Anaesthetic incidents are not always obvious. Many times they pass without the anaesthetist even knowing they have taken place. They may range from a drop in blood pressure through to cardiac arrest.
The dependance on monitoring equipment can provide misleading information for a variety of reasons. Monitors don’t necessarily pick up the finer nuances of the patient such as subtle changes in pulse nature, mucous membrane colour or capillary refill time. By the time these changes amount to a significant enough shift in the patient’s condition to result in an alarm alert, the damage may already have occurred. If you ever monitor a patient during euthanasia, you will be aware that the patient can be dead for a little while before the monitor registers certain parameter changes.
Many medications have a dose range specific to individual animal species. Some products have a quite large range which can be confusing for the person calculating an effective dose volume. The tendency is to play it safe and go for lower rather than higher dose volumes. This is understandable in light of a patient’s safety, but may result in ineffective pain management.
Most veterinary practices utilise nursing staff to monitor patient anaesthesia. While nurses become incredibly skilled at this process, they may not fully understand some of the subtleties between anaesthesia and analgesia. Many anaesthetic agents are designed to regulate consciousness not pain. A common mistake made by the anaesthetist is to increase the concentration or volume of anaesthetic agent administered to control pain. This will increase patient anaesthetic depth but not necessarily provide pain relief.
Many drugs are misunderstood and either used when they shouldn’t be, or not used at all. A good understanding of individual patient requirements is essential to appropriate drug selection.
Communication is one of the key factors associated with medical misadventure. It is documented as a major contributing factor in 43% of human surgical errors. These include ineffective pre surgery check lists, pre op briefings, or surgical leadership. When junior or inexperienced staff are placed in a position of responsibility, intimidation may prevent them speaking out about a patient’s condition for fear of being incorrect or overreactive.
Studies about veterinary misadventure place cognitive limitations as a significant contributing factor. Fatigue, distraction, inexperience or forgetfulness all play a role in patient mistakes. The use of simple check lists in human medicine have helped reduce mistakes by up to 50%. Check-list implementation in veterinary practice could result in similar reductions. Mistakes such as setting up an anaesthetic machine incorrectly or overfilling an ET cuff could be easily reduced if adequate systems were implemented.
I suspect one of the biggest distractors to appropriate systems in veterinary practice is the fear of litigation, retribution or professional castigation. To maintain open, transparent systems means others have access to practice data (both positive and negative). That very data which helps practices perform safer more effective veterinary services also opens the practice (and it’s staff) to outside critique. In a world that is both litigious and accusing it is difficult to move from a defensive to a preventative mode of action.