Knowledge Award audio overview: Post-operative pain management in cats spays

Hannah Jones BVMS (Hons) MRCVS:
Hi, I am Hannah and I’m Clinical Director at Avenue Vets in Malvern, Worcestershire. We are a companion animal only practice. However, we were mixed just a few years ago and we are part of the IVC Group. Before I became Clinical Director, I wanted to introduce more regular Quality Improvement in our team to make better use of our regular discussions and help
implement changes.

In the topic chosen; pain relief for routine cat spays, there was some scepticism from more longstanding members of staff who had a ‘if it isn’t broke, why fix it’ attitude. This was despite
the nursing team bringing up concerns that cats may not be comfortable after spays due to them being more fractious to handle. We therefore started pain scoring these cats using our
current pain and anaesthetic protocol. This overwhelmingly showed that cats required improved pain management with 72% scoring five or more on the Glasgow Feline Composite
Measure Pain Scale indicating possible need for further analgesia.

We therefore changed the cats spay perioperative pain protocol and on follow-up audit performing pain scores again, those with a score of five or more reduced to 27%. Although we
hoped for a better improvement, we felt there were limitations to using the pain scoring, especially as we were doing many anxious and fearful shelter kittens who would actually have
a score of four prior to surgery as they were cowering in the back of their cage, anxious and fearful, both of which carry a score of two. The nursing team also felt the cats were happier
and less uncomfortable on handling post-op, but we also discussed other ways to help these cats like Feliway in the environment and pre-visit drugs to help reduce fear, anxiety, and stress. Our positive results helped to overcome doubts from some staff members, and everyone could see that this benefited the patients as well as the staff handling the cats.

This has made staff more open to other projects and discussing change or ideas for improvement. This RCVS Knowledge Award has prompted myself and the team to continue learning, largely via the excellent resources on the RCVS Knowledge website, to continue with further QI and keep trying, even if initial changes don’t make the impact we hoped. I have also
shared the project with the IVC Group via their QI Hub and become involved in group QI collaboration, and I became involved in presenting at area and regional meetings as well.

My advice from starting out with this initial project is to start small with just one simple change and something that when discussing with the team, they’re keen and excited to do and feel is important to them for wellbeing of patients and the staff alike.

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