Quality Improvement in the Nursing Care of Exotics
Quality Improvement is the continuous review of clinical work and patient care in order to ensure that we are delivering the best and most appropriate care for our patients.
The concept is well established in human medicine, and now gathering traction in veterinary medicine. However, the focus has rarely been on exotics - something this course seeks to remedy.
Quality Improvement:
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Utilising Evidence Based Practice to INFORM
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Comparing outcomes with National Standards
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Carrying out a Clinical Audit
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Improving Patient Centred Care
What does the course cover?
How do I book?
Have a look at our case study examining QI in action.......
Case Study 1
Over coffee one of the vets mentions that the practice has run out of EMLA cream. They have been using it when placing intravenous catheters in dogs, cats and rabbits, and forgot to let you know that stock was getting low. The other assistant replies that they never use EMLA cream to place an intravenous catheter, and have never seen the need for it. There then follows a discussion around the advantages and disadvantages of local anaesthesia when placing catheters, particularly in small mammals – what should or should not be used, how far ahead of catheterisation should the cream be applied, how much to use, and whether the skin should be covered whilst it takes effect.
You decide to look into this in more detail........
Where are you going to start?
​Well you could start with google or google scholar. If you or the practice has access to an online database such as the RCVS library then that would be helpful. Other options include Web of Science, Medline, PubMed or CAB Abstracts as well as any text books in the practice.
What is reliable evidence?
A good starting point is to look at how recent the article is, and whether it was published in a peer reviewed veterinary journal. That gives you some assurance that the information is up to date and has already been scrutinised by veterinary professionals.
After undertaking this, you find a variety of different references (some of these are listed at the end of the article) which would support the use of EMLA cream when placing an intravenous catheter but the time required to be most effective isn’t very clear. One paper (Chung et al, 2022), found that applying EMLA cream 60 minutes before catheterisation was preferable to 10 minutes before. Keating et al (2012) demonstrated that 20 minutes was sufficient to provide analgesia when carrying out tattooing of the pinna. In people application 30-60 minutes before intervention and covering the skin with a light dressing is advised and Varga (2014), agrees with this in rabbits, suggesting that an occlusive dressing should be placed over the EMLA cream and left in place for 45 – 60 minutes to take full effect.
As you can see there is a need for more studies to provide more substantial evidence but common sense would suggest that leaving the cream in place for a longer time rather than shorter would be associated with a deeper level of local anaesthesia.
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You decide to discuss with colleagues at the next team meeting, and update the practice standard operating procedures to include the use of EMLA cream for all intravenous catheter placement.Whilst carrying out this work, you also find some references on the use of multi-modal analgesia and pain scoring in rabbits.
The practice does have a Standard Operating Procedure (SOP) for rabbit analgesia, and a checklist giving information about how to use the Rabbit Grimace Scale, but now you wonder just how many people in the practice are using these, and how reliable the results are. That’s the start of another QI study!
How to find out more
Quality Improvement is all about reviewing what you do in practice, looking for the evidence, comparing your work with current evidence and work of others, and adapting your practice as and where needed. We all do this informally, in practice.
QI gives structure and focus to this, enabling teamwork, highlighting areas of good practice, and identifying new areas of scientific advances.
Bringing this together allows us to demonstrate that we are giving our patients the best care possible, tailored to their own individual needs, and those of their owners.
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If you're interested in signing up for this training programme, please get in touch.
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