Using clinical audit to assess veterinary practices during lambing

I am Rachel Forster, a Senior Vet at Market Veterinary Centre in North Devon and Chair of the IVC Evidensia Sheep Clinical Working Group. The group comprises of a number of vets working within IVC Evidensia who are interested in sheep health and production. Between 2021 and 2023, the IVC Evidensia Sheep Clinical Working Group carried out a lambing and ovine caesarean audit open to all farm mix practices within IVC Evidensia over two audit cycles. A project was awarded highly commended in the Quality Improvement in Practice section of the 2025 RCVS Knowledge Awards. The aim of the audit was to recall clinical decision-making by veterinary surgeons in lambing and caesarean cases.

A results summary and clinical guidance arising from the results of the first audit was distributed to all IVC Evidensia farm in mixed practices with a recommendation that the results should be discussed within individual practice teams. The information is also available to all IVC vets via the IVC Evidensia intranet. The second audit was then completed to access the impact of the guidance with respect to behaviour change in the field when treating clinical cases.

The audits were carried out using online survey forms. In both audit cycles, a paired survey was used where veterinarians completed part one immediately after the procedure and part two seven days post-procedure in order to record outcomes. The same questions were used in both audit cycles, plus some additional questions regarding the impact of guidance were added in the second audit.

The first audit identified three areas where clinical decision-making could potentially be improved. Antibiotic choice, analgesia and anaesthesia, specifically caudal epidural anaesthesia for assisted vaginal delivery and infection control, specifically the use of sterile surgical gloves for ovarian caesarean section. These areas provided the focus for analysis in the second audit cycle.

There were 441 case submissions into the second audit from 30 different IVC Evidensia practices. Of these submissions, 313 paired datasets were suitable for data analysis. 39% of respondents had modified their clinical approach to lambing or caesarean after the previous audit. There was a significant change in the first line antibiotic choice for ovine caesarean section between the two audits.

Initially, 81% of respondents chose category C antibiotics. However, in the second audit, this had fallen to 38%, with 52% of respondents now choosing category D as a first-line treatment. This represents a significant step towards more responsible antibiotic prescribing for these cases. Uptake of our other guidance recommendations was surprisingly much lower.

Guidance for the use of caudal epidural in assisted vaginal delivery impacted only 3% of respondents despite distribution of guidance describing epidural technique, drug dosages and the welfare benefits of epidural anaesthesia for assisted vaginal delivery. In fact, the use of caudal epidural anaesthesia decreased from 25% in the first audit to only 11% in the second audit and we feel that this is likely to be much lower than the use of
epidurals in bovine carvings and caesareans where the figure is probably more likely to be around the 50% mark.

Our primary guidance with respect to infection control was to recommend the use of surgical gloves for all ovine caesarean procedures. 25% of respondents reported using sterile gloves for caesarean procedures in the first audit and this was unchanged in the second audit with 6% of respondents reporting influence of the audit in decision making.

Over 80% of vets were already following the general industry guidance to wear protective gloves for assistant vaginal delivery in both cycles of the audit. Overall the impact of the audits has been positive. There has been very good engagement from vets in both audit cycles. The audit has led to significant change in antibiotic choice for lambing and caesarean sections leading to an increase of use of category D antibiotics over category C.

The uptake of the other guidance recommendations has been more challenging. In recent discussions with our farm vets at IVC Farm Conference, we have identified several barriers to the uptake of the guidance, which include confidence in the technique and habits. This discussion has provided valuable feedback to us to help provide more precise guidance to assist quality improvement. We’d like to thank all the vets and vet practices that have participated in our audits. We plan to repeat the audit again soon.