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Evaluation of compliance among nursing staff in administration of prescribed analgesic drugs to critically ill dogs and cats

Dr. Elizabeth A. Armitage MA, VetMB1,2, Lois A. Wetmore DVM, ScD, DACVA3, Daniel L. Chan DVM, DACVECC4, and Jane C. Lindsey ScD5
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  • 1 Section of Anesthesia, Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.
  • | 2 Present address is the Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
  • | 3 Section of Anesthesia, Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.
  • | 4 Section of Critical Care, Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.
  • | 5 Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115.

Abstract

Objective—To investigate the prescription of analgesic drugs to hospitalized critically ill dogs and cats and determine compliance of nursing staff in administering the prescribed analgesics.

Design—Cross-sectional study.

Animals—272 dogs and 79 cats hospitalized in an intensive care unit during a 2-month period.

Procedure—Patient treatment orders were examined daily for details regarding prescribed and administered analgesic drugs.

Results—A mean of 39% of cats and dogs in the intensive care unit were prescribed analgesic drugs each day, the most common of which were opioids. Local anesthetic drugs, nonsteroidal anti-inflammatory drugs, and ketamine were prescribed less frequently. Cats were less likely than dogs to receive analgesics after traumatic injury, but the difference was not significant. There was no difference between species in frequency of prescription of analgesic drugs after surgery. Most patients were prescribed a single class of analgesic drug; only 13% had orders for multiple analgesics. Of the patients for which analgesics were prescribed, 64% received them exactly as prescribed, 23% had at least 1 reduction in dosing, and 13% had at least 1 increase in dosing. When a decrease in dosing occurred, the drugs were opioids in each instance, whereas when drug dosing was increased, the drugs were of various types.

Conclusions and Clinical Relevance—Discrepancies sometimes existed between the dose of analgesic prescribed and that administered. This appeared to occur primarily because of concerns about adverse effects of opioid drugs. Strategies to reduce these effects may improve pain management in critically ill dogs and cats. (J Am Vet Med Assoc 2005;227:425–429)

Abstract

Objective—To investigate the prescription of analgesic drugs to hospitalized critically ill dogs and cats and determine compliance of nursing staff in administering the prescribed analgesics.

Design—Cross-sectional study.

Animals—272 dogs and 79 cats hospitalized in an intensive care unit during a 2-month period.

Procedure—Patient treatment orders were examined daily for details regarding prescribed and administered analgesic drugs.

Results—A mean of 39% of cats and dogs in the intensive care unit were prescribed analgesic drugs each day, the most common of which were opioids. Local anesthetic drugs, nonsteroidal anti-inflammatory drugs, and ketamine were prescribed less frequently. Cats were less likely than dogs to receive analgesics after traumatic injury, but the difference was not significant. There was no difference between species in frequency of prescription of analgesic drugs after surgery. Most patients were prescribed a single class of analgesic drug; only 13% had orders for multiple analgesics. Of the patients for which analgesics were prescribed, 64% received them exactly as prescribed, 23% had at least 1 reduction in dosing, and 13% had at least 1 increase in dosing. When a decrease in dosing occurred, the drugs were opioids in each instance, whereas when drug dosing was increased, the drugs were of various types.

Conclusions and Clinical Relevance—Discrepancies sometimes existed between the dose of analgesic prescribed and that administered. This appeared to occur primarily because of concerns about adverse effects of opioid drugs. Strategies to reduce these effects may improve pain management in critically ill dogs and cats. (J Am Vet Med Assoc 2005;227:425–429)