Does your surgical protocol need a little CPR?
Check It Twice
Patients Are Individuals
You know that song about a big man in a red suit that comes to town once a year?? Well, even someone as experienced as Santa makes a list and checks it twice. Countless industries use checklists to ensure every step from A to Z get done each and every time, and veterinary medicine should be no different. If you haven’t heard of Atul Gawande, please google him!
In his New York Times Best Seller, The Checklist Manifesto, Dr. Gawande details the evolution of expertise in varying fields and that even the most expert among us can miss steps; “We miss stuff. We are inconsistent and unreliable because of the complexity of care.” The research undertaken for The Checklist Manifesto showed staggering success when two minute safe surgery checklists were instituted in hospitals around the world. Its success was not only in making sure that no step was missed but also in making a group of people think ahead and come together as a team for the betterment of the patient in their care.
As a team, make a list of all the steps from intake to discharge associated with anesthetizing patients. All steps are important to list, even if they seem trivial. It is usually the “little things” that are overlooked, but when dealing with the life of another being, even the most seemingly insignificant of steps can have the greatest effect on outcome. Then break this list down into responsibilities for each team member, giving everyone a smaller list for which they are accountable.
Patients Are Individuals
No matter the age or health status of the patient, they are still going under anesthetic. It is easy to become complacent, but important to remember that each patient is an individual and that they require customized protocols and monitoring. Anesthesia is not one size fits all and it is helpful to have a range of medications available for use in order to tailor your approach for each patient’s sedation and induction.
As well as anesthetics being individualized, choice of analgesics should be as well. Remember that different procedures come with different levels of pain and it is crucial to anticipate and plan ahead when choosing appropriate modalities for pain control whether they be a regional block, CRI, epidural, injectable opioids, or even better – a combination of the aforementioned, providing a multimodal approach!
Advocating for a patients care should be your first priority. Before each anesthetic procedure the surgery team should come together to discuss each patient's history, drug protocol, specifics of the surgical procedure, possible complications, anticipated physiological changes, and plan for recovery.
Anesthesia and surgery, while commonplace for us, are often clouded in fog and mystery to many clients. They’ve heard all kinds of stories about their neighbours best-friends sisters dog that went under anesthetic to have a tooth pulled and never woke up. It is our job to put their mind at ease by explaining the procedure to be performed, detailing the precautions that will be taken and the monitoring that will occur to ensure that their pets' surgery is as safe and uneventful as possible. Before consenting to surgery, clients should also know what to expect from their pet after the procedure as well as the at-home-care and compliance that will be required.
Along with putting the clients mind at ease by preparing them for the ins and out of the surgical procedure, it is equally important to prepare your patient for a visit that will be as stress free as possible. This should be a team discussion and based on the demeanor and anxiety level of the patient, you may choose to:
- Send the client home with oral medications to be given to the patient the morning of the procedure to help reduce anxiety associated with coming to the hospital.
- Schedule a very anxious patient to be the first procedure of the day and allow them to stay with their owner while their “pre-med” takes effect.
- Have an owner come back shortly after a surgical procedure is complete so that they can sit with their pet during the recovery process.
- Administer mild sedation after surgery (oral or injectable) to a patient who is stressed being at the hospital. In this case it is also important to pain score the patient as to not confuse discomfort with anxiety, and then treat appropriately.
Pain and stress can negatively affect a patient's recovery after surgery. Those with well controlled pain and reduced anxiety will have vastly improved recoveries, as well as a higher chance of eating, and ambulating, allowing for earlier discharges to get them back in the comfort of their home.
About the Author
Alie Volpatti is an RVT & the Technical Team Lead at Caledon Mountain Veterinary Hospital in Caledon Village, ON. She graduated from Seneca College in 2011 and has been working in small animal medicine and orthopedics ever since. Alie is currently working towards her IVAPM certification to become a Certified Veterinary Pain Practitioner as well as Fear Free Certified.
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