College Connection Winter 2018 - Page 6

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 complaints case and is offered as a self-reflection tool to improve practice across the province. STANDARD ON PRESCRIBING OUTLINES LABEL NECESSITIES CASE SUMMARY The allegations suggested the member provided Acepromazine Maleate to clients knowing the drug was being administered to pigs that were raised and sold to local butcher shops. Thereby, the meat being sold to the general public could be contaminated. It is further alleged the drug was not prescribed for a specific animal and the client used the drug at their discretion. As well, there was no dosage for the drug on the label and the member did not have paperwork for dispensing the drug. The complaint was submitted by a third party who claimed to have received Acepromazine from the member’s client. CASE OUTCOMES The panel decided the nature of the allegations involving the member did not warrant a discipline hearing. The panel advised the member of concerns with regard to the maintenance of medical records. The panel advised the member to ensure records are comprehensive and include details about treatment provided and medication prescribed and dispensed. Advice is meant to be educative and serves as a remedial tool to assist licensed members in correcting areas of practice identified as problematic. Such advice provides education about standards and expectations and/ or changes necessary in the veterinarian’s practice so similar concerns do not arise in the future. CASE CONSIDERATIONS In consideration of this complaint, a panel reviewed the material provided. As is standard practice for investigations, the panel considered previous proceedings against the member. The member indicated he provides veterinary 6 / College Connection care to the client’s horses and donkeys. The member’s associate vaccinated the horses and sedated two donkeys for the blacksmith. The member later delivered two bottles of Acepromazine for the donkeys to assist with ongoing hoof care, but said he didn’t know the client was using the drug for pigs. The member acknowledged the mistake in not writing the donkeys’ names on the drugs. The dosage was written on the drug label and it was specified the drug was for the purpose of shoeing. The panel noted Acepromazine is a prescription tranquilizer used in many aspects of veterinary medicine, including companion animals, equine and food producing situations. Its use includes sedation, treatment of toxicities and general anesthesia. Acepromazine is licensed for use in swine as an injectable medication and has a seven day withholding period before slaughter. The panel was not able to conclude that meat contaminated with Acepromazine was being sold to the public. The panel acknowledged the challenges of practising in rural Ontario where access to veterinary care is limited. It is acceptable veterinary practice to prescribe a quantity of sedative medication such as Acepromazine to be used at the discretion of the animal owner. This is a common practice in both companion animal medicine and equine medicine. With respect to the concern the medication was not prescribed for a specific animal, the panel determined that while the actual medication bottle was not labelled for the donkeys, this information was recorded in the medical records. As well, the bottle included dosage instructions for equine shoeing. From the information provided to the panel, the Acepromazine was appropriately prescribed for the donkeys. The panel had concerns about how the medication was dispensed. The panel noted that according to Ontario Regulation 1093 Part 111 Drugs and in particular section 27, subsection (3), the drug label must include specific information such as the date the drug is dispensed and the identity of the animal or group of animals for which it is dispensed. All members must comply with this Regulation. The panel directs the member to review the standard on Prescribing a Drug, published in August 2018. When reviewing a complaint matter, the panel relies on information contained in the medical record to substantiate the veterinary care provided. The medical records in this case did not meet the requirements of the College’s standard on Medical Records. Members are expected to maintain clinical records in a manner that adheres to the standard and is reflective of providing care in the best interest of patients. The panel encouraged the member to participate in the College’s online module related to preparation of medical records for assistance regarding this important aspect of professional practice. The panel’s advice is educative and will remain on the member’s record with the College should another complaint arise in the future. For further learning opportunities on the concerns raised in this case: Veterinary Obligations Related to Drugs: Professional Practice Standard Prescribing a Drug Medical Records Professional Practice Standard Medical Records Webinar Series - Foundations for Medical Record Keeping (companion animals) Medical Records Self-Assessment Tool