Auditing post-operative complications in routine neuters

Hello, my name is Bethany Moss and I’m a registered veterinary nurse at Garston Vets in Frome. We are a first opinion practice with five sites spread across Somerset and Wiltshire. I mainly work in our Frome site, which is our 24 hour hospital. As a whole team, we had noticed that there were a lot of post-amacetic patients coming back for appointments or to be hospitalised that had gastrointestinal upset, specifically diarrhoea and a lot were after neutering.

I had only recently taken on the role of quality improvement nurse in practice, but I knew that the RCVS Knowledge did a national small animal neutering audit every year looking at post-operative complications. And given what we had started noticing as a team, thought this would be a good place for me to start. Initially, it was my job to look through the clinical notes of patients coming in for their post-operative checks, post-neutering, to see if they were having any problems and what those problems were.

I chose to look at six months worth of neuterings to ensure I had a large amount of data to analyse. A few different problems were noticed, however, out of the 160 patients that returned with a problem, 44.37 % or 71 out of the 160 had gastrointestinal upset in the form of diarrhoea.

After a lot of research, reading clinical papers and other practices post-operative advice I discovered online, I discovered that what the patient is being fed post-operatively can have an impact. Our current advice was for all patients to return home on a diet of chicken and rice for the first few days. However, I read a research paper that showed chicken to be the most common allergen in dogs with the main side effect being diarrhoea.

This got me thinking that maybe the anaesthetic mixed with a sudden change in diet to a food that’s known to cause gastrointestinal upset could be the problem. I wrote up my initial report to send to my managers recommending our advice to change from feeding the patient a bland meal to them being fed their normal food instead. We would also ask the clients to bring in some of their pet’s own food with them on the day of their operation so we could feed it to them during their stay with us.

This idea was approved by management and after creating new client information sheets and getting the team on board with the new advice, the change was put in place. After six months with the new advice, I gathered new data to compare back to the original findings to see if there had been an improvement. Myself and the team were already confident that it had made an impact as the amount of post-operative diarrhoea cases we were seeing coming through the door had already decreased.

But it wasn’t until I had calculated all the figures that I realised the extent of the change. Whereas previously 71 patients returned with diarrhoea, it had now reduced to 29, meaning an overall reduction of 59.15%. Something that surprised me though was that the 29 patients that still returned with diarrhoea all had something in common, and that was that they had either been fed something different during their stay with us because the client had forgotten to bring in some of their usual food or the client had still been feeding them on chicken at home despite the new advice.

This makes me believe that if there was more compliance then the reduction could have been a lot larger. Regardless of that, the reduction we had has significantly improved animal welfare as well as client satisfaction.

It’s also made us as a team more conscious that even something that seems like such a small change can have a big impact. I’m very proud to have won a highly commended RCVS Knowledge Award and I hope anyone listening to this can be inspired to get involved in quality improvement in practice. Yes, it can be time consuming to gather and analyse data, but if you and your team are able to make a positive impact on a specific area of the practice, then it’s worth it.