Auditing the use of medicines in small animal practice

Hello, I’m a veterinary surgeon working in a small animal first opinion practice in Tavistock Devon. I am our QI lead here at Westmoor Vets. As part of CVS Vets, we have a strong quality improvement ethos. My inspiration for this clinical audit came from reading a paper in JSAB on the prescribing habits for the use of omeprazole as a gastro-protectant in dogs in a veterinary teaching hospital.

At our ward rounds, we discussed inappropriate prescribing of omeprazole in our inpatients and reflected whether the reported side effects of the omeprazole could be contributing to our patients nausea or diarrhoea. So I reviewed all our omeprazole prescriptions over the previous three months for cats and dogs, specifically recording the dose, the dose frequency and the indication for prescribing omeprazole.

This audit showed we were prescribing the correct dose in all 46 patients, but only 37 % of cases have been correctly prescribed twice daily in omeprazole and only 57 % of cases have been prescribed for an appropriate indication. The most common inappropriate indications were vomiting with no hermatomyces and diarrhoea with no malina.

Our team collaborated at our next clinical meeting by discussing the audit and the JSAQ paper. We found the main barrier had been a lack of awareness of the recently published evidence. So we planned to repeat the audit in six months. The repeat audit found we had a good reduction in the total number of cases prescribed in omeprazole over a three month period from 46 to 25 patients.

We continued to prescribe the correct dose in all 25 cases. We had a significant improvement in appropriate omeprazole prescribing with 76% of cats and dogs being prescribed omeprazole for an appropriate indication and twice daily. The repeat audit highlighted the need to repeat training for newer team members. This audit and discussing our use of omeprazole helped improve our omeprazole prescribing habits contributing to an improvement in the quality of our veterinary healthcare for our patients.