Features

It’s a busy morning on the production line but Bill takes a moment to look up - he can hear the sound of heavy rain above the din of machinery. ‘Glad I’m working inside on a day like today,’ he thinks to himself. The shower passes and the noise subsides.

It’s a Tuesday morning after the August bank holiday and Ben, your new Veterinary graduate has just seen a long-standing client – Mrs Maladi and Mr Tiddles her cat. He has come to ask about the nurse availability to explain to Mrs Maladi about how to begin diabetic treatment – Ben is really enthusiastic and wants to get all of this right as this is his first diabetic case.

Julie, a friend from home on the local farm, phones you on a weekend. They have an active 7-year-old dog (Daisy) who has had a swelling on one of her front paws (P3). Julie’s vets have been brilliant. Following initial assessment, Daisy was given antibiotics as the raised red area was most likely caused by an infection. The swelling settled initially, but returned a few days after finishing the treatment course.

In the discipline of human factors, we are tasked with understanding and evaluating all the things that affect people at work by considering both the mental and physical characteristics of people, the organisation, and the wider profession in which they work.  We apply what we learn to the design of tasks, jobs, equipment, work environments, and systems of care to make life better for people at work and make it easier to deliver the right care for the patient.

It had been another busy day in the theatre, and as the last patient was transferred to recovery, the team gathered to debrief. Whilst three of the four surgeries completed had been straightforward and went smoothly, adrenaline still coursed through the veins of the team as they began to reflect on the first patient of the day. Cathy (one of the nurses) led the debrief:

An estimated 237 million errors involving medication occur in the NHS annually. These contribute to 1,700 deaths each year (Elliott et al., 2021). Early data on patient safety events from the Veterinary Defence Society’s Vet Safe has found that 30% of recorded patient safety events are medication errors.

Boston 1846: Anaesthesia was first demonstrated on a man who was having a tumour removed from his jaw. The pain free procedure was a big departure from the standard technique of pinning down patients while they screamed and writhed in agony. The discovery of ‘insensibility produced by inhalation’ was published by surgeon Henry Jacob Bigelow in November 1846 in the Boston Medical and Surgical Journal. The idea spread like wildfire, and by June of the following year, anaesthesia had been used in most regions of the world.

An integral part of veterinary medicine is of course the management of risk and it’s something we as veterinary professionals do almost instinctively. Through a combination of training, experience and what could be called our ‘risk antenna,’ we manage workflows, look out for our colleagues, and ourselves. It is in large part because of the veterinary team’s ability to manage risk, that veterinary care so often has a positive outcome. However, occasionally an accident happens. Why is this?

Florence the Great Dane had just come out of surgery, with Tom wiping the sweat from his brow after correcting her gastric dilatation and volvulus (GDV). James had assisted with the anaesthetic and was psyching himself up to deal with the aftermath; the prep room looked like a wrecking ball had gone through it. It was a skeleton bank holiday weekend crew, so Tom left James to look after Florence, while he went to start consults.

Fiona strode into the prep room, chuffed that she had navigated a morning surgery full of challenging cases. She was pleased to see that she was working with Esther, the deputy head nurse, although less pleased that her initials were by both the cat dentals. Esther was super organised and fun to work with. “Joanna’s on first ops, isn’t she?” Fiona asked, “I’ll see where she’s got to and if there’s anything I need to know.” “She was straight into theatre first thing, haven’t seen her since, you know she likes to crack on and be efficient- I say we leave her to it!” said Esther.