Patient Safety in Veterinary Medicine

1. Auflage 2026
ISBN: 978-1-394-25023-3
Verlag: John Wiley & Sons Inc

Buch, Englisch, 288 Seiten

Autoren/Hrsg.

Mcmillan, Matthew

Fachgebiete

• Medizin | Veterinärmedizin Veterinärmedizin Veterinärmedizin
• Medizin | Veterinärmedizin Veterinärmedizin Veterinärmedizin: Anästhesiologie
• Medizin | Veterinärmedizin Veterinärmedizin Veterinärmedizin: Sonstige Disziplinen

Inhaltsverzeichnis

Dedication i

Preface ii

Acknowledgements

Introduction v

Chapter 1. The language of (patient) safety - 1 -

What is the difference between an adverse event and a patient safety incident? - 1 -

Acronyms and Abbreviations - 7 -

References - 9 -

Chapter 2. A Brief History of Healthcare-associated Harm and Patient Safety - 11 -

A timeline of patient safety in healthcare literature - 13 -

References - 20 -

Chapter 3. Modern Prevalence and Impact of Healthcare-Associated Harm - 23 -

Overall prevalence of harm - 26 -

Prevalence and type of healthcare-associated harm by medical setting and clinical specialty - 30 -

Prevalence of harm from primary care medicine - 30 -

Prevalence of harm from anaesthesia - 31 -

Prevalence of harm from surgery - 32 -

Prevalence of harm associated with diagnostic imaging - 33 -

Laboratory medicine - 33 -

Emergency care - 34 -

Intensive care - 35 -

Other medical specialties - 36 -

How does this harm break down? - 36 -

Medication error - 36 -

Healthcare-associated infections - 37 -

Misdiagnosis - 37 -

Patient misidentification - 38 -

Communication failure - 39 -

What is the evidence for veterinary healthcare-associated harm? - 41 -

Errors among veterinary new graduates - 42 -

Errors in veterinary malpractice claims - 43 -

A study of veterinary referral and emergency hospitals - 44 -

Errors in corporate veterinary practices and hospitals in mainland Europe - 46 -

Studies of complications associated with specific specialties - 47 -

Studies of specific veterinary errors and healthcare-associated harms - 55 -

Conclusion - 62 -

References - 62 -

Chapter 4. Why are patients harmed by healthcare? Theories, concepts and models - 73 -

From simple linear causality models to complex non-linear models. - 75 -

Are certain individuals just accident prone? - 77 -

Simple linear models - 80 -

Generalised Time Sequence Model - 81 -

More advanced models - 84 -

What is a system? - 85 -

Normal Accident Theory - 88 -

High Reliability Organisation theory - 93 -

Normal Accident Theory versus High Reliability Organisations - 95 -

Practical drift - 97 -

Reason’s Organisational Accident and “Swiss Cheese” Models - 103 -

Vincent et al.’s model of accidents in healthcare - 107 -

Accidents as emergent properties of systems - 108 -

Current approaches to safety - 110 -

Systems Approaches - 110 -

Human Factors Approaches - 113 -

Resilience Engineering - 114 -

Ways of envisioning and understanding working practices - 115 -

Local rationality principle - 116 -

Work-as-done versus Work-as-imagined - 116 -

Efficiency-Thoroughness Trade-Off - 118 -

The blunt-end and sharp-end of healthcare systems - 121 -

Comparisons between Healthcare and Aviation - 122 -

Comparisons of veterinary healthcare to other industries - 133 -

The characteristics of working in veterinary medicine - 134 -

Contrasting approaches to safety and risk management - 138 -

What does this tell us about risk management in healthcare? - 139 -

Why is patient safety so hard to improve? - 141 -

Summary - 142 -

References - 142 -

Chapter 5. Human performance and error - 147 -

What is an error? - 148 -

Classification of human error - 149 -

Violations - 152 -

How we make decisions - 154 -

Dual Process Theory - 154 -

Rationality - 158 -

Heuristics - 160 -

Cognitive biases - 164 -

Cognitive load and effort - 177 -

Decision making styles - 179 -

Decision making in clinical teams - 180 -

Personality traits and affective state - 182 -

Conclusions on decision-making - 184 -

The effect of the social environment - 185 -

Other important facets of human nature - 186 -

What are Non-Technical Skills? - 187 -

How do non-technical factors shape our performance - 188 -

What are the different non-technical skills? - 189 -

Situation awareness - 190 -

Teamwork including Communication and Leadership - 197 -

Task management - 218 -

Personal self-management - 219 -

Social and interpersonal management - 224 -

When might human error be the most influential factor in an accident? - 228 -

Failing to pay attention - 229 -

Exceeding performance capabilities - 232 -

Developing patterns of unsafe behaviour - 240 -

Conclusion - 243 -

References - 243 -

Chapter 6. Organisational, professional and safety cultures - 249 -

What do the terms organisational, professional and safety culture mean? - 251 -

Organisational Culture - 251 -

Subcultures and cultural variations within organisations - 256 -

Professional culture - 258 -

What is Safety Culture? - 262 -

Dimensions of Safety Culture - 263 -

Themes in Safety Culture Identified in Healthcare - 272 -

Other Key Principles Pertaining to Safety Culture - 274 -

Psychological safety - 274 -

Speaking Up is Hard to Do - 277 -

Culture-as-imagined versus Culture-as-experienced - 279 -

Dissonance in Organisational Culture - 280 -

Groupthink - 282 -

Blame Shifting and Blame Contagion - 284 -

The Culture of “Making Do” and Innovative Problem Solving - 285 -

Top-down versus Bottom-up Approaches to Safety - 290 -

Bureaucratising Safety - 292 -

Assessing Safety Culture - 293 -

Safety Attitudes Questionnaire - 293 -

Hospital Survey on Patient Safety - 295 -

The Nottingham Veterinary Patient Safety Culture Survey - 296 -

Veterinary Student Survey on Patient Safety Culture - 301 -

Application of safety culture surveys - 304 -

Errors Made when Applying Information Gained from Safety Culture Surveys - 305 -

The link between safety culture and outcomes - 305 -

Conclusion - 307 -

References - 307 -

Chapter 7. Dealing with the non-clinical aftermath of an incident or error - 311 -

Primary Victims - 312 -

The Animal - 312 -

The Owner and their Family - 313 -

Disclosure of Errors - 313 -

The Ethics of Disclosure - 314 -

Legislation and Guidelines on Disclosing Medical Errors - 315 -

What is the Current Evidence on Disclosure in Human Healthcare? - 322 -

Does Encouraging Disclosure Increase Litigation? - 324 -

Does Disclosure Worsen Public Perception of Healthcare? - 325 -

Barriers to Disclosure - 326 -

Considerations for Disclosing Error - 327 -

Dealing with Emotional Situations - 333 -

Communication Models for Error Disclosure - 334 -

Communication models in veterinary healthcare - 335 -

Truth, Transparency and Teamwork - 335 -

Empathy - 336 -

Apology and Accountability - 336 -

Management - 337 -

Disclosure and Organizational Culture - 337 -

Managing Secondary Victims - 338 -

Assessment of second victim syndrome - 341 -

What is the Prevalence of Second Victim Syndrome? - 343 -

Dealing with Second Victim Syndrome - 345 -

Conclusions - 351 -

References - 352 -

Chapter 8. Methods of assessment and measurement in patient safety - 356 -

Underlying principles - 358 -

Summary - 358 -

Surveys and Questionnaires - 360 -

Designing a Survey - 360 -

Patient safety surveys in veterinary healthcare - 369 -

Modified Delphi Method - 372 -

Delphi studies in patient safety research - 374 -

Chart review - 376 -

General considerations for performing chart reviews - 376 -

Identifying important data in chart review - 379 -

Pros and cons of chart review - 384 -

Surveillance of adverse event and incidents - 386 -

Safety Diaries - 387 -

Benefits and limitations of safety diaries - 388 -

Safety diaries in veterinary healthcare - 389 -

Surveillance forms - 392 -

Incident surveillance - 392 -

Complication surveillance forms - 393 -

Non-routine event surveillance - 399 -

Non-routine event reporting tools - 400 -

Incident reporting - 403 -

What should a good incident report consist of? - 405 -

Structured component of an incident report - 408 -

Unstructured component of an incident report - 413 -

Benefits and limitations of incident reporting - 415 -

How to Improve the Quantity and Quality of Incident Reports - 418 -

Examples of Established Reporting Systems - 422 -

Examples of Reporting Systems in Veterinary Healthcare - 423 -

VetSafe - 423 -

Cornell University system - 428 -

Anicura study - 430 -

Generating Your Own Reporting System - 433 -

Getting the Most Out of a Reporting System - 437 -

Conclusions on Incident Reporting Systems - 439 -

Debriefing - 440 -

The Structure of Debriefs - 441 -

Who? - 443 -

What? - 444 -

When? - 445 -

Where? - 447 -

Why? - 447 -

How? - 448 -

Debrief Tools and Frameworks - 449 -

Benefits and Limitations of Debriefing - 457 -

Debriefing in Healthcare - 457 -

Debriefing in Veterinary Healthcare - 458 -

Cognitive autopsy - 460 -

Interview techniques - 465 -

The aim of interviews in patient safety - 465 -

Unstructured and Semi-structured interviews - 466 -

Designing, Planning and Preparing for Interviews - 467 -

Question Types - 468 -

Choosing the correct time and place - 472 -

Developing a rapport with an interviewee - 472 -

Being prepared to handle an emotional response - 474 -

Benefits and limitations of interviews - 475 -

Interviews in patient safety research - 475 -

Critical Incident Technique - 476 -

Critical Incident Technique in healthcare - 478 -

Critical Incident Technique in Veterinary Healthcare - 481 -

Other applications of Critical Incident Technique - 482 -

Controversy surrounding Critical Incident Technique - 483 -

Focus Groups - 484 -

Setting up a focus group - 484 -

Define the purpose of the focus group - 485 -

Define the shared characteristics of the participants - 486 -

Select a moderator - 486 -

Develop a focus group discussion guide - 487 -

Identify and prepare a space for the focus group - 487 -

Arrange a specified time for the focus group - 487 -

Develop a “group agreement” statement - 488 -

Benefits and limitations of Focus groups - 489 -

Focus groups in veterinary healthcare - 491 -

Morbidity and Mortality rounds - 494 -

Case selection - 495 -

Timing, Frequency and Duration - 496 -

Moderator - 496 -

Presenter - 497 -

Audience - 498 -

Tone and Environment - 498 -

Format - 499 -

Situation - 499 -

Background - 500 -

Assessment - 500 -

Analysis - 500 -

Recommendations - 501 -

Follow-up - 502 -

Morbidity and Mortality Rounds in healthcare - 502 -

Morbidity and Mortality rounds in veterinary healthcare - 503 -

Direct Observation - 506 -

Study Design and Research Questions - 507 -

The Direct Observation Process - 508 -

Data collection - 508 -

The Observer - 511 -

Other Considerations - 511 -

Benefits and Limitations of Direct Observation - 512 -

Observation in patient safety research - 513 -

Direct Observation in Veterinary Healthcare - 515 -

Closed malpractice and liability insurance claims - 520 -

What is included in a closed Claim investigation - 520 -

Benefits and Limitations of Closed Claim studies - 521 -

Closed Claim Analysis in Healthcare - 522 -

Closed Claim Analysis in Veterinary Healthcare - 522 -

Big data, large databases and registries - 525 -

Benefits and Limitations of Big Data and Registries - 527 -

Outcome Registries in Healthcare - 528 -

Outcome Registries in Veterinary Healthcare - 529 -

Benefits and Limitations to Investigations using Big Data and Large Databases - 532 -

Process Walks and Process Mapping - 534 -

Define the Process and its Boundaries - 535 -

Purpose and Outcomes - 535 -

Resources Involved in Process - 536 -

Define Current Ideal Standards - 537 -

Establish How the Process fits within the System - 537 -

Data Collection - 537 -

Investigative Questions - 538 -

Developing the Process Map - 541 -

Analysis of Process Maps - 542 -

Benefits and limitations of Process Mapping - 542 -

Process Mapping in Human Healthcare - 543 -

Process Mapping in Veterinary Healthcare - 544 -

Using multiple methods to collect patient safety data - 545 -

Benefits and limitations of using Multiple Methods - 545 -

Use of Multiple Methods in Veterinary Patient Safety Investigations - 546 -

References - 548 -

Chapter 9. Analysis Techniques for Patient Safety Investigations - 568 -

Quantitative versus Qualitative Analysis - 569 -

Setting Basic Objectives for Analysis - 575 -

Setting Improvement Objectives: SMART Goals - 576 -

Which Incidents or Situations should I analyse? - 578 -

The Classification and Categorisation of incidents - 579 -

The Pareto Principle - 594 -

Incident Analysis - 595 -

Process Analysis - 597 -

General approaches to safety investigations - 598 -

Systems-based analysis - 599 -

Human Factors-based analysis - 600 -

Resilience-based approaches - 602 -

Conclusion - 603 -

Timeline techniques - 604 -

Event and Condition Network Analysis - 606 -

Root Cause Analysis - 610 -

The Five Whys Technique - 612 -

Ishikawa or Fishbone Diagram - 615 -

Bow-Tie Diagrams - 617 -

The London Protocol Systems-Based Approach - 625 -

How to perform the London Protocol - 626 -

Identify an incident or situation to investigate - 626 -

Data collection - 627 -

Identify Care Management Problems - 628 -

Assessment of Barriers, Safeguards and Defences - 629 -

Identify Contributing Factors - 629 -

Develop recommendations and interventions - 631 -

Write a report - 632 -

Develop an Action Plan - 634 -

The benefits and limitations of the London Protocol - 634 -

The London Protocol in human healthcare - 635 -

The London Protocol in veterinary healthcare - 636 -

Systems Engineering Initiative for Patient Safety - 641 -

Systems Engineering Initiative for Patient Safety model - 641 -

Work systems - 647 -

Work processes - 648 -

Work outcomes - 648 -

Using the Systems Engineering Initiative for Patient Safety model - 649 -

The Systems Engineering Initiative for Patient Safety in healthcare - 653 -

Human Factors Analysis Classification System - 656 -

Benefits and limitations of the Human Factors Analysis Classification System - 657 -

Adaptations of Human Factors Analysis Classification System used in healthcare - 658 -

Application of the Human Factors Analysis Classification System in healthcare - 663 -

Human Factors Analysis Classification System in Veterinary Healthcare - 666 -

Further incident analysis techniques - 668 -

Concise Analysis of Patient Safety Incidents - 668 -

Prevention and Recovery Information System for Monitoring and Analysis - 669 -

General Analysis Model - 670 -

Failure Modes and Effects Analysis - 671 -

Preparation for Failure Modes and Effects Analysis - 672 -

Performing Failure Modes and Effects Analysis - 673 -

Describe the process and produce a flow diagram - 673 -

Identify the hazards - 673 -

Identify actions and outcome measures - 675 -

Failure Modes and Effects Analysis application in healthcare - 675 -

The Structured What-If Technique - 677 -

Performing the Structured What-If Technique - 677 -

Describe the process - 677 -

Identify hazards and risks - 677 -

Assess the hazards and risks - 680 -

Consider current control measures and safeguards - 680 -

Propose actions - 681 -

The Structured What-If Technique in healthcare - 681 -

Functional Resonance Analysis Method - 683 -

Performing the Functional Resonance Analysis Method - 685 -

Identify and describe the essential functions - 685 -

Identify variation within each of the functions - 687 -

Determine how variability of functions affects the process - 687 -

Develop recommendations on how to monitor and manage the variability - 688 -

Functional Resonance Analysis Method in Healthcare - 689 -

Further process analysis methods - 691 -

Systems Theoretic Process Analysis - 691 -

Qualitative techniques: Thematic analysis - 692 -

Thematic Analysis: the basics - 692 -

References for analysis techniques - 701 -

Chapter 10. Patient Safety Interventions - 713 -

Interventions Categorised According to Human Factors Engineering - 714 -

Recognising the “Need for Change” - 719 -

Managing change - 721 -

The Behaviour Change Wheel - 723 -

Further assessment of interventions: the APEASE criteria - 730 -

Fear of and resistance to change - 731 -

Facilitating change - 732 -

Monitoring change - 735 -

Conclusions - 735 -

Individual-based strategies - 737 -

Self-improvement and personal approaches - 737 -

Self-care - 737 -

Self-reflection - 740 -

Metacognition - 741 -

Debiasing strategies - 742 -

Non-Technical Skills development - 745 -

Planning and Preparation - 745 -

Communication - 747 -

Training and Education - 751 -

Rules, Policies, Standard Operating Procedures and Protocols - 757 -

Enforcement of compliance - 761 -

Increasing Staff Vigilance - 765 -

Signs and Notices - 769 -

Bulletins and broadcasts - 771 -

Clinical Practice Guidelines - 773 -

Team-based strategies - 782 -

Double-checking - 782 -

Medication Labelling - 787 -

Drug packaging and the labelling of vials and ampoules - 788 -

Syringe labelling - 790 -

Briefings - 793 -

Debriefings - 801 -

Communication strategies and tools - 803 -

Cognitive Aids - 810 -

What is a Cognitive Aid? - 810 -

How do cognitive aids work? - 810 -

What are the properties of the ideal cognitive aid? - 811 -

Checklists - 824 -

System-level strategies - 849 -

Work demands, resource allocation, workflow & scheduling - 849 -

Human Factors-based systems redesign - 852 -

Standardisation and Simplicity versus Resilience and Flexibility - 858 -

Engineering solutions - 865 -

Simulation-based training for aligning the individual with the system - 869 -

References for patient safety interventions - 878 -

Chapter 11. Feedback and closing the loop: Quality Improvement Cycles - 890 -

Clinical Audit - 892 -

How to perform a Clinical Audit - 893 -

Clinical Audit in veterinary healthcare - 898 -

Conclusions - 900 -

References - 901 -

Chapter 12. Ethics in Patient Safety Investigations - 902 -

Do we need to consider ethics when we are just trying to do what is best for our patients? - 902 -

What is the difference between patient safety activities and research? - 904 -

Why is this a problem? - 904 -

Why is there so much confusion? - 904 -

How can we differentiate between a quality improvement activity and research? - 906 -

When does a patient safety activity require ethical review? - 907 -

Why is this distinction so important? - 911 -

Why can traditional ethical review of patient safety activities be problematic? - 912 -

Guidelines on the performance of quality improvement activities - 915 -

What are the key ethical considerations in patient safety activities? - 920 -

Benefits and risks to patients and staff - 923 -

When should the investigators intervene? - 925 -

Managing Underperformance and Violations - 926 -

Anonymization and Confidentiality - 928 -

Informed Consent - 930 -

Why not get informed consent in all patient safety activities? - 931 -

When is informed consent required for patient safety activities? - 932 -

What ethical considerations should be made when designing a patient safety activity? - 935 -

Conclusion - 937 -

References - 938 -

Chapter 13. Suggested unified approach for veterinary healthcare - 940 -

Building the prototype “A PET Hospital” Model - 942 -

Step1 - 944 -

Step 2 - 945 -

Step 3 - 946 -

Step 4 - 947 -

Step 5 - 948 -

Step 6 - 949 -

Step 7 - 950 -

Step 8 - 951 -

Step 9 - 952 -

Step 10 - 953 -

Step 11 - 954 -

Step 12 - 956 -

Step 13 - 958 -

Step 14 - 960 -

Step 15 - 961 -

Step 16 - 962 -

Step 17 - 964 -

Step 18 - 966 -

Step 19 - 967 -

Brief Walkthrough of the completed A VET Hospital Model - 969 -

Applying the A VET Hospital Model to a Patient Safety Investigation - 971 -

Conclusion - 977 -

References - 978 -

Appendix I. Glossary of terms - 980 -

Appendix II: List of veterinary clinical practice guidelines - 989 -

Anaesthesia and Analgesia - 989 -

Emergency and Critical Care (including transfusion medicine) - 991 -

Cardiology - 992 -

Dentistry - 993 -

Dermatology - 994 -

Internal medicine - 996 -

Neurology - 1011 -

Oncology - 1012 -

General practice - 1012 -

Equine - 1017 -

Appendix III. Case studies - 1023 -

Case Study 1: Improving Compliance with a Checklist - 1023 -

Situation - 1023 -

Background - 1023 -

Assessment & Analysis - 1024 -

Recommendations - 1025 -

Case study 2: Improving Reliability and Safety in an Intensive Care Unit - 1027 -

Situation - 1027 -

Background - 1027 -

Assessment & Analysis - 1028 -

Recommendations - 1029 -

Case study 3: Improving the Safety of Infused Medications - 1032 -

Situation - 1032 -

Background - 1032 -

Assessment & Analysis - 1033 -

Recommendations - 1034 -

Case Study 4: Introducing an Incident Reporting System - 1037 -

Situation - 1037 -

Background - 1037 -

Assessment & Analysis - 1039 -

Recommendations - 1041 -

Case study 5: Improving the Safety of Overnight Care - 1043 -

Situation - 1043 -

Background - 1043 -

Assessment & Analysis - 1044 -

Recommendations - 1047 -

Case Study 6: Reducing Wound Complications and Surgical Site Infections - 1049 -

Situation - 1049 -

Background - 1049 -

Assessment & Analysis - 1052 -

Recommendations - 1053 -