The worst days of my veterinary career have been when something happened in our hospital that meant we did more harm than good. It is those stomach dropping moments when we realize a mistake has been made and that there might be irreversible damage.
No one ever wants a mistake to happen but, “to err is human.” Mistakes in healthcare happen not because people don’t care but because humans are fallible and our jobs are complex.
As I stated in a previous blog, I define quality as safe, reliable, effective healthcare that puts pets and their families first.
I have safe listed first because that is where we should start our quality journey. One of the mantras of the Mayo Clinic, is “In order to be trusted, we must be safe.” This also applies to veterinarians. We, as a profession, need to look at why mistakes happen and work together to prevent them.
Here are 3 things every veterinary clinic should do today to prevent mistakes and improve patient safety.
1) Throw out/ban the use of electric heating pads, hot water bottles, and heat discs in your hospitals. Several years ago, I received a phone call at home at 3am. One of the emergency doctors called to let me know that a dog who was kept warm with hot water bottles wrapped inside of fleece blankets looked like he was going to develop burns. We mistakenly thought if warmed IV fluid bags were wrapped in fleece they would be safe. They are not. We notified the owner immediately and did everything in our power to save the dog, but he died after 9 days and 3 surgeries. In nationwide lectures, I have asked how many people have seen a severe burn from a hot water bottle or electric heating pad and almost everyone has. There are also numerous reports of burns from heating discs, electric heating pads, and hot water bottles discussed in online veterinary forums.
I know forced air warming devices such as Bair Huggers seem costly but it is devastating to lose a patient. Circulating water blankets, warming towels in the dryer, and dog sweaters are also good options for warmth.
I would like to give kudos to Blue Pearl who last year banned the use of hot water bottles and electric heating pads for warming patients in all of their locations.
2) Add protection devices to your anesthetic machines to prevent pop-off valve lung injuries. Pneumothorax and tracheal tears secondary to excessive pressure inside an anesthetic circuit are a known but preventable risk. These injuries can occur when a pop off valve is closed to administer a breath but then inadvertently not re-opened. There are several devices on the market that can be added to your anesthetic machine to help prevent these injuries.
Pictured below is an anesthetic machine equipped with both a pop-off occlusion valve and a pressure release valve.
The Pop-off occlusion valve is simply a button that you hold down to fill the bag so you can give a breath. As soon as you let go, the circuit is open again. This simple device means you don’t have to tighten the pop off valve itself to give a breath. Many companies make these inexpensive valves. Here are a couple links:
http://www.surgivet.com/catalog/anesthesia-accessories/pop-off-occlusion-valve.html
https://pattersonscientific.com/products/occlusion-pop-off-valve/
The pressure release valve prevents the pressure in the circuit from ever going over 20-30 mm Hg (depending on the valve) EVEN if the pop off is left closed. These are useful if you have to close the pop off when switching to an anesthetic ventilator and the valve could be inadvertently left closed when switching back off the ventilator. A pressure release valve can be purchased or can be created using a reverse PEEP pressure relief valve .
3) Implement the use of a surgery/anesthesia checklist in your hospital.
In 2009, the WHO’s Safe Surgery Saves Lives program published the results of a study in the NEJM . This study demonstrated that the implementation of a simple checklist before, during and after surgery in 8 hospitals in 8 different countries decreased both complications and mortality. This checklist added no cost and minimal time but on average, decreased post-operative complications by 36%.
Shortly after reading this article, we implemented a surgical checklist in our hospitals. We had a committee of nurses and doctors who worked together to modify the WHO checklist to make it work for veterinary patients. We started with a trial team, modified the checklist based on feedback, and then implemented.
A study has now been done in veterinary medicine which confirmed the NEJM findings. In a prospective clinical trial, 300 dogs and cats undergoing surgery were followed to document a baseline incidence of complications and mortality. A surgery checklist was then implemented and used with the following 220 surgeries. The research team found a statistically significant REDUCTION in the incidence of all complications after the implementation of the checklist.
These 3 steps will add minimal cost and will make your hospital safer for pets. Start them today!!