Standards: In Pursuit of Veterinary Excellence and Animal Health and Welfare
I will be bringing a North American and specifically, an American Animal Hospital Association (AAHA), perspective to this philosophy, that having Standards will enhance animal health and welfare by way of veterinary excellence. Simply by having Standards of Care, which can be customized to culture and socio-economics of each country, and often entailing little cost, will do much for promoting global veterinary excellence and the care of animals.
Goals of today are to define a standard and acknowledge the working definition of "animal health and welfare. Additionally, I will discuss the historical perspectives and the evolution in North America of these ideas. We will follow with some actual examples of Standards in use in North America, followed by a discussion of the value to the profession.
Definition of a standard: While there are several, the definition that best fits with our profession and use today is, "a benchmark of quality to measure self against."
In use by AAHA, this measure is NOT static and continually changing with improvements in the field. The constant goal is to improve animal health and welfare through veterinary excellence.
Definition of animal health and welfare: Again, there are many different definitions, some controversial. We will use the following, "... is the physical and psychological well-being of animals."
Historical perspective: Caring for animals is not a new or even modern philosophy. One can go back to some of the earliest recorded documents, some 5,000 years ago, that demonstrate the many caring interactions between humans and animals. There were even "laws" (the edict of King Asoka) outlining the building of human and animal sciences and hospitals. Some cultures protected certain species, like the cats of ancient Egypt, where it was illegal to kill or hurt such animals. Animals were also part of legend and folklore in many cultures.
Evolution of standards in North America: In 1933, the American Animal Hospital Association was formed to focus on high quality standards for the rapidly evolving small animal practice. The initial goals were to improve facilities, protect the interests of the practitioner, and to educate and maintain high standards on equipment, methods, and personnel. At first described as an inspection, this has changed to become more of a consultation to help the practice (and profession) improve. Initially, there were less than 90 standards, but today there are over 900 standards, 46 of them are mandatory, divided into 19 major sections. So, today, an AAHA practice is evaluated on everything from design and efficiency, to cleanliness, record keeping and human resources, and more.
A few examples of AAHA Standard (many do not require major investment other than time):
A means of assisting ventilation, either manual or mechanical, is readily available.
A practice team member performs frequent and regular evaluations of vital signs and other parameters...
In the event of a respiratory or cardiac arrest, the practice team follows a standard procedure for resuscitation directed in each case by a veterinarian....
Pain assessment is ... part of every patient evaluation...
Appropriate pain management is provided for the anticipated and duration of pain.
Practice team members follow infection control policies related to personal hygiene, patient care and disinfection of equipment and facilities. Frequent hand-washing and the use of antimicrobial agents to prevent the spread of contagious disease to hands and hospital surfaces.
The practice utilizes a single purpose isolation room where activities are restricted to providing care to contagious patients.
Practice team members demonstrate humane care of animals.
Animal holding areas are secure, escape proof, in good condition, and clean....
The general condition of each animal is assessed at least twice daily.
Routine examinations of hospitalized include documenting: behavior, activity, temperature, pulse, respiration, CRT, HR, rhythm, appetite, fluid intake, eliminations.
Patients are walked frequently enough to avoid elimination in their cages.
Floors and runs are well sealed, clean and in good condition.
Immediately prior to a surgical procedure, a practice team member performs a pre-surgical assessment. Such assessment ensures:
Positive patient identification
Verification of surgical procedures and anatomic location
Appropriate presurgical diagnostic testing performed, evaluated and documented
The practice utilizes the following devices for maintenance of optimum body temperature:
In-line fluid warmer
Forced warm air devices
Circulating warm water pads
Medical records are legible.
Patient care documented
... able to proceed with continuity of care and treatments.
Problem oriented system used.
Client and patient areas of the practice are neat, clean, and well organized:
The practice's professional library includes current books, periodicals and multimedia materials appropriate to the needs of the practice team.
Approved sharps containers used...
Compressed gases secured...
Tentative diagnoses and medical plans or their subsequent revisions are communicated to clients at the earliest reasonable opportunity.
Only trained practice team members perform lab tests.
Services provided by in-house or outside labs include: Hematology, serology, chemistries, urinalysis, urolith analysis, microbial cultures & sensitivities, fecal exams, blood parasite exams, cytology, histopathology, toxicology, PCR testing, electrolyte tests, more ...
The practice routinely utilizes infusion pumps to administer IV fluids.
Surgical suites are separate, closed, single purpose rooms entered only for activities associated with aseptic surgical procedures.
X-ray machines evaluated every 5 years for accuracy and safety...
Radiographs reviewed by DACVR (0%-100%) of time.
A special file of normal anatomic structures and specific conditions is maintained for comparison purposes
Abdominal case study includes 6 images and interpretations
Cardiology ultrasound...verified by specialists...
Standard development: At AAHA, standards are developed via feedback from membership, input from professional experts, statistical analysis of existing standard scores, and a Standards Task Force. They are continuously updated and modified as the profession evolves.
Value of standards: Standards work to improve veterinary medicine and the animal health in many ways. They establish goals for continuous improvement, promote teamwork and pride within the veterinary teams, establish credibility with clients and colleagues, and provides for relevance of the profession within the community. This is important, as not only have we seen historically, the many bonds animals and humans have formed, but evidence supports that the trend is for an increase in the perceived value of human-animal interactions. Also, as we move towards the concept of One Health, the emotional and health benefits of animals for humans is becoming better understood and accepted. Thus, any action to improve the relevance of our profession is critical to the continued success and respect of our profession.