College Connection | Spring 2024
Panel provides advice on pain management , recordkeeping
College Connection | Spring 2024
LEARNING IN PRACTICE
Panel provides advice on pain management , recordkeeping
Case Summary
The veterinarian performed a cryptorchid surgery using a prescrotal approach to the left testicle and a right inguinal incision to remove the retained testicle . Both incisions were closed and a final skin closure was done with tissue glue . The dog was given a Duplocillin and Anafen injection post-operatively . Six days later , the dog had significant swelling at the surgical site . The veterinarian recommended ice packs , and prescribed an anti-inflammatory .
The next day , the dog was taken to an emergency hospital where the examination indicated trace discharge from the abdominal incision with mild crusting and swelling and hard swelling of the scrotum . During the examination , the prescrotal incision opened and produced purulent discharge . The dog was admitted and received IV fluids , pain medication and antibiotics .
The dog developed a necrotic area on the scrotal skin and an opening at the prescrotal incision . Blood work indicated a systemic infection . The dog underwent a scrotal ablation surgery to remove the affected tissue . The dog remained at the hospital for another day and was treated with oral Aventiclav antibiotics and pain management . Culture results revealed Streptococcus canis 4 +.
Case Outcomes
The Complaints Committee panel decided the allegations did not warrant a referral to the Discipline Committee . The panel advised the member on areas of concern including , use of antibiotics , prescription of pain medication postoperatively , addressing post-surgical complications , communication with clients and medical recordkeeping .
Case Considerations
In considering the complaint , the Complaints Committee panel reviewed medical records and written submissions . As is standard for all investigations , the panel considered previous proceedings , if any .
The panel was concerned how the veterinarian managed the post-surgical concerns . Dismissing the client ’ s concerns and attempting to address the situation with ice packs was not appropriate . The dog ’ s swelling was not typical . The client ’ s report that the dog was uncomfortable and in pain , which developed five to seven days post-neuter should have signaled his recovery was not progressing normally . The veterinarian should have suspected and assessed for an infection .
The panel was concerned with the medication choices postoperatively , including the lack of pain management . A mature neuter is a painful surgery for which a multi-day prescription of an anti-inflammatory is indicated , at minimum .
The panel also took issue with the prophylactic use of Duplocillin , a longduration penicillin antibiotic . While it can still be referenced for use in dogs , this is no longer acceptable in small animal medicine .
The panel was also concerned with the medical records . The records did not include the photographs of the incision sites , nor was there any documentation of the conversation about the post-surgical concerns .
It ’ s a veterinarian ’ s responsibility to maintain medical records according to the provisions of the College ’ s Professional Practice Standard , Medical Records . This includes updating the medical records in a timely manner . A delay in documenting an interaction should be explained .
Keeping complete medical records facilitates good patient care , allows a subsequent practitioner to understand the patient ’ s condition and the basis for the current treatment , provides a method of communication with fellow veterinarians and satisfies ethical and regulatory obligations for maintaining appropriate records .
In conclusion , the panel acknowledged the client ’ s concerns and appreciates the opportunity to assist the veterinarian with advice to improve their practice .
Veterinarians have a responsibility to provide safe , quality care . The College assists veterinarians in doing so when matters are reviewed by the Complaints Committee . The public has a right to ask questions about the care that was provided to their animal ( s ) and this process provides veterinarians with feedback on whether they have met the standards of practice or whether there are improvements needed to mitigate risks in practice . The Committee provides advice or may request a veterinarian enter into an undertaking when remediation would reduce risks and support a veterinarian in meeting the standard of practice . Only the most serious cases , where there is bad intent , incompetence , reckless behaviour , or a history of failure to remediate at-risk behaviour are referred to the Discipline Committee for a discipline hearing to determine if an act of professional misconduct or serious neglect may have occurred . This example is taken from a case that was reviewed by the Complaints Committee and is offered as a self-reflection tool to support veterinarians in understanding how to meet the standards of practice .
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