974. Veterinary audit of one case TP ..569
TRUST & AUDIT PROCESS AT TOA PAYOH VETS
Saturday, May 5, 2012 10.25 am
I did a veterinary audit of one surgical case done by one of
the vets (Dr X) at Toa Payoh Vets as part of my management of
the practice to make it as one of the top 5 vet practices in
Singapore. This is to ensure a high standard of veterinary
care from vets at all times especially in veterinary surgery.
Chihuahua, Male, 10 years
Complaint: Blood in the urine.
Blood in the urine. X-rays and blood tests done by another
practice (Vet 1) on Mar 31, 2012
Admitted: April 16, 2012.
Cystotomy: Bladder stones removed by Dr X: April 18, 2012
Neuter by Dr X: April 18, 2012
Sent home: Apr 18, 2012
Owner returned dog for hospitalisation as the dog screamed
when touched or given medication: Apr 19 - May 3, 2012.
VETERINARY AUDIT PROCESS -
LIST OF RECORDS MAINTAINED
Veterinary Surgeon - Dr X
1. Follow up phone call. I phoned owner today to find out
about the present situation. No response on this Saturday
2. Outpatient record - Yes.
3. Anaesthetic and surgical record - Yes.
Anaesthetic dosage recorded. Number of packets used and type
of sutures not recorded. 3 packets were used.
4. Inpatient record - Yes. 2 days. Apr 16-18, 2012
5. Hospitalisation record - Yes. Apr 19 to May 3, 2012
100g dry food given and consumed per day. I checked on weight
of food given by Mr Min.
TESTS DONE AS AIDS TO DIAGNOSIS
6. Blood test - done by Vet 1. Nothing abnormal
7. Urine test - not done by Dr X. Reason being
that there was urethral obstruction. In this "audit and trust"
procedure, I informed the vet that urine test should be
done in all cases. It could be collected during cystotomy if
there was urethral obstruction. This is to enable us to know
the pH of the urine and whether there is bacterial infection.
8. X-ray of bladder - done by Vet 1 - 6 small stones seen on
hard copy kept by the owner.
9. Bladder stone analysis done by Dr X - Yes. Mainly
calcium oxalate with trace of phosphate and magnesium. This
test is important.
It is extremely difficult to effect changes in all
organisations as each manager or vet in this case, has his or
her own mindset and way of practising veterinary medicine and
surgery. The Domitor and Ketamine IV sedation formula, much
discussed in my case reports, is now accepted by Dr X after
many months as being scientific, effective and safe. Formerly
Dr X would use Domitor in low dosages irrespective of weight
of the dog and then top up with isoflurane gas for general
anaesthesia taking a much longer time to do surgical
procedures than nowadays.
Post-op care. As the dog was neutered and had urinary stones
removed, the dog could have been hospitalised more than 2 days
to enable him to recuperate and nursed at Toa Payoh Vets,
rather than being sent home after 2 days. The owner was unable
to nurse the dog and sent him back to be hospitalised for
around 14 days.