Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study.

BACKGROUND: Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing. METHODS: A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique. RESULTS: Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events. LIMITATIONS: The qualitative nature of this study limits the generalisability of the findings. CONCLUSIONS: Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

Sustainability policies and practices at veterinary centres in the UK and Republic of Ireland.

BACKGROUND: Veterinary professionals operate at the human-animal-environment interface and are concerned about sustainability issues. This study examined the extent to which sustainability is represented in policy and enacted in veterinary practice settings, as reported by practice representatives. METHODS: An online survey was completed by 392 veterinary centre representatives in the UK and Republic of Ireland to identify existing policies and practices around the environmental impacts of veterinary services and animal husbandry, responsible medicine use, animal welfare and social wellbeing. RESULTS: A minority of respondents were aware of an environmental policy at their practice (17%, 68/392). Many others were undertaking waste reduction initiatives, but wider environmental interventions were infrequently reported. The majority were aware of medicine stewardship and animal welfare policies or guidelines, but a minority reported social wellbeing policies (40%, 117/289) and the provision of advice to clients on the environmental impacts of animal husbandry (31%, 92/300). LIMITATIONS: The bias arising from the small convenience sample of practice representatives and potential discrepancies between the claims of survey respondents and their practices' policies and activities are acknowledged. CONCLUSION: Results depict a value-action gap between the concern of veterinary professionals towards sustainability and the policies and practices at their workplaces. Building on progress in the sector, wider adoption of comprehensive policies and practices, with guidance, could enhance veterinary contributions to the sustainability agenda, in particular to mitigate the environmental externalities of veterinary services and animal care and ensure safe, fair and inclusive workplaces.

'We're gonna end up scared to do anything': A qualitative exploration of how client complaints are experienced by UK veterinary practitioners.

BACKGROUND: UK veterinary practitioners are reported to be fearful of client complaints, but their experiences have not been formally captured. Understanding how complaints impact veterinary practitioners is key to mitigating detrimental consequences. METHODS: A qualitative exploration of how UK veterinary practitioners experience and respond to adverse events was conducted. Data were collected via focus groups and interviews, which were transcribed and simultaneously analysed. Coding and theme development were inductive rather than restricted by preconceived theories. RESULTS: Twelve focus groups and 15 individual interviews took place. One theme identified focused on the impact of client complaints. Practitioners experienced unintentional distraction and disengagement from clinical work, as well as employing defensive strategies as a direct result of complaints. The vexatious nature of some complainants was highlighted, along with concerns about practice and regulatory complaint management, lack of appropriate support, discriminatory behaviours and the influence of 'trial by media'. CONCLUSIONS: Client complaints present a threat to practitioner mental health and workforce sustainability, as well as having implications for patient safety. Mitigating these effects is a complex and multifaceted undertaking, but fairness, transparency and timeliness of practice and regulatory complaint investigation must be prioritised, along with provision of tailored support for those facing complaints.

Type and impact of clinical incidents identified by a voluntary reporting system covering 130 small animal practices in mainland Europe.

BACKGROUND: Veterinary healthcare can be a complex process and may lead to unwanted, potentially harmful patient safety incidents as a consequence, negatively impacting both the practice team and client satisfaction. The aim of this study was to identify how such incidents impact cats and dogs by analysing reports gathered in a large-scale voluntary incident reporting system. METHODS: Descriptive statistical analysis was used to study a total of 2155 incident reports, submitted by 130 practices on mainland Europe. RESULTS: Incidents caused harm in more than 40% of reports. Medication-related incidents were the most frequent type of incident recorded (40%). Treatment-related incidents were the most common type of incident causing patient harm (55%). Anaesthesia-related incidents were the most severe type of incident, resulting in patient death in 18% of these reports. Most incidents were reported from hospital wards, and a significantly higher proportion of cats were harmed by incidents compared to dogs. CONCLUSION: This study demonstrates that patients are regularly harmed by incidents, with medication-related incidents being most common. In depth understanding of incident data can help develop interventions to reduce the risk of incident recurrence.

Uncovering the 'messy details' of veterinary communication: An analysis of communication problems in cases of alleged professional negligence.

BACKGROUND: Communication failure is reported as a cause of error in veterinary practice and has been associated with complaints and litigation. Evidence describing the types and nature of communication problems is lacking. This limits our ability to mitigate the risk poor communication poses. METHODS: This study used a mixed methods approach to explore the frequency and types of communication problems present in settled cases of alleged veterinary professional negligence. Thematic analysis was conducted on written documents associated with 100 such cases involving canine patients. Interpretation was informed by human factors thinking and communication theory. Results were triangulated with findings from a focus group with the Veterinary Defence Society claims consultants and with healthcare literature on communication failures. RESULTS: Communication problems played a contributory role in 80% of the cases examined. The analysis highlighted features of problematic communication in veterinary practice that are underrepresented in the current literature. These include the prominence of communication problems within veterinary teams, the impact of communication on the safety of care and also the interdependence of communication events with the context, system and environment in which they occur. CONCLUSIONS: These results suggest that communication is a collective competency. Effective communication is something veterinary systems, rather than individuals alone, achieve. There is a need to consider the team and organisational contexts in which communication occurs to ensure individual communication skills can be translated into communication practices that support the delivery of high-quality, safe veterinary care for the benefits of clinicians, owners and patients.

Turning the wrongs into rights.

Mistakes in practice can really have a negative impact on wellbeing. An error can prey on the mind, turning supposed relaxation time into rumination time. Here, Catherine Oxtoby offers a method of dealing with errors in a more productive and healthier way.

Getting it right on mistakes.

Mistakes are an inevitable part of both life and veterinary practice. But Catherine Oxtoby says there are ways to reduce the risk both of an error occurring and of it impacting on your wellbeing.

Blame and shame in the veterinary profession: barriers and facilitators to reporting significant events.

Significant event reporting is an important concept for patient safety in human medicine, but substantial barriers to the discussion and reporting of adverse events have been identified. This study explored the factors that influence the discussion and reporting of significant events among veterinary surgeons and nurses. Purposive sampling was used to generate participants for six focus groups consisting of a range of veterinary professionals of different ages and roles (mean N per group=9). Thematic analysis of the discussions identified three main themes: the effect of culture, the influence of organisational systems and the emotional effect of error. Fear, lack of time or understanding and organisational concerns were identified as barriers, while the effect of feedback, opportunity for learning and structure of a reporting system facilitated error reporting. Professional attitudes and culture emerged as both a positive and negative influence on the discussion of error. The results were triangulated against the findings in the medical literature and highlight common themes in clinician's concerns regarding the discussion of professional error. The results of this study have been used to inform the development of the 'VetSafe' tool, a web-based central error reporting system.