Friday, May 4, 2012

974. Veterinary audit of one case TP 43569


TRUST & AUDIT PROCESS AT TOA PAYOH VETS

Saturday, May 5, 2012
10.25 am
I did a veterinary audit of one surgical case done 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.

TP ...569
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 XXX: April 18, 2012
Neuter by Dr XXX: 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.

AUDIT PROCESS - LIST OF RECORDS MAINTAINED
Veterinary Surgeon - Dr XXX
1. Follow up. I phoned owner today to find out about the present situation. No response on this Saturday morning.
2. Outpatient record  - Yes.
3. Anaesthetic and surgical record - Yes.
Anaesthetic dosage recorded. Number of packetes 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 discovered.
7. Urine test - not done by Dr XXX. 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 and could be collected during cystotomy. 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 XXX - Yes. Mainly calcium oxalate with trace of phosphate and magnesium.

CONCLUSIONIt is extremely difficult to effect changes as each vet 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 XXX after many months as being scientific, effective and safe. Formerly Dr XXX would use Domitor in low dosages irrespective of weight of the dog.   



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