Implementation of pre-emptive calculation of emergency drug doses

Hello, I am Kirsty White and I have been on the diagnostic imaging team at Paragon Veterinary Referrals Wakefield, West Yorkshire. Paragon is a small animal referral centre with multiple specialisms. I am interested in improving quality of patient care and safety to share the knowledge amongst the veterinary profession. In my practice, our sedation and anaesthetic forms have a section to calculate emergency drug doses based on the patient’s weight.

I noticed this section was not always utilized, so I set out to improve efficiency and safe practice. This prepared calculation could impact the efficiency of providing CPR in a timely manner. Early calculation may reduce the risk of calculation error, and efficient preparation time can reduce the risk of complications.

I performed a retrospective audit looking at all medical and surgical patients for both sedation and full anaesthetics across the period of one month. I assessed whether adrenaline, atropine and naloxone had been calculated for each patient. My objective setout to assess and increase the compliance of this being calculated, ideally for all patients. My goal was for 100 % completion on this calculation.

My initial audit found with a total of 354 patients in the period of one month, 30 did not have this calculation performed. This would equate to 8.5%. This audit showed inconsistencies in completion of the calculation. Interventions were then carried out, including team training with the importance of the preparation explained, updates in the team newsletter and on the notice board.

I requested the pre-procedure checklist be amended to include emergency drugs calculated. This checklist is completed prior any procedures commencing. I later performed a follow-up audit, again assessing all patients across a given month, and found 100 % compliance. I feel this suggests the impact a pre-procedure checklist and team understanding can have on holistic care.

I then submitted this successful audit for the RCVS Knowledge Award to hopefully share with the wider community.

I suppose the take home message is to check emergency drug calculations are prepared in advance to hopefully aid a better outcome should the unfortunate arise. Preparation is key and team knowledge and understanding can impact this. I highly recommend the use of relevant checklists and would like to express how grateful I am that this audit was highly commended for the quality improvement. Thank you for your time.