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
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