hospital will invariably strengthen the loyalties of clients to the hospital as well as deepen the pride the staff have in their roles, both of which are the basis of successful veterinary practice.
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Affiliation(s)
- Jason W. Stull
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
| | - Erin Bjorvik
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
| | - Joshua Bub
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
| | - Glenda Dvorak
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
| | - Christine Petersen
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
| | - Heather L. Troyer
- From the Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, and Department of Health Management, Atlantic Veterinary College, the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.W.S.); Veterinary Specialty Center, Buffalo Grove, Illinois (E.B.); Mesa Veterinary Hospital, Golden, Colorado (J.B.); C
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Cray MT, Selmic LE, McConnell BM, Lamoureux LM, Duffy DJ, Harper TA, Philips H, Hague DW, Foss KD. Effect of implementation of a surgical safety checklist on perioperative and postoperative complications at an academic institution in
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orth
A
merica. Vet Surg 2018; 47:1052-1065. [DOI: 10.1111/vsu.12964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/05/2018] [Accepted: 08/10/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Megan T. Cray
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Laura E. Selmic
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Briana M. McConnell
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Lorissa M. Lamoureux
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Daniel J. Duffy
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Tisha A. Harper
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Heidi Philips
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Devon W. Hague
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
| | - Kari D. Foss
- Department of Veterinary Clinical MedicineUniversity of Illinois Urbana‐Champaign Urbana Illinois
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Rodriguez FR, Kirby BM, Ryan J. Evaluation of factors associated with retained surgical sponges in veterinary patients: a survey of veterinary practitioners. J Small Anim Pract 2018; 59:570-577. [DOI: 10.1111/jsap.12873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/26/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- F. R. Rodriguez
- Department of Small Animal Surgery; Animal Bluecare Hospital; A7 Km 204, 29649, Mijas Costa Malaga Spain
| | - B. M. Kirby
- Department of Small Animal Surgery; University College Dublin School of Veterinary Medicine; Belfield Campus, Dublin 4 Ireland
| | - J. Ryan
- Royal (Dick) School of veterinary Studies; University of Edinburgh, Easter Bush Veterinary Centre; Roslin Midlothian, EH25 9RG UK
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Menoud G, Axiak Flammer S, Spadavecchia C, Raillard M. Development and Implementation of a Perianesthetic Safety Checklist in a Veterinary University Small Animal Teaching Hospital. Front Vet Sci 2018; 5:60. [PMID: 29666797 PMCID: PMC5891598 DOI: 10.3389/fvets.2018.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/12/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction The use of a surgical safety checklist is recommended by the World Health Organization and is associated with advantages: improved communication and reduced complications and mortality. Adapting checklists to the environment in which they are used improves their efficiency, but their implementation can be challenging. The aim of this study was to develop and implement a perianesthetic safety checklist for a small animal hospital. Materials and methods A panel of eight anesthesia diplomates and seven residents and doctoral students were gathered. The Delphi method was used to generate a checklist. The checklist was presented individually to each user by the primary investigator and introduced into the clinical routine over a 5-week period. An interdisciplinary meeting was then held, and the checklist was modified further. Six months after introduction, the use of the checklist was directly observed during 69 anesthetic cases and a survey was sent to the users. A second implementation was organized after formally presenting the checklist to the staff, designating the anesthesia clinical lead as the person responsible for printing and controlling use of the checklist. A second evaluation was performed 3 months later (64 anesthetic cases). Results Using the Delphi process led to the creation of a checklist consisting of three parts: “sign in” (before induction of anesthesia), “time out” (before the beginning of the procedure), “sign out” (at the end of the procedure). At the first assessment, the checklist was printed and used in 32% of cases and not printed in 41% of cases. Response rate of the survey was fair (19/32 surveys): 14/19 users thought the checklist contributed to improving communication; 15/19 reported improved safety and better management of the animals; 9/19 users avoided mistakes (77% would have omitted the administration of antimicrobial prophylaxis); 10/19 thought it was time consuming. At the second assessment, the checklist was used in 45% of cases (printed but not used in 55%). The use of the sign-out section of the checklist was significantly improved. Conclusion and clinical relevance This study illustrates an innovative use of the Delphi method to create a safety checklist. Challenges associated with implementation are reported.
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Affiliation(s)
- Gwennaëlle Menoud
- Section of Anesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Shannon Axiak Flammer
- Section of Anesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Claudia Spadavecchia
- Section of Anesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Mathieu Raillard
- Section of Anesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Human error and surgical complications. Vet Comp Orthop Traumatol 2016; 29:V. [PMID: 27652376 DOI: 10.3415/vcot-16-08-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022]
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