Avoiding anaesthesia related complaints   Veterinary Practitioners Board of New South Wales Avoiding anaesthesia related complaints John Baguley BVSc MBA PhD GradCert(HigherEd) MANZCVS MAICD

Outline Overview of complaints General principles Risk mitigation 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 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%).

Complaint decisions 2007-2017 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)).

Complaints investigated by decision 2007-2014

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 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 Pre-anaesthetic blood testing performed as indicated, results discussed with the client and used to inform the anaesthetic protocol as required 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 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 Provide pain management in accordance with current standards Ensure drugs and any combination of drugs are not contraindicated and used in accordance with current standards Ensure appropriate monitoring of anaesthesia (pulse oximeter required) Ensure any thermal support provided is in accordance with current standards Ensure staff are familiar with protocols for adverse events 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 Incorrect dose rates Protocol not compatible with differential diagnosis of megaoesophagus Use of an alpha 2 agonist with atropine Poor technique and development of a tracheal tear Failure to create a contemporaneous record of dose rates and agents used Failure to adequately monitor the animal during recovery Failure to ensure availability for the ongoing care of the animal Failure to adequately address complications (aspiration pneumonia) Aggressive animals Burns Brachycephalic dogs

Summary of common issues Record keeping Teeth cleaning 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 Avoid dogs and cats

Complaints by year of graduation 2007-2014 Hopefully not a graduate from 1972,1982,1986 or 2003

Questions