Eye on EBVM: it takes a team to make change happen

I joined Beech House Veterinary Centre in Southampton a little more than a year ago in June 2021. I was excited about my new role and keen to bring in my passion for Quality Improvement – especially with regards to improving patient safety.

Beech House is a busy centre with a team of six vets, four RVNs, three SVNs, one animal care assistant, and a reception team of five. I was very enthusiastic to make an impact and bring about changes quickly.

As soon as I started, I set out to understand the team’s roles and responsibilities, but also to get to know everyone in a more personal way. I spent time with everyone and I am very thankful that all in the team shared their perspective of what we could improve.

Truth be said, the practice had been struggling with regards to workplace culture. Vets and nurses worked very separately, and communication was poor. The pandemic and staffing issues had only made things worse.

Once I settled in, I began looking into the clinical aspects of our work, with the hope this would also help to improve the culture.

Aims of the audit

The team noticed an increase had occurred in the number of dogs that were coming back after routine neutering with vomiting and/or diarrhoea. We set out to complete an audit so we could compare our outcomes to the national benchmark – available via the RCVS Knowledge National Audit for Small Animal Neutering – and to work towards ongoing improvements in our level of care. We set aside time each week to log all the data for every routine neutering procedure.

While there were other areas that I wanted to improve, I had learned previously that if I tried to make too many changes, and do too much at once, this would disengage the team. I decided to focus on postoperative complications as this could be addressed quickly, and I hoped the results of our efforts would prove that it is worth spending time on Quality Improvement – by keeping this first step simple, I hoped that the team would be engaged to keep addressing other areas of our work.

Actions

Our initial audit showed our postoperative complication rates were much higher than the national averages. Most postoperative complications for that month were gastrointestinal (GI) problems: vomiting, diarrhoea, or both.

When designing interventions, we researched many relevant peer-reviewed clinical studies and presented a concise version at practice meetings to discuss what changes were needed.

The existing anaesthetic forms were quite basic, which meant we were missing out on recording important findings during the peri-operative period. As a team, we decided to use the Association of Veterinary Anaesthesia anaesthetic forms. We also ensured that the IVC postoperative assessment chart was visible in the consultation rooms to remind people to add the correct codes to the animals’ record.

We updated our protocols as follows:

• We ensured all team members gave consistent advice on starving patients before surgery – from midnight rather than from 9pm.
• We considered the types of foods that are common allergens and stopped giving this to dogs in recovery, instead providing a commercial GI diet. For dogs with a sensitive stomach, we encouraged owners to bring in their normal food.
• We encouraged the use of the new multiparameter machine for all procedures – especially for blood pressure (BP) monitoring and a new protocol was introduced to state that NSAIDs should only be given when the patients’ BP had returned to normal. This was to reduce the risk of vomiting or diarrhoea occurring due to the administration of NSAIDs, alongside low GI perfusion caused by low BP.

Results

The changes we made have led to improved patient safety and welfare, have helped us provide a better service to our clients, and have helped us create a much more positive workplace culture.

The data has shown our postoperative complications have reduced.

Our overall postoperative complication rate dropped from 28% in June, to 24% in July-August and to 9.68% by the end of September.

In June, we had an issue with 16% of patients having postoperative GI problems. After changing our protocols, this dropped to 8% in July and August, 0% in September, and 4% in October.

Personally, I learned so much from this process. When I started my role, I was so enthusiastic to bring about change quickly, but I was mindful to try not to do too much at once. I learned it was essential to engage the whole team in identifying the changes needed and implementing them to make a lasting difference.

A happy and engaged team provides better patient and client care. It’s been fantastic to see everyone get involved, adopt the changes and feed into the process to continuously improve. Without everyone’s combined efforts, we would not have achieved the results we have seen.

I’m pleased to say we’re carrying out further audits, focusing on specific areas of care to make continuous improvements in the way we work.