Rosemullion Veterinary Practice is a three-site small animal practice owned by CVS.
It has 100 members of staff and dispenses 3,584 medications in an average month.
According to an article in Companion Animal, medication errors account for 30% of all reported errors in veterinary practice1.
Errors can be prescribing errors - where the vet prescribes the incorrect medication or dosage, or dispensing errors where the incorrect medication, strength or volume is dispensed by the pharmacy team.
Some errors can ‘look or sound alike’ – where medications have similar names or packaging – making them easy to mix up.
Rosemullion conducted an initial clinical audit of entries on its VetSafe system between 1st March and 31st May 2023.
Analysis was conducted on the drugs involved, whether they were prescribing or dispensing errors or near misses, and looking for patterns of behaviour or the drugs involved.
During this time there were 29 (0.27%) near misses and 14 (0.13%) errors.
Prescribing near misses most often involved flea and worm products.
Here additional feedback from vets was that it was difficult to remember weight brackets for all products and when weight brackets were included in the drug description this made them easier to prescribe accurately.
As a consequence, the Rosemullion pharmacy team introduced the inclusion of weight brackets on all flea and worm products.
Dispensing errors and near misses were mostly related to ‘look or sound alike’, particularly in worming tablets, flea treatments and Rheumocam cat and dog.
To address this, the Rosemullion pharmacy team added extra labelling to dispensary draws and separated draws for flea and worm treatments into different weight brackets.
Rheumocam – with its similar packaging design and box sizes – was also split into separate cat and dog drawers, and drawers clearly labelled up with the version and volume to make dispensing clearer.
Feedback was also given to the drug manufacturer.
Rosemullion also held a CPD session to highlight the common errors that were occurring, to explain resulting process and systems improvements, and ask the team to take extra care with these dispensaries.
A new ‘handing out medication’ process was also created – involving checking the medication in the bag matched the on the screen notes, confirming it was for the correct animal and validating it was what the owner was expecting.
A subsequent audit was run from 1st October to 31st November 2023.
The results revealed there were no prescribing or dispensing errors (0%) and only 8 (0.13%) near misses during this time.
Alice Bell, Senior Vet and Quality Improvement Lead at Rosemullion Veterinary Practice, said: “We place patient safety at the forefront of all we do.
"We wanted to conduct this extensive audit to assess our prescribing and dispensing processes and systems.
“The methods we had in place made it easy to do the task correctly and the changes we have now put in place have made the process even safer for our clients.
"Our overall error and near miss is now at a really low number compared to our total number of medication dispenses.
“The teams have been very receptive to the improvements and the project has had a positive impact on various aspects of the practice, including on team wellbeing.”
Rosemullion Veterinary Practice’s initiative has recently been recognised with a RCVS Knowledge Highly Commended status at its 2024 awards.
Reference
First, the practice carried out an infection control audit to ensure its protocols were robust.
The audit covered the cleaning of clinical areas, non-clinical areas (including offices, reception desks, kltchens and bathrooms), and the personal hygiene of staff members (including hand hygiene and work wear).
Using using the Nationwide Laboratory practice cleanliness screening programme, Rosemullion then conducted environmental swabbing of 10 clinical and non-clinical areas around the practice, including theatre tables, kennels, telephones and door handles, to review contamination levels.
Results showed varying levels of bacterial contamination in both clinical and non-clinical areas.
Finally, Rosemullion assessed personal hygiene and the potential for cross-contamination between patients, colleagues and the environment.
Staff were asked to complete an anonymous ‘Hygiene Self-assessment Questionnaire’ which covered ten areas, including; disinfecting hands; wearing gloves, scrubs with short sleeves and dedicated work shoes, and changing into uniforms when arriving at work.
Amongst clinical staff, there was a 66.75% compliance.
The team then discussed the results, consulted a lab microbiologist and formulated an improvement plan, which included updating the practice cleaning processes (including the cleaning of new touch points), introducing new colleague uniform rules (including changing into uniform upon arrival at work), improving hand hygiene (including providing hand gels for all colleagues) and using sanitising wipes in all office areas.
One month after the policy revisions, swab tests were repeated. They found no bacterial growth in any of the 10 previously swabbed areas.
After two months the colleague questionnaire was run again.
It found clinical colleague compliance over eight personal hygiene indicators had jumped from 66.75% to 92.5% compliance.Abi Redfearn, Senior Veterinary Nurse at Rosemullion, said: “When we opened in 2021, we were keen to monitor our infection control - as part of providing a hospital level of care under the RCVS Practice Standards Scheme.
"With around 100 colleagues and hundreds of patients passing through our doors every week, we are an extremely busy practice – so infection control is paramount in maintaining high clinical standards.“By updating our protocols and taking simple steps - such as providing sanitising materials in high-touch areas – we’ve significantly decreased the risk of environmental contamination.
"Our project is now being used as an example to encourage other practices.”