Abnormal healing

If your audit shows a higher rate of abnormal healing, it’s important to review your results, discuss them with your team, and identify areas for improvement. This could involve reviewing protocols, updating training, or exploring new evidence-based practices.

Use the resources below to investigate potential contributing factors and support your Quality Improvement efforts.

Anaesthesia

Find below the available research regarding anaesthesia within practice and published Knowledge Summaries from Veterinary Evidence. Some of these are not directly related to neutering procedures but may be applicable to your processes when neutering animals in practice.

Veterinary Evidence

• Barry, L. (2020) In dogs undergoing anaesthesia do pre-anaesthetic gastroprotectants reduce gastro-oesophageal reflux?. Veterinary Evidence, 5 (4). https://doi.org/10.18849/ve.v5i4.340 (CPD: 30 minutes)
• Fausak, E., and Soules, K. (2017) Does the use of lidocaine in dogs and cats reduce post-operative tracheitis?. Veterinary Evidence, 2 (1). https://doi.org/10.18849/ve.v2i1.61 (CPD: 10 minutes)
• Littlehales, R. (2020) In dogs undergoing elective procedures is medetomidine superior to acepromazine when used as a premedication?. Veterinary Evidence, 5 (4). https://doi.org/10.18849/ve.v5i4.318 (CPD: 60 minutes)
• Naden, K. (2020) Developments in surgical fluid therapy rates in veterinary medicine. Veterinary Evidence, 5 (3). https://doi.org/10.18849/ve.v5i3.299 (CPD: 40 minutes)
• Roberts, C. (2017). Choice of suture pattern for linea alba closure. Veterinary Evidence, 2 (3). https://doi.org/10.18849/ve.v2i3.99 (CPD: 20 minutes)

Journal watch

• Comparison of two topical treatments of gastro-oesophageal regurgitation in dogs during under general anaesthesia [inFOCUS][online]. Available from: https://www.infocusvj.org/comparison-of-two-topical-treatments-of-gastro-oesophageal-regurgitation-in-dogs-during-under-general-anaesthesia/ [accessed 14/4/2022]
• Brachycephalic anaesthesia [inFOCUS][online]. Available from: https://www.infocusvj.org/brachycephalic-anaesthesia/ [accessed 14/4/2022]

Articles

• Adin, C.A. (2011) Complications of ovariohysterectomy and orchiectomy in companion animals. Veterinary Clinics of North America: Small Animal Practice, 41 (5), pp. 1023-1039 (subscription required) https://doi.org/10.1016/j.cvsm.2011.05.004 [RCVS Knowledge Library members, click here] (CPD: 45 minutes)
• Charlesworth, T. (2018) Minimising complications in soft tissue surgery — recent advances. Companion Animal, 23 (5) (subscription required) https://doi.org/10.12968/coan.2018.23.5.282  [RCVS Knowledge Library members, click here] (CPD: 20 minutes)
• Stavisky, J. and Brennan, M. (2020) Midline versus flank approach and wound complications in neutering of cats. [BestBETs for Vets][online] Available from: https://bestbetsforvets.org/bet/558 (CPD: 15 minutes)

Guidelines

• Grubb, T. et al (2020) 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats. Journal of the American Animal Hospital Association. 56 (2), pp. 59-82. https://doi.org/10.5326/jaaha-ms-7055 (CPD: 90 minutes)
• Davis, H. et al (2013) 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats. Journal of the American Animal Hospital Association. 49 (3), pp.149-59. https://doi.org/10.5326/jaaha-ms-5868 (CPD: 45 minutes)

Analgesia

Find below the available research regarding analgesia within practice and published Knowledge Summaries from Veterinary Evidence. Some of these are not directly related to neutering procedures but may be applicable to your processes when neutering animals in practice.

Veterinary Evidence

• Fausak, E. et al (2018) Does the use of intratesticular blocks in dogs undergoing orchiectomies serve as an effective adjunctive analgesic?. Veterinary Evidence, 3 (4). https://doi.org/10.18849/ve.v3i4.206 (CPD: 25 minutes)
• Fausak, E. et al (2018) Does the use of intratesticular blocks in cats undergoing orchiectomies serve as an effective adjunctive analgesic?. Veterinary Evidence, 3 (4). https://doi.org/10.18849/ve.v3i4.160 (CPD: 10 minutes)
• Fletcher, A. (2020) Non-Steroidal Anti-inflammatories: Does carprofen or meloxicam have fewer gastrointestinal side effects?. Veterinary Evidence, 5 (3). https://doi.org/10.18849/ve.v5i3.301 (CPD: 30 minutes)
• Leask, E. (2021) Efficacy of EMLA™ cream for reducing pain associated with venepuncture in felines. Veterinary Evidence, 6 (3). https://doi.org/10.18849/ve.v6i3.456 (CPD: 60 minutes)

Journal watch

• The clinical efficacy of EMLA cream for intravenous catheter placement in client-owned dogs [inFOCUS][online]. Available from: https://www.infocusvj.org/the-clinical-efficacy-of-emla-cream-for-intravenous-catheter-placement-in-client-owned-dogs/ [accessed 14/4/2022].
• Pain scoring systems for cats [inFOCUS][online]. Availiable from: https://www.infocusvj.org/pain-scoring-systems-for-cats/ [accessed 14/4/2022].
• Definitive Glasgow acute pain scale for cats: validation and intervention level [inFOCUS][online]. Available from: https://www.infocusvj.org/definitive-glasgow-acute-pain-scale-for-cats-validation-and-intervention-level/ [accessed 14/4/2022].

Guidelines

• Steagall, P.V. et al (2022) ISFM Consensus Guidelines on the Management of Acute Pain in Cats. Journal of Feline Medicine and Surgery. 24 (1), pp.4-30. https://doi.org/10.1177%2F1098612X211066268 (CPD: 80 minutes)
• WSAVA (2014) Guidelines for the recognition, assessment and treatment of pain [WSAVA] [online]. Available from: https://wsava.org/global-guidelines/global-pain-council-guidelines/ [accessed 14 April 2022]

Post-operative infections

Find below the available research regarding infection control and hygiene within practice and published Knowledge Summaries from Veterinary Evidence. Some of these are not directly related to neutering procedures but may be applicable to your processes when neutering animals in practice.

Veterinary Evidence

• Husband, C., McMillanA., and Sweeney, L. (2020). An assessment of the impact of educational interventions on hand hygiene compliance. Veterinary Evidence, 5 (3). https://doi.org/10.18849/ve.v5i3.320 (CPD: 20 minutes)
• Mann, A. (2016) In small animal surgery are alcoholic hand rubs superior to scrubbing brushes and antimicrobial soap at reducing bacterial counts?. Veterinary Evidence, 1 (4). https://doi.org/10.18849/ve.v1i4.51 (CPD: 10 minutes)
• Mann, A. (2018) When preparing veterinary patients for surgery is the friction (back and forth) method of scrubbing the skin more effective than concentric circles at reducing bacterial levels on the skin?. Veterinary Evidence, 3 (2). https://doi.org/10.18849/ve.v3i2.157 (CPD: 15 minutes)
• Vasanthakumar, M. (2019) Reducing veterinary waste: surgical site infection risk and the ecological impact of woven and disposable drapes. Veterinary Evidence, 4 (3). https://doi.org/10.18849/ve.v4i3.251 (CPD: 23 minutes)

Journal watch

• Hospital-acquired infections in the veterinary establishment [inFOCUS][online]. Available from: https://www.infocusvj.org/hospital-acquired-infections-in-the-veterinary-establishment/ [accessed 14/4/2022].
• Scrubs contamination, domestic laundry effect and workwear habits of clinical staff at a referral hospital [inFOCUS][online]. Available from: https://www.infocusvj.org/scrubs-contamination-domestic-laundry-effect-and-workwear-habits-of-clinical-staff-at-a-referral-hospital/ [accessed 14/4/2022].
• Fluorescent tagging for environmental surface cleaning surveillance in a veterinary hospital [inFOCUS][online]. Available from: https://www.infocusvj.org/fluorescent-tagging-for-environmental-surface-cleaning-surveillance-in-a-veterinary-hospital/ [accessed 14/4/2022].

Journal club

• Staphylococcal bacterial contamination of portable electronic devices in a large veterinary hospital [inFOCUS][online]. Available from: https://www.infocusvj.org/staphylococcal-bacterial-contamination-of-portable-electronic-devices-in-a-large-veterinary-hospital-2/ [accessed 14/4/2022].

Infection control

This webinar series provides guidance on different aspects of infection control. Aimed at veterinary professionals, the series will help you to improve your infection control and biosecurity practices, helping you instigate responsible antimicrobial use. This series is not directly related to neutering procedures, however, may help you adapt processes related to neutering within your practice. 

[add links to the infection control webinar series]

Tools and templates

Use these tools to help you improve processes within practice. Adapt and change the checklists to be more suitable to your individual practices. Some of these are not directly related to neutering procedures but may be applicable to your processes when neutering animals in practice.

• Surgical Safety Checklist Manual: A new resource detailing how surgical safety checklists can be used to improve patient safety within practice. This manual includes examples and testimonials from a variety of practices to help with the development and implementation of your surgical safety checklist [PDF 1529KB] (updated December 2019).
• Surgical Safety Checklist: This surgical safety checklist template has been designed by RCVS Knowledge to help you get started with creating and implementing your own [PDF 56KB] (Updated March 2020).
• Surgical Safety Checklist: This surgical safety checklist template has been designed by RCVS Knowledge in a differing format. Checklists can be designed in any way your team feels they will be most beneficial [PDF 446KB] (Updated March 2020).
• Peripheral Intravenous Catheter Care checklist: You can use this template to help create your own peripheral intravenous catheter care checklist. Feel free to download it and adjust it to your own requirements [Word 144KB] (Updated September 2019).
• Peripheral catheter care and phlebitis score checklist: This peripheral catheter care checklist has been designed in combination with Sarah Hancill RVN and Anne Ward PGCertTLHE DipAVN(Surgical) RVN. It combines a catheter care checklist and the Ward Phlebitis Scoring chart [PDF 662KB] (Updated September 2019).
• Antibiotic usage- self-assessment checklist: This checklist will help you understand your antibiotic usage. Once downloaded, please ‘save as’ and reopen from your saved location. Adapted from the Public Health England and Royal College of General Practitioners: TARGET Antibiotics: Self-assessment checklist [Word 76KB] (Published April 2021).
• Clinical Governance Policy: This document included examples of Quality Improvement principles and tools which can be implemented within your practice to form your clinical governance plan. You should adapt this for your own practice, or local circumstances [Word Doc 174KB] (Published July 2021).

Case examples

These case examples show how practices have implemented checklists and performed audits to improve their patient outcomes. They may give you ideas on how to improve processes, implement new ideas and help inspire your team. Some of these are not directly related to neutering procedures but may be applicable to your processes when neutering animals in practice.

• Warm air blanket and hypothermia audit (CPD: 20 minutes): Dr Jessica Pennock from CVS South Hub was awarded as a Knowledge Champion for her outcome audit on peri-operative hypothermia. The audit was inspired after the practice purchased a warm air circulating blanket for anaesthetic procedures, prompting the team to perform a process audit to ensure that the equipment was being utilised, and an outcome audit to see if the equipment was having a positive effect on patient care and recovery. The results demonstrate what can be achieved with an accessible audit that will have a positive impact on patient welfare [PDF 301KB] (Published June 2021).
• Implementing a peripheral catheter care checklist (CPD: 15 minutes): This case example shows how one practice implemented a peripheral catheter care checklist, and monitored its use and effectiveness through clinical audit [PDF 662KB] (Published September 2019).
• Surgical safety at Animal Health Trust (CPD: 10 minutes): This case example shows how the small animal theatre team at Animal Health Trust have successfully implemented and used a surgical safety checklist to improve patient safety in a number of different theatres and specialities. The theatre team became a Champion Practice in the 2020 Knowledge Awards for their dedication to making the checklist a part of their daily routine [PDF 1293KB] (Published March 2020).
• Auditing post-operative neutering complications (CPD: 20 minutes): This award-winning case example shows how post-operative neutering complications were monitored using the National Audit for Small animal Neutering via vetAUDIT.org. Complications were cut down by half by assessing hygiene and post-operative care guidelines. Louise Northway VNCert(ECC) NCert(Anaesth) RVN became a Knowledge Champion for the second year running due to her work on this continuous quality improvement cycle [PDF 781KB] (Published March 2020).
• Post-operative hypothermia audit (CPD: 10 minutes): This case example shows how Samantha Thompson RVN initiated a clinical audit to identify hypothermia in post-operative patients and used the results to make changes within practice. Samantha was awarded Highly Commended in the 2020 Knowledge Awards for her QI initiative [PDF 547KB] (Published August 2020).
• Analgesia process audit (CPD: 20 minutes): This case example shows the national process audit undertaken after implementing a national pain protocol at PDSA. By identifying which areas had successfully implemented the change, assistance could be provided to those that required further support. This case example was one of the initiatives that made PDSA a 2020 Knowledge Award Champion Practice [PDF 632KB] (Published March 2020).
• Peri-operative temperature audit (CPD: 10 minutes): This case example shows how Holly Warrilow RVN performed several audits over short periods to identify whether patient temperatures were being taken during the peri-operative period and to implement improvements to benefit patient care within the same period. Holly was awarded Highly Commended in the 2020 Knowledge Awards for her QI initiative [PDF 227KB] (Published November 2020).
• Suture material use in feline spays (CPD: 15 minutes): This case example shows how one practice created guidelines for the use of suture material during feline spays [PDF 620KB] (Published July 2019).
• Hygiene and uniform audit (CPD: 15 minutes): This case example shows how the team at The Laurels initiated a clinical audit to monitor hand hygiene and compliance to uniform protocols within practice. Sandra Hunt, practice manager of The Laurels, was awarded Highly Commended in the 2020 Knowledge Awards for this QI initiative [4687KB] (Published September 2020).
• Hygiene audit (CPD: 15 minutes): This case example shows how Vale Vets performed a hygiene audit through self-assessment to maintain a just culture and to identify any at-risk areas and further training required. This case example was one of the initiatives that made Vale Vets a 2020 Knowledge Award Champion Practice [PDF 1134KB] (Published March 2020).
• Hand hygiene audit (CPD: 20 minutes): Vets Now Referrals Glasgow was highly commended for its clinical audit which assessed adherence to WHO handwashing guidelines [PDF 922KB] (Published June 2019).
• Patient trends and complications (CPD: 15 minutes): This award-winning case example shows how Louise Northway completed an audit to look for trends and complications that could be addressed for improvements to patient care. Louise Northway VNCert(ECC) NCert(Anaesth) RVN won an RCVS Knowledge Champion Award in 2019 for her work in this area [PDF 797KB] (Published May 2019).

For further case examples visit the QI Boxset, a free CPD multimedia toolbox, offering bite-sized content designed with the busy team in mind, for on-the-go and at-home learning at the user’s own time and pace.

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