Veterinary Practitioners Board OF NEW SOUTH WALES Avoiding anaesthesia related complaints John Baguley BVSc MBA PhD GradCert(HigherEd) MANZCVS MAICD
Outline 1. Overview of complaints 2. General principles 3. Risk mitigation 4. Common issues
Overview For the period 2008 to 2017 the Board investigated 439 complaints against veterinarians in NSW and 294 of these complaints were dismissed (67%). Approximately 17 of the 439 complaints investigated by the Board during this period involved an adverse event in relation to anaesthesia (4%). Complaints are assessed for evidence of a possible breach of the legislation and more specifically of the Veterinary practitioners code of professional conduct (Code) (Veterinary Practice Regulation 2013 (sch 2)).
Finalised and New Complaints 2007-2017 80 70 60 50 40 30 20 10 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Finalised Complaints 33 21 32 50 39 45 44 54 55 37 62 New Complaints 25 31 37 42 44 42 49 53 48 44 72 2017 Finalised Complaints New Complaints
70 Complaint decisions 2007-2017 60 50 40 30 20 10 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Dismissed 16 15 22 39 27 32 21 31 38 20 49 Finalised Complaints 33 21 32 50 39 45 44 54 55 37 62 2017 Dismissed Finalised Complaints
Complaints investigated by decision 2007-2014 Reprimanded, 13, 3% Withdrawn, 17, 4% Cautioned, 86, 19% Removed, 8, 2% Dismissed, 314, 72%
General principles Veterinary practitioners code of professional conduct Maintain knowledge of and perform professional procedures in accordance with current standards Obtain informed consent from the person responsible for the care of the animal where practicable and this must include a discussion of likely extent and outcome of services together with an estimate of costs and referral options where appropriate Create a detailed record as soon as practicable and in sufficient detail to enable another veterinarian to continue treatment Assistants must have the skills, knowledge and available equipment to enable duties to be performed in accordance with current standards Ensure availability for the ongoing care of the animal
Risk mitigation 1. Thorough history and physical examination and address associated risks Breeds and breed types such as brachycephalic dogs Aggressive animals Accurate weight Feeding history Concurrent medication Differential diagnoses and definitive diagnoses 2. Pre-anaesthetic blood testing performed as indicated, results discussed with the client and used to inform the anaesthetic protocol as required 3. Obtain informed consent when practicable from the client and ensure the client is aware of likely extent and outcome of services and is provided with an estimate of costs (including additional procedures) Consider offering referral for cases requiring additional knowledge, skills or resources
Risk mitigation 4. Ensure records are made as soon as practicable and are in sufficient detail for another veterinarian to continue the treatment of the animal Record the use of drugs of addiction in a separate register as required 5. Provide pain management in accordance with current standards 6. Ensure drugs and any combination of drugs are not contraindicated and used in accordance with current standards 7. Ensure appropriate monitoring of anaesthesia (pulse oximeter required) 8. Ensure any thermal support provided is in accordance with current standards 9. Ensure staff are familiar with protocols for adverse events 10. Ensure you are available for the ongoing care of the animal or that you make arrangements for another veterinarian to take over the care of the animal
Summary of common issues 1. Incorrect dose rates 2. Protocol not compatible with differential diagnosis of megaoesophagus 3. Use of an alpha 2 agonist with atropine 4. Poor technique and development of a tracheal tear 5. Failure to create a contemporaneous record of dose rates and agents used 6. Failure to adequately monitor the animal during recovery 7. Failure to ensure availability for the ongoing care of the animal 8. Failure to adequately address complications (aspiration pneumonia) 9. Aggressive animals 10. Burns 11. Brachycephalic dogs
Summary of common issues 1. Record keeping 2. Teeth cleaning 3. Poor client communication Images from: http://www.theivrytower.com/hearing-protection-guide-buyers/ https://www.dogstardaily.com/training/bite-scale https://www.colourbox.com/vector/cartoon-pen-raising-his-hands-vector-3460781
Complaints by species 2007-2014 N/A, 18, 4% Horse, 39, 9% Goat, 2, 1% Ferret, 1, 0% Rabbit, 2, 1% Sheep, 2, 0% Turtle, 2, 0% Cattle, 2, 0% Bird, 4, 1% Cat, 70, 17% Dog, 282, 67%
Complaints by year of graduation 2007-2014 25 20 15 10 5 0
Questions