A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units.

OBJECTIVE: To investigate associations among care errors, staffing, and workload in small animal ICUs. DESIGN: Multicenter observational cohort study conducted between January 2017 and September 2018. SETTING: Three small animal teaching hospital ICUs. ANIMALS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1-18). Median patient illness severity was 15.1 (4.7-27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02-1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84-3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002-1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30-2.25; P < 0.001) for APPLEfast :technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97-0.99; P = 0.01) for each year increase in total technician years of ICU work experience. CONCLUSIONS: Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.

What drives antimicrobial prescribing for companion animals? A mixed-methods study of UK veterinary clinics.

Antimicrobial use in companion animals is a largely overlooked contributor to the complex problem of antimicrobial resistance. Humans and companion animals share living spaces and some classes of antimicrobials, including those categorised as Highest Priority Critically Important Antimicrobials (HPCIAs). Veterinary guidelines recommend that these agents are not used as routine first line treatment and their frequent deployment could offer a surrogate measure of 'inappropriate' antimicrobial use. Anthropological methods provide a complementary means to understand how medicines use makes sense 'on-the-ground' and situated in the broader social context. This mixed-methods study sought to investigate antimicrobial use in companion animals whilst considering the organisational context in which increasing numbers of veterinarians work. Its aims were to i) to epidemiologically analyse the variation in the percentage of antimicrobial events comprising of HPCIAs in companion animal dogs attending UK clinics belonging to large veterinary groups and, ii) to analyse how the organisational structure of companion animal practice influences antimicrobial use, based on insight gained from anthropological fieldwork. A VetCompassTM dataset composed of 468,665 antimicrobial dispensing events in 240,998 dogs from June 2012 to June 2014 was analysed. A hierarchical model for HPCIA usage was built using a backwards elimination approach with clinic and dog identity numbers included as random effects, whilst veterinary group, age quartile, breed and clinic region were included as fixed effects. The largest odds ratio of an antimicrobial event comprising of a HPCIA by veterinary group was 7.34 (95% confidence interval 5.14 - 10.49), compared to the lowest group (p < 0.001). Intraclass correlation was more strongly clustered at dog (0.710, 95% confidence interval 0.701 - 0.719) than clinic level (0.089, 95% confidence interval 0.076 -0.104). This suggests that veterinarians working in the same clinic do not automatically share ways of working with antimicrobials. Fieldwork revealed how the structure of the companion animal veterinary sector was more fluid than that depicted in the statistical model, and identified opportunities and challenges regarding altering antimicrobial use. These findings were organised into the following themes: "Highest priority what?"; "He's just not himself"; "Oh no - here comes the antibiotics police"; "We're like ships that pass in the night"; and "There's not enough hours in the day". This rigorous mixed-methods study demonstrates the importance of working across disciplinary silos when tackling the complex problem of antimicrobial resistance. The findings can help inform the design of sustainable stewardship schemes for the companion animal veterinary sector.

2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats.

Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client communication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and "tip" boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia.

2019 AAHA Canine Life Stage Guidelines.

The guidelines are an update and extension of the AAHA Canine Life Stage Guidelines published in 2012. A noteworthy change from the earlier guidelines is the division of the dog's lifespan into five stages (puppy, young adult, mature adult, senior, and end of life) instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their dog's maturation and aging process and provides a readily understood basis for an evolving, lifelong healthcare strategy. The guidelines provide the following recommendations for managing 10 health-related factors at each of the first four canine life stages: lifestyle effect on the patient's safety, zoonotic and human safety risk, behavior, nutrition, parasite control, vaccination, dental health, reproduction, breed-specific conditions, and a baseline diagnostic profile.

Making space for escape.

Getting away from the daily grind is central to wellbeing, but is it possible to find a place to which to escape during the working day? At Willows Veterinary Centre and Referral Service, there has been a conscious effort to ensure the answer to that question is yes. Claire Read reports.

Sociodemographic factors which predict low private rabies vaccination coverage in dogs in Blantyre, Malawi.

Although rabies kills approximately 60,000 people globally every year, vaccination of over 70 per cent of the canine population has been shown to eliminate the disease in both dogs and human beings. In some rabies endemic countries, owners are able to vaccinate their dogs through private veterinary clinics. However, uptake of dog vaccinations through private veterinary clinics is often low in many rabies endemic countries. In this study, the authors examined the sociodemographic factors which predicted low private rabies vaccination coverage in Blantyre, Malawi. Data on 23,205 dogs were recorded during a door-to-door rabies vaccination programme in 2016. A multivariable logistic regression model was built to identify factors associated with private rabies vaccination. Negative predictors of private vaccination included increasing poverty levels, higher housing densities, male dogs, pregnant or lactating dogs, and puppies and dogs allowed to roam. In contrast, neutered and healthy dogs had greater odds of being privately vaccinated. The present study demonstrated that low private rabies vaccination coverage can be accurately predicted by sociodemographic factors. This information may help inform public health interventions which deliver mass vaccination programmes in rabies endemic countries.

State-of-the-art camel care.

An international team of vets is providing expert care in the world's first dedicated camel hospital, explains Daniel Gillett.

Evaluation of a welfare assessment tool to examine practices for preventing, recognizing, and managing pain at companion-animal veterinary clinics.

Successful prevention, recognition, and treatment of pain are integral to ensuring veterinary patient welfare. A canine and feline welfare assessment tool, incorporating verbal interviews with veterinarians using open-ended questions, was developed to assess pain management practices that safeguard and improve patient welfare. The tool was evaluated in 30 companion- and mixed-animal veterinary clinics in Ontario in order to assess its reliability, feasibility, and validity, while also benchmarking current practices. Responses were analyzed according to a scoring scheme developed based on published literature and expert opinion. Based on weighted kappa statistics, interview scoring had substantial inter-observer (Kw = 0.83, 0.73) and near-perfect intra-observer (Kw = 0.92) agreement, which suggests that the tool reliably collects information about pain management practices. Interviews were completed at all recruited clinics, which indicates high feasibility for the methods. Validity could not be assessed, as participants were reluctant to share information about analgesic administration from their clinical records. Descriptive results indicated areas for which many veterinarians are acting in accordance with best practices for pain management, such as pre-emptive and post-surgical analgesia for ovariohysterectomy patients, and post-surgical care instructions. Areas that offer opportunity for enhancement were also highlighted, e.g., training veterinary staff to recognize signs of pain and duration of analgesia in ovariohysterectomy patients after discharge. Overall, based on this limited sample, most veterinarians appear to be effectively managing their patients' pain, although areas with opportunity for enhancement were also identified. Further research is needed to assess trends in a broader sample of participants.

Être en mesure de prévenir, reconnaitre, et traiter la douleur avec succès est essentiel pour assurer le bien-être des patients vétérinaires. Un outil d'évaluation du bien-être des chiens et des chats, incorporant une entrevue orale avec des vétérinaires avec des questions ouvertes, a été développé pour évaluer les pratiques de gestion de la douleur qui sauvegarde et améliore le bien-être des patients. L'outil a été évalué dans 30 cliniques vétérinaires pour animaux de compagnie et cliniques mixtes en Ontario afin de vérifier la fiabilité, la faisabilité, et la validité, tout en réalisant un étalonnage des pratiques actuelles. Les réponses ont été analysées selon un schéma de pointage basé sur la littérature publiée et l'opinion d'expert. Sur la base des statistiques kappa pondérées, les pointages des entrevues avaient un accord inter-observateur marqué (Kw = 0,83, 0,73) et un accord intra-observateur presque parfait (Kw = 0,92), ce qui suggère que l'outil a permis d'obtenir des informations fiables sur les pratiques de gestion de la douleur. Les entrevues ont été complétées dans toutes les cliniques recrutées, ce qui indiquait une excellente faisabilité pour les méthodes utilisées. La validité n'a pu être vérifiée car les participants étaient réfractaires à partager de l'information sur l'administration d'analgésique à partir de leurs dossiers médicaux. Les résultats indiquent que plusieurs vétérinaires agissent en concordance avec les bonnes pratiques de gestion de la douleur pour l'analgésie préventive et post-chirurgicale des patients subissant une ovariohystérectomie et les instructions pour les soins post-chirurgie. D'autres domaines ont été identifiés comme nécessitant des améliorations, e.g. former le personnel de la clinique à reconnaitre les signes de douleurs et la durée de l'analgésie chez les patients ayant eu une ovariohystérectomie après leur congé. De manière générale, sur la base de cet échantillonnage limité, la plupart des vétérinaires semble gérer la douleur de leurs patients de manière efficace, bien que des améliorations à faire aient été identifiées. De la recherche supplémentaire est requise pour évaluer les tendances dans un échantillonnage plus grand de participants.(Traduit par Docteur Serge Messier).

Making a dream come true.

Rachel Wright qualified as a veterinary nurse in England and volunteered extensively in developing countries before setting up an animal hospital in Rajasthan in India.

Management of Feedyard Hospitals.

There are many considerations when managing feedyard hospitals. The type of hospital system must fit the facility design, the type of cattle fed at the feedyard, the crew that is employed by the feedyard, and the protocol established by the veterinarian. Ensuring the animals are well-cared for and have their basic needs met should be the priority of the feedyard personnel and the veterinarian maintaining the veterinarian-client-patient relationship with the feedyard.

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Location-allocation and accessibility models for improving the spatial planning of public health services.

This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA) model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.