Errors in practice

RE: Errors in practice

J G Wray — Fri, 13 Nov 2015 15:47:29 GMT

Veterinary Record 2015;177:419 doi:10.1136/vr.103312

Research

Paper

Veterinary team interactions, part one: the practice effect

T. Kinnison, BSc, MSc1,
S. A. May, MA VetMB PhD DVR DEO FRCVS DipECVS FHEA1 and
D. Guile, Post-Graduate Teaching Certificate, MA, BA, PhD2

+ Author Affiliations

¹Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
²Department of Lifelong and Comparative Education, The Institute of Education, 20 Bedford Way, London WC1H 0AL, UK

E-mail for correspondence: tkinnison@rvc.ac.uk

Abstract

Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.

RE: Errors in practice

J G Wray — Fri, 13 Nov 2015 15:46:20 GMT

Veterinary Record 2015;177:436-437 doi:10.1136/vr.h5653

Research

Reducing error and improving patient safety

Mickey Tivers, BVSc, PhD, CertSAS, DipECVS, MRCVS

+ Author Affiliations

School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK e-mail: mickey.tivers@bristol.ac.uk

AS veterinary surgeons, the safety of our patients has always been a priority. However, the formal concept of patient safety has only filtered down from our medical colleagues relatively recently. This concept has developed rapidly in the medical profession over the past 25 years. While error and complications have always been associated with healthcare, specific interest in this area was, perhaps understandably, limited. In 1991 the Harvard medical practice study highlighted the problem of error and adverse events in human healthcare, showing that 3.7 per cent of hospitalised patients suffered harm and that 13.6 per cent of these incidents resulted in death (Brennan and others 1991, Leape and others 1991). Since then there has been increasing focus in the medical profession on reducing complications and improving patient safety. Patient safety has been defined as ‘the reduction of risk or unnecessary harm associated with health care to an acceptable minimum’ (Runciman and others 2009), and this definition has resulted in research on ways to improve patient safety in a variety of disciplines. One notable development is the World Health Organization (WHO) surgical safety checklist, designed to reduce surgical complications (Haynes and others 2009). The use of the checklist has resulted in a significant decrease in …

RE: Errors in practice

J G Wray — Fri, 13 Nov 2015 15:44:17 GMT

We need to talk about error

3 Nov, 15 | by Kristy Ebanks

By Catherine Oxtoby

A paper that has recently appeared in Veterinary Record exploring the causes and types of error in veterinary practice is the first phase of a three year PhD into mistakes in veterinary practice – a hugely neglected area of research in our profession. It wasn’t until I started researching the background to errors and mistakes in other industries that I realised how little attention our profession has shown to a topic which is the driving force of policy and procedures in other sectors.

What we found, was that vets are no different to anyone else. Our brains are wired the same way – we make mistakes for the same reasons, it’s just that when a vet makes a slip during surgery the consequences are serious. It’s all about context, rarely about competence and almost never about a lack of care. Psychological limitations, system failures in the form of poor communication, poor teamwork and badly designed equipment or packaging were major causes of error, not simply a vet having a bad day. It is vital that we understand that mistakes don’t happen because someone was being careless – it’s much more complicated than that, and blaming the clinician does nothing to prevent it happening again. What we need are simple tools to support clinicians, and training in non-technical skills to help reduce mistakes.

Patient safety influences many areas of practice – not just the obvious example of ‘why things go wrong’. Reporting and discussing error, the reactions of our piers and seniors in the aftermath of mistakes and the way we look at our systems to prevent recurrences, all reflect the culture and ethos of a practice, its visons, values and leadership. Actively engaging with the concepts of patient safety drives quality, empowers staff and increases efficiency as well as saving lives and law suits. The final two years of the PhD study will be spent investigating safety culture in veterinary practice – the force which drives attitudes and behaviours. I believe that this is where efforts to improve should be targeted, as it is the culture of the place which determines its willingness to embrace the changes which may be required for interventions such as surgery checklists and reporting systems to really work.

I hope the paper will shine some light on a difficult and sensitive subject in the profession. The vast majority of veterinary surgeons and nurses are dedicated, compassionate people who care deeply about both their patients and their clients, but they are also human beings. We need to recognise the things which impair their performance and build resilience into our personnel and systems to ensure consistent quality of care, through a better understanding of the true causes of veterinary medical error.

More details can be found here

RE: Errors in practice

J G Wray — Fri, 13 Nov 2015 15:39:09 GMT

Veterinary Record 2015;177:492 doi:10.1136/vr.103327

Research

Paper

Errors in veterinary practice: preliminary lessons for building better veterinary teams

T. Kinnison, BSc, MSc1,
D. Guile, MA, BA, PhD2 and
S. A. May, MA VetMB PhD DVR DEO FRCVS DipECVS FHEA3

+ Author Affiliations

¹The LIVE Centre, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
²Lifelong and Comparative Education, Institute of Education, UCL, London, UK
³Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK

E-mail for correspondence: tkinnison@rvc.ac.uk

Abstract

Case studies in two typical UK veterinary practices were undertaken to explore teamwork, including interprofessional working. Each study involved one week of whole team observation based on practice locations (reception, operating theatre), one week of shadowing six focus individuals (veterinary surgeons, veterinary nurses and administrators) and a final week consisting of semistructured interviews regarding teamwork. Errors emerged as a finding of the study. The definition of errors was inclusive, pertaining to inputs or omitted actions with potential adverse outcomes for patients, clients or the practice. The 40 identified instances could be grouped into clinical errors (dosing/drugs, surgical preparation, lack of follow-up), lost item errors, and most frequently, communication errors (records, procedures, missing face-to-face communication, mistakes within face-to-face communication). The qualitative nature of the study allowed the underlying cause of the errors to be explored. In addition to some individual mistakes, system faults were identified as a major cause of errors. Observed examples and interviews demonstrated several challenges to interprofessional teamworking which may cause errors, including: lack of time, part-time staff leading to frequent handovers, branch differences and individual veterinary surgeon work preferences. Lessons are drawn for building better veterinary teams and implications for Disciplinary Proceedings considered.

RE: Errors in practice

J G Wray — Fri, 13 Nov 2015 11:36:05 GMT

There are four of these papers in Oct/Nov VR

Having worked my way through them and shown them to the nurses, who are now saying "ERROR!" in a Dalek voice, a lot, I came to the conclusion that they make me feel a bit like how some indigenous people must have felt when the topee wearing knock kneed anthropologist turned up from some worthy London Society to observe them and report back to frock coated gents with beards and pince-nez.

See what you think.

RE: Errors in practice

Arlo Guthrie — Fri, 13 Nov 2015 10:22:54 GMT

link??

RE: Errors in practice

J G Wray — Thu, 12 Nov 2015 22:59:04 GMT

Or this

We need to talk about error: causes and types of error in veterinary practice

Errors in practice

RE: Errors in practice

Veterinary team interactions, part one: the practice effect

Abstract

RE: Errors in practice

Reducing error and improving patient safety

RE: Errors in practice

We need to talk about error

We recommend

RE: Errors in practice

Errors in veterinary practice: preliminary lessons for building better veterinary teams

Abstract

RE: Errors in practice

RE: Errors in practice

RE: Errors in practice

We need to talk about error: causes and types of error in veterinary practice