For the period 2008 to 2017 the Board investigated 439 complaints against veterinarians in NSW and 294 of these complaints were dismissed (67%).  The number of new complaints each year ranged from 31 in 2008 to 72 in 2017 reflecting an increasing trend in the number of complaints received by the Board each year.  Further complaint statistics are available from Statistics page of the Board's website.

Approximately 17 of the 439 complaints investigated by the Board during this period involved an adverse event in relation to anaesthesia (4%).

Complaints are assessed for evidence of a possible breach of the legislation and more specifically of the Veterinary practitioners code of professional conduct (Code) (Veterinary Practice Regulation 2013 (sch 2)).

A brief analysis of these complaints and alignment of areas of concern with specific clauses of the Code has identified a number of principles that may assist veterinarians in avoiding anaesthesia related complaints with the Board.  These risks need to be addressed prior to, during, and after anaesthesia.

 

Prior to anaesthesia

1. Gather history and perform a physical examination in accordance with current standards

2. Obtain informed consent from the person responsible for the care of the animal where practicable and this must include a discussion of likely extent and outcome of services together with an estimate of costs and referral options where appropriate

3. Ensure client contact details are correct

4. Create a detailed record as soon as practicable and in sufficient detail to enable another veterinarian to continue treatment

 

During anaesthesia

1. The anaesthetic protocol must be in accordance with current standards and address risks as determined by findings from history, physical examination and other diagnostic tests

2. Ensure appropriate monitoring of anaesthesia including skills, knowledge and experience of staff and use of appropriate and required equipment

3. Contact the client when practicable if further consent is required

4. Create a detailed record as soon as practicable and in sufficient detail to enable another veterinarian to continue treatment

4. Develop and employ adverse event protocols

 

Post anaesthesia

1. Post anaesthetic protocol in accordance with current standards and addressing additional complications or risks arising from previous findings and the procedure

2. Appropriate monitoring during recovery period

3. Contact the client when practicable if further consent is required

4. Create a detailed record as soon as practicable and in sufficient detail to enable another veterinarian to continue treatment

5. Develop and employ adverse event protocols

6. Ensure availability as appropriate for the ongoing care of the animal

 

Summary of specific actions for risk mitigation

1. Thorough history and physical examination and address associated risks

a. Breeds and breed types such as brachycephalic dogs

b. Aggressive animals

c. Concurrent medication, differential diagnoses and definitive diagnoses

d. Accurate weight

e. Feeding history

2. Pre-anaesthetic blood testing performed as indicated, results discussed with the client and used to inform the anaesthetic protocol as required.

3. Obtain informed consent when practicable from the client and ensure the client is aware of likely extent and outcome of services and is provided with an estimate of costs (including additional procedures)

Consider offering referral for cases requiring additional knowledge, skills or resources in relation to all aspects of case management including anaesthesia

4. Ensure records are made as soon as practicable and are in sufficient detail for another veterinarian to continue the treatment of the animal

a. Record the use of drugs of addiction in a separate register as required

5. Provide pain management in accordance with current standards

6. Ensure drugs and any combination of drugs are used in accordance with current standards and not contraindicated in relation to either other drugs used or differential diagnoses

7. Ensure appropriate monitoring of anaesthesia (current standards are that the minimum requirement is to have a pulse oximeter)

8. Ensure any thermal support provided is in accordance with current standards

9. Ensure staff are familiar with protocols for adverse events

10. Ensure you are available for the ongoing care of the animal or that you make arrangements for another veterinarian to take over the care of the animal

 

Summary of recent issues investigated by the Board

1. Protocol not compatible with differential diagnoses (for example megaoesophagus)

2. Protocol not in accordance with current standards (for example the use of an alpha 2 agonist with atropine, incorrect dose rates)

3. Technique not in accordance with current standards (for example development of a tracheal tear)

4. Failure to create a contemporaneous record of dose rates and agents used

5. Addressing and avoiding burns

6. Failure to adequately monitor the animal during recovery and use of an inappropriately sized cage during recovery

7. Failure to address additional anaesthetic risks associated with brachycephalic dogs

8. Failure to diagnose or appropriately treat aspiration pneumonia

9. Failure to address additional anaesthetic risks associated with anaesthesia of aggressive animals

10. Failure to ensure availability for the ongoing care of the animal

 

The Board has received an increasing number of complaints in recent years associated with dental procedures and these cases highlight the need to ensure many of the above risks are addressed.

It has often been said but it is worth repeating that poor client communication (e.g. explaining the risks of anaesthesia or the procedure) and inadequate record keeping (e.g. recording the results of the clinical examination before the anaesthetic) are common factors in many complaint investigations.