Kirby's Rule of 20: the Veterinary Nurse's Critical Patient Checklist Part 3
Abstract
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 3 includes: renal function, gastrointestinal motility and integrity, nutrition, glucose and immune status.
As veterinary medicine is continuously evolving, so are the expectations for the level of patient care. In the veterinary emergency and critical care setting, patient care checklists can be utilised to optimise patient care quality and standards. Checklists create a step-by-step process of evidence-based interventions and procedures that help prevent medical oversights (Berenholtz et al, 2002; Fulbrook and Mooney, 2003).
Kirby's Rule of 20 is a checklist created by Rebecca Kirby, DVM, DACVIM, DACVECC that includes 20 patient parameters that should be evaluated daily in critically ill patients. Kirby's Rule of 20 was created as a reminder for veterinarians and veterinary nurses to examine the status of critically ill patients, including organ systems involved, clinical parameters, diagnostic parameters, and treatment goals in order to optimise patient survival (Kirby, 2017). Following the Kirby's Rule of 20 checklist allows veterinary nurses to assess the overall clinical picture of a patient (taking a holistic approach), implement critical thinking skills, elevate the quality of patient care, set standards for patient care, and decrease morbidity and mortality which results in improved patient outcomes (Berenholtz et al, 2002; Fulbrook and Mooney, 2003).
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