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in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

Studies in human medicine indicate that between 22,000 and 400,000 people die every year as a direct result of medical errors. In veterinary medicine, 42% of human-caused incidents caused harm to the patient, including 5% resulting in death. In a university veterinary teaching hospital, there were 5.3 errors/1,000 patient visits, and 4 of these resulted in death. Veterinary medicine falls far behind other safety-critical industries in adopting a culture of patient safety. Organizations should respond in a just and effective way when errors occur. Psychological safety for team members to identify and speak up about areas of concern must be created and the results of improvements made based on these concerns shared within the professional group. If veterinary medicine is going to embrace patient safety culture, it needs to be included in the curriculum. Accrediting and licensing bodies need to require the teaching and application of principles of patient safety culture. Faculty must be trained to deliver patient safety–oriented care. Experts in human systems engineering should be brought in to educate veterinarians on how the systems we work in impact patient outcomes. If we are going to fulfill the promise of the Veterinarian’s Oath, we must embrace patient safety culture and all the difficult changes it requires of our professional culture.

Open access
in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine agreement between arterial partial pressures of carbon dioxide (PaCO2) and end-tidal partial pressures of carbon dioxide (PETCO2) measured with a nasal catheter in spontaneously breathing, critically ill dogs.

Design—Validation study.

Animals—26 client-owned dogs admitted to an intensive care unit for various conditions.

Procedures—PaCO2 was measured with a commercial blood gas analyzer, and PETCO2 was measured with a sidestream capnograph attached to a nasal catheter. Measurements were obtained twice (ie, with and without supplemental oxygen). Paired values were compared by means of the Pearson correlation method. Level of agreement was assessed by means of the Bland-Altman method.

Results—Mean difference between PaCO2 and PETCO2 when dogs did not receive supplemental oxygen (mean ± SD, 3.95 ± 4.92 mm Hg) was significantly lower than mean difference when dogs did receive supplemental oxygen (6.87 ± 6.42 mm Hg). Mean difference in dogs with a condition affecting the respiratory system (8.55 ± 5.43 mm Hg) was significantly higher than mean difference in dogs without respiratory tract disease (3.28 ± 3.23 mm Hg). There was a significant linear correlation and good agreement between measured values of PaCO2 and PETCO2. Catheter size, ventilatory status, and outcome were not significantly associated with mean difference between PaCO2 and PETCO2.

Conclusions and Clinical Relevance—Results suggested that nasal capnography is a clinically relevant method of estimating PaCO2 in spontaneously breathing, critically ill dogs, but that values should be interpreted with caution in dogs receiving supplemental oxygen and in dogs with conditions affecting the respiratory system.

Full access
in Journal of the American Veterinary Medical Association