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

2. Outline Overview of complaints General principles Risk mitigation
Common issues

3. 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)).

4. 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%).

5. Complaint decisions
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)).

6. Complaints investigated by decision 2007-2014

7. 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

8. 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

9. 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

10. 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

11. Summary of common issues
Record keeping
Teeth cleaning
Poor client communication
Images from:

12. Complaints by species 2007-2014
Avoid dogs and cats

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

14. Questions