college connection
LEARNING IN PRACTICE
Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to safe , quality veterinary care . When those standards are compromised , the College responds . Every veterinarian can learn from these situations and publishing the details of complaints received and resolved is intended to support that learning . The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province .
MEMBER GIVEN GUIDANCE ON CONSENT , CHANGES TO RECORDS
CASE SUMMARY
The member examined the clients ’ bird , which was referred to the animal hospital by another clinic . Following the appointment , the clients were concerned with the bird ’ s breathing and that blood was coming out of her nose . They returned to the hospital and the member concluded the bird had epistaxis ( a nose bleed ). The member told the client the bird ’ s air sac may have been punctured during the venipuncture performed earlier that day .
CASE OUTCOMES
The panel decided the nature of the allegations did not warrant a discipline hearing and that educational advice for the member would be more appropriate .
The member is advised of the panel ’ s concerns regarding her conduct as it pertains to ensuring that she consistently document the particulars of her physical examination and other assessments in the medical records , as required by Ontario Regulation 1093 . The panel also had concerns with regard to the lack of disclosure when a complication arose with a patient . CASE CONSIDERATIONS
In consideration of this complaint , a panel reviewed the material provided . As is standard practice for all its investigations , the committee also considered all previous proceedings against the member .
In the complaint , the clients alleged the member was negligent when she punctured the bird ’ s breathing sack during several attempts to extract blood causing a potential life threatening situation . The clients also alleged the member did not have the expertise required to perform the blood drawing procedures and should not have attempted to do so .
In consideration of the literature on venipuncture on birds , the panel noted the member used the correct technique to draw
blood and further noted there are always risks of complications . One of the more common complications with venipuncture on birds is a hematoma . In this case , the member said that when the bird moved , the needle went through the jugular vein and punctured her cervicocephalic air sac which is directly below the right jugular . After this happened , the member looked up information on a veterinary information network . While doing research , the bleeding stopped and since the bird appeared stable she was discharged .
Hospital staff could also attest to the fact the bird moved during venipuncture . When the client returned to the hospital , the bird was immediately admitted and treated with subcutaneous fluids , oxygen therapy , a vitamin B injection and a vitamin K injection at no charge . The member also contacted a bird clinic to discuss treatment options . The charges from earlier that day were reversed which included the examination , blood sample collection and avian / reptile CBC , for a total of $ 208.70 .
In review of the information , the panel did have concerns with the member ’ s lack of transparency to the clients . When an unforeseen complication arose , it would be expected that the member would speak with the clients regarding what happened and what potential problems may arise from the complication . It appeared there was a twohour delay before the bird was brought out after what should have been a relatively quick procedure with no explanation as to why the blood draw took two hours .
The panel agreed it was unacceptable to discharge the bird without first going over what transpired and potential further complications . The panel advised the member to improve client communications with complete disclosure of a patient ’ s procedure , outcome and / or current health condition .
The bird ’ s condition at discharge was
questionable as the clients were under the impression that she was sedated due to her appearance . There was no documentation of sedation in the medical record or on the invoice .
On further review of the medical record , it appeared the clients were quoted and charged for an examination but it was not documented on initial presentation or on the bird ’ s recheck examination . The only comments found in the medical record was one reference of the clients observing blood from her nostrils and a conversation explaining the likely complication of venipuncture .
Although the treatments were listed in the medical record , there were no amounts or routes recorded , other than one notation that referred to 1cc SQ . The panel advised the member to review the College ’ s Professional Practice Standards : Medical Records and to make changes immediately .
The College ’ s professional practice standard for medical records requires that a complete medical record must be made for every patient . A quality record is fundamental to quality practice and lack of , interferes with the continuity of care of the patient . The panel did note , the member followed up with the clients to inquire about the bird that same evening and when she was unable to reach them , called back the following morning .
Key Considerations
• Medical Records •
A quality record is fundamental to quality practice . Review the Professional Practice Standard and Guide on Medical Records for details on practice expectations .
www . cvo . org / Resources / Medical- Records-and-Information
6 / College Connection