college connection
college connection
LEARNING IN PRACTICE
QUALITY PRACTICE NEWS
CASE SUMMARY
The member examined a male, neutered dog
that was not eating well and was lethargic.
The member suggested the dog had gotten
into something. No diagnostic tests were
performed and no treatment was initiated.
CASE CONSIDERATIONS
The Complaints Committee panel (panel)
decided the allegations did not warrant
a discipline hearing. The member was
presented with a Mutual Acknowledgment
and Undertaking to address the concerns
regarding the management of the dog’s
condition, the use of Apo-Meloxicam, as well
as concerns with the medical records.
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College Connection
The panel was concerned the member
failed to look deeper into the dog’s illness
despite the client’s request. While the panel
agreed some cases of Lyme disease can
start as vague malaise, the dog continued
to deteriorate despite treatment, and there
was no indication of declined services by
the client. The panel had the impression
the clients respected the member’s
recommendations and had confidence the
member was doing all that was required.
The panel further noted a lack of
completeness in the medical records. The
panel was unable to evaluate the member’s
consideration or communication of options,
rule outs, assessments and plans due to
the lack of comprehensive recording in the
medical records.
The panel was also concerned the member
dispensed Apo-Meloxicam knowing the dog
was not eating or drinking, was vomiting
The panel also considered that the failure to
offer a second opinion is not necessarily an
omission; however it might have been a valid
consideration in a clinic with more than one
veterinarian to discuss a refractory case.
Further, the panel noted it was unfortunate
that clinic staff failed to accommodate an
earlier appointment when the dog’s condition
was critical. This would not have changed the
outcome; however, it is important veterinary
staff not expect owners to indicate when a
patient is “critical”. Because the dog had
been in poor condition for so long, it would
have been difficult for the clients to evaluate
deterioration.
As part of the undertaking, the member
• prepared a written study addressing “Lyme
Disease in Dogs,”
• prepared a written study addressing “The
Use of Non-Steroidal Inflammatory Drugs
in Dogs with Hematologic Abnormalities
and/or Gastrointestinal Abnormalities,”
• undertook a medical records workshop
provided by a peer reviewer,
• provided copies of medical records to the
College for review by a peer reviewer, and
• paid all costs associated with the
undertaking.
The information required for these two logs
need not be separate and can be combined
into a single log. Logs can also be maintained
electronically. The details of the requirements
for the Anesthesia and Surgery logs are at
www.cvo.org/Sample-Inspection-Forms.
• Get the Facility Accreditation Emblem at
http://www.cvo.org/getemblem.
• Read and agree to the Guidelines for Use.
• Download the Emblem package.
• Upload the Emblem to your website’s
server.
The College recommends that directors
of facilities, particularly for those facilities
undergoing inspection, familiarize themselves
with the requirements for their facility type(s)
as set out in the MSVFO. Sample inspection
forms for specific facility categories are also
available at www.cvo.org/Sample-InspectionForms.
• Link the Emblem to http://www.cvo.org/
facilityaccreditation.
LE
GE
OF VET
ER
ACCREDITED
FACILITY
OF
O N TA R I
I ANS
The client made another appointment for
the dog for two days later when the dog
had passed a black stool and continued to
pant. The client called that day to request an
earlier appointment. Unfortunately the dog
died before the appointment. A post mortem
examination performed at a laboratory
diagnosed a rare form of leukemia.
The client indicated the dog had been on
a tick protection program but there was no
mention of a discussion.
In consideration of other concerns raised
by the client, the panel examined the
radiographs and did not suspect they were
not the dog’s radiographs due to the size
and findings. The panel hoped the lack of
identification on the radiograph, which is
require d to identify the patient, the clinic, the
date and the view, was an isolated error.
AR
Four days later, the dog was again taken
to the clinic and radiographs were taken
indicating his intestines were full but the
member indicated there was no need to
change the treatment plan.
The complete blood count appeared to have
been performed twice on the same sample;
however there was no record of interpretation
or concern for the leukocytosis (high white
blood cell count) or severe thrombocytopenia
(lack of platelets) on the printed report, or a
notation that a blood smear was performed to
validate the findings.
and there was evidence of anemia and
thrombocytopenia.
Promote your commitment to quality
veterinary care and service by letting
everyone know your veterinary facility meets
provincial standards and supports safe,
quality animal care.
IN
A couple days later, the dog returned to
the clinic. The dog was in pain, had trouble
walking, was not eating well and was
vomiting. After performing blood work, the
member dispensed Apo-Meloxicam and
an antibiotic for suspected Lyme disease.
The dog returned to the clinic a third time
a couple days later as he was not eating
any better, and was not drinking much. The
member dispensed Advantage Multi and
signed the dog up for a “Wellness” plan.
The panel was concerned the client did not
appear to have understood the member’s
suspicion of Lyme disease. While the member
indicated Lyme disease was explained to the
clients, there was no record of discussion
offering additional diagnostic testing such as
a quantitative C6 test or urinalysis to assess
for proteinuria.
The Minimum Standards for Veterinary
Facilities in Ontario (MSVFO) now require
veterinarians keep both anesthetic monitoring
charts as well as the anesthetic/surgery log.
This requirement has been in place since
2012.
Facility
Accreditation
Emblem
L
dog’s deteriorating condition required deeper look
Standards require both anesthetic
monitoring charts and logs
THE CO
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.
O
Learnings from a colleague ...
social media 101: Communication Skills for Veterinarians
Social Media groups are an expanding
platform for communications amongst the pet
loving populations. While veterinarians can
benefit from an online presence within the
greater community and beyond, it is important
to bear in mind the breaches that may surface
in the process. The first is providing advice
without an appropriate Veterinarian-ClientPatient Relationship (VCPR), and the second
is the way in which our valued opinions
as professionals can be misunderstood,
misinterpreted or taken right out of context
leading to the downfall of the profession as a
whole.
The field of veterinary medicine is one of
variable studies, opinions and practice,
however, the agreed priority is patient health.
When expressing personal opinions and
practice, one must do so without haste and
without dismissing those of our colleagues.
It is important that we are reminded of our
value within the community, and ensure we are
maintaining a professional alliance with our
colleagues.
In speaking of professional alliances with
respect to a declining economy and a large
population of unaltered animals, pet numbers
in local rescues and shelters is likely on the
rise. While it would be one veterinarian’s
dream to assist them all, the reality is the stray
populations will require the concomitant help
of a number of community veterinarians.
However, offering free veterinary services
to a local rescue group can result in two
significant breaches, the first being a form of
solicitation (of rescue groups with pre-existing
relationships with veterinarians and members
of the community following our initiatives), the
second being an assumption that the services
provided (eg. spay/neuter) would be done
without an appropriate VCPR.
When communicating through social media,
include a disclaimer to visit your local or
regular veterinarian to allow for a thorough
physical examination, discussion and short
and long term plans to be put in place to
ensure the patient issues are addressed and
followed. Ensure your intention to help is not
misunderstood as an intention to solicit for
patients, and that an appropriate VCPR is
important for effective patient care. Finally,
veterinary professionals should be cautious to
maintain the integrity of the profession in an
online presence.
Winter 2016 / 7