There is no question that mistakes occur in veterinary medicine; we are human after all. But what do we do when these errors or near misses occur? What protocols do we have in place to deal with these misadventures? How can we assure our clients that patient safety is a top priority?
To facilitate effective reporting, we first need to define the different types of patient safety events that occur. Terms that would be suitable for veterinary medical reporting might include the following: Near miss - any situation in which an error was caught before it reached a patient; Harmless hit - an error that reached the patient however did not cause any harm; Adverse incident - one in which either temporary or permanent harm to the patient occurred as a result; and Unsafe Condition - a situation that increases the chance of a patient safety event.
Recent reports have found that the most common mistakes that occur in veterinary practice are errors in drug administration (be it incorrect drug/dose/frequency/route of administration) and failures in communication. A retrospective review of 560 incident reports collated over a 3-year period from three US veterinary hospitals identified a total error rate of 5 per 1000 patient visits1. Of these, 15% of errors resulted in patient harm; with 8% of those suffering permanent morbidity or death. In the same study, 45% of incidents reported reached the patient, but did not cause harm ie) a harmless hit1.
Given the increasing number of corporate practices, separate emergency and afterhours clinics, more veterinary staff opting to work part-time, and the continued pressures of veterinary medicine, communication failures are likely going to become more prominent. Regardless of the method of transmission (verbal, written or electronic), all communications are prone to error; and a breakdown in communication will inevitably result in risk to patient safety. Effective communication between team members requires the delivery of information (transmission) from point A (the source) to point B (the receiver), and there are multiple points at which the transfer of information may be disrupted or incomplete. Often with verbal communication, the receiver will only partially recall the message; the written delivery may not be completely legible; and electronic communications might be incomplete or too lacking detail.
So, what can we do to ensure accurate transmission of important information? Firstly, don’t multi-task! If a team member is trying to communicate with you about a case, give them your full attention. If you can’t at that particular moment, ask them to come back to you when you can give them your attention. Secondly, utilise multiple forms of communication. With case handovers for example, make sure your clinical notes and hospital charts (if applicable) are updated and then take a couple of minutes to verbally discuss the critical points of the case(s) with the colleague who is taking over. That way, they have heard the highlights straight from the horse’s mouth, as well as having some written communications to refer back to. If you are referring a case to an afterhours emergency centre, personally send a quick email highlighting the pertinent aspects of the case, along with the completed medical records. Yes, this might take 5 minutes - but it will be time well spent.
When it comes to veterinary misadventures, it is not only the risk of causing harm to our patients that we need to consider; what about the negative effects on the person(s) responsible, ie. the second victim? No one sets out to deliberately make a mistake, especially one that will put a patient in danger, which is why we need to embrace a “No Blame” culture. There is no question that those responsible for a misadventure will be feeling all kinds of negative emotions - guilt, shame, embarrassed, even fear; and in that moment, what they probably really need from their team is support, understanding and an opportunity to discuss the situation in a safe environment.
Then what about the emotional impact on the client? The potential for damage to your hospital’s reputation? The financial implications? These are all valid concerns that will need to be addressed, and is actually where incident reporting and effective client communication can be very valuable. Consider this scenario: A patient has inadvertently received a NSAID overdose that resulted in acute kidney injury. The adverse event was: i) identified; ii) reported to the practice’s voluntary incident reporting system; iii) communicated to the client; and iv) successfully managed in-hospital. In this situation, it is very possible that although the client involved is understandably upset, they will be less likely to pursue litigation or further action if they are aware the practice has formal protocols and procedures in place for dealing with such situations.
Regardless of whether patient safety was indeed put into jeopardy by the mistake or near miss, reporting is essential; and in order to create solutions, we must first be able to identify the problems.
Below are 5 initiatives that have been shown to help manage misadventures in veterinary practice:
- Adopt a “no-blame” workplace culture.
- Incorporate an anonymous voluntary incident reporting system.
- Initiate monthly or quarterly morbidity and mortality (“M&M”) rounds.
- Perform an annual practice audit to determine your error rate and identify areas that can be improved.
- Hold frequent staff meetings.
As veterinary professionals we have a duty of care, not only to the communities we serve, but to our team members as well. It is therefore definitely time for us to follow our human healthcare colleagues, and begin to foster a culture supportive of the admission, discussion and subsequent reporting of medical misadventures and near misses.
What reporting methods does your veterinary practice currently employ? What do you think could work well for your clinic? Get in touch, we would love to hear your thoughts!
1 Wallis J, Fletcher D, Bentley A, Ludders J. 2019 Medical Errors Cause Harm in Veterinary Hospitals. Front. Vet. Sci. https://doi.org/10.3389/fvets.2019.00012
