Inclusion, diversity and equality

Quality improvement, checklists and systems of work: why do we need them?

Missing out one small step in a complex procedure can lead to an error. A checklist is a list of actions that can identify the small but crucial steps which may be missed out. Checklists are just one of the tools used to form a culture of continuous quality improvement (QI) in veterinary practice. QI is about understanding the level of care practices provide and implementing interventions to try to improve it. Checklists have been used in aviation and in human healthcare to reduce errors. The use of a surgical safety checklist can be very effective both in human healthcare and in veterinary practice. Checklists can be used in many other areas of practice too. They are a patient safety system, not just a piece of paper, they encourage teamwork, communication and situational awareness and can help to reduce errors.

Introduction to complementary and alternative pain management in canines

Pain management can easily be overlooked in the overall care of canine patients. Often, oral pain medications are the only means of pain control provided to clients. There are several other options for pain managements in canine patients. There are many benefits to adding additional modes of pain relief to the patient's care regimen, whether they have chronic conditions such as arthritis or a neurological disease, or are recovering from a procedure. Pain control therapies such as: therapeutic laser, targeted pulsed electro magnetic field technology, ultrasound, acupuncture, and massage and passive range of motion combined or individually, neuromuscular electrical stimulation and transcutaneous electrical stimulation, can benefit canine patients greatly in their pain management needs. All of these pain therapies provide unique modes of pain relief in the patient's body.

Nutrition in critical care

Veterinary professionals in emergency and critical care see the sickest and most unstable patients, and it is understandable that nutrition is not at the forefront of their minds. This article demonstrates why nutrition is important in the most critical patients, and why studies show it is no longer advisable to delay assisted nutrition. Absence of nutrition in the critical patient leads to muscle catabolism, protein deficiencies and increased risk of sepsis. There are options for enteral or parenteral nutrition, and various feeding tubes that can be used depending on the status of the patient. Both underfeeding and overfeeding can be detrimental to the critical patient; requirements should be calculated for each patient on an individual basis, considering the dietary requirements and risks associated with each presentation and disease process. There are also changes that can be made in the hospital to encourage patients to eat voluntarily; it is important not to forget holistic care in the critical patient.

The veterinary nurse's role in the management of wound drains

Wound management is an exciting and well-researched area of veterinary medicine. It is a key area for veterinary nursing involvement from initial management to possible surgical reconstruction. An essential aspect of this is provision of the ideal wound environment to encourage normal and effective wound healing, and to reduce the incidence of wound breakdown and dehiscence. Throughout this clinical review, consideration will be given to the normal process of wound healing and how this can be assisted by drain placement. The types of drain used in practice, in addition to novel drainage techniques, will be considered throughout, as well as the veterinary nurse's role in their management. Comprehensive and accurate knowledge and understanding of different drain types, in addition to their potential applications, can help to ensure more informed veterinary nursing and, in turn, better wound healing and patient outcomes.

Kirby's Rule of 20: the veterinary nurse's critical patient checklist part 1

Kirby's Rule of 20 is a patient checklist including 20 parameters that should be checked daily in the critically ill patient. It reviews the established evidence-based information regarding patient checklist use in veterinary emergency and critical care medicine. The list of 20 will be discussed over a four-part series to give an appropriate level of information and attention to each patient parameter. Part 1 includes: fluid balance, albumin and oncotic pull, electrolytes and acid–base, mentation, and heart rate/rhythm/contractility.

How to place a FreeStyle Libre in veterinary patients

This article will discuss the recently developed flash glucose monitoring system (FreeStyle Libre, Abbot) and its current use in diabetic veterinary patients. The placement, monitoring and interpretation of the device is presented. Diabetes mellitus is a common endocrinopathy seen in both first opinion and referral veterinary hospitals and these cases require a large amount of nursing care. Therefore, the registered veterinary nurse should have a good understanding of the disease itself, treatment required and how best to support their clients during this time.

Assessing pain in rabbits: how well does the Rabbit Grimace Scale work in the veterinary practice?

Background: Pain recognition in rabbits (<i>Oryctolagous cuniculi</i>) can be a challenging task for the registered veterinary nurse (RVN) and can often result in the delivery of suboptimal nursing care if pain goes undetected. Although the Rabbit Grimace Scale (RbtGS) can assist in pain assessment, it is a tool that is currently underutilised in practice. Aims: The aim of this research was to evaluate the efficacy of the RbtGS to assess if it is useful in the veterinary practice to improve rabbit welfare standards. Methods: 31 individuals, 25 student veterinary nurses and six RVNs participated, taking RbtGS scores for 19 rabbits through either live or video observations. The rabbits were either healthy or experiencing a pre-existing illness or health condition as assessed by a veterinary surgeon. Results: The RbtGS scores indicated that the majority of participants were unable to accurately identify the rabbits most likely to be in pain, suggesting that it may not be an optimal tool in rabbit pain assessment. However, RVNs who had more experience in practice were better at identifying signs of pain and stress in the rabbits. Conclusion: Experience and ongoing education is invaluable to improve rabbit care. There is a need for a veterinary rabbit pain score system in order to standardise pain management across species.

Raising awareness of seizure triggers and pre-seizure behaviour changes in dogs

A new study by the Royal Veterinary College (RVC) has identified pre-seizure behavioural changes and potential seizure triggers that may help owners predict when a seizure is going to occur. The RVC's animal behaviour scientist Dr Rowena Packer explains.