6. Clinical governance

Introduction

6.1 Clinical governance is a continuing process of reflection, analysis and improvement in professional practice for the benefit of the animal patient and the client owner. This practical guidance is intended to help all veterinary surgeons and veterinary nurses to undertake clinical governance, whether they are in clinical practice, or not. Much of the advice for individual veterinary surgeons and veterinary nurses, and the veterinary team, will be covered in other parts of the Code and its supporting guidance.

Guidance for individual veterinary surgeons and veterinary nurses

6.2 Clinical governance may include:

keeping up to date with continuing professional development (CPD) and new developments relevant to the area of work;
reflecting upon performance, preferably in the form of a learning diary, and making appropriate changes to practice;
reflecting upon any unexpected critical events and learning from the outcome and making appropriate changes to practice;
critically analysing the evidence base for procedures used and making appropriate changes to practice;
reflecting upon communication with other members of the work team and making appropriate changes to practice;
reflecting upon communication with clients and making appropriate changes to practice; and,
assessing professional competence in consultation with more experienced or better qualified colleagues and limiting your practice appropriately.

Guidance for the veterinary team

6.3 Clinical governance may include:

Animal safety

In case of any critical event eg unexpected medical or surgical complications, serious complaint, accident or anaesthetic death, hold a no-blame meeting of all staff involved as soon as possible after the incident and record all the details.
At the critical event meeting consider what, if anything, could have been done to avoid this incident, and what changes can be made in procedure as a result.
Have clear protocols in place to ensure all staff are familiar with procedures for ensuring patient safety.
Communicate changes in procedure to the whole practice team.
Ensure staff are aware that referral (to an appropriate veterinary surgeon in the practice or another practice) is an option to the client.

Clinical effectiveness

Organise regular clinical discussion meetings for the practice team, record minutes, and review any action points at future meetings. All clinical staff should be encouraged to participate and input items onto the agenda.
Follow up any clinical issues arising from clinical discussion meetings.
Make appropriate changes as a result of clinical discussion meetings and monitor these changes to ensure they are effective.
Organise online discussion forums to discuss clinical cases where geography or part-time working make face-to-face meetings difficult.
Organise practice team discussions on guidelines or protocols used in practice. Look at the evidence base for common procedures and treatments used in the practice and revise these as a result if necessary.
Build up a manual that can be used as clinical guidance in the practice. Make sure that it is regularly updated and new or temporary members of staff are made familiar with its contents at the earliest opportunity.
Organise clinical clubs or journal clubs, either live or online, critically discussing cases and clinical papers.
Audit the results of clinical procedures of interest to the practice team and use the results to improve patient care (see www.vetaudit.co.uk for more information).
Have a policy, with funding if possible, to encourage CPD for all veterinary surgeons and veterinary nurses and clinical support staff.
Have a system for individuals to feedback interesting information from CPD courses to the rest of the practice team.
Incorporate information learned at CPD courses into practice protocols, where appropriate.
Ensure clinical staff have access to suitable up-to-date reference material.
Have systems to ensure that information on new veterinary products or new pieces of equipment is communicated to the veterinary team.
Have a performance review system in place for all clinical staff to monitor and plan development.

Patient and client experience

Ensure continuity of care for patients by having effective systems of case handovers between clinical staff.
Have protocols to safeguard the pain relief and nursing care for all inpatients.
Have an effective means of communicating with clients, eg newsletters, web sites etc.
(N.B. Any electronic marketing communications presented or sent to the client should, however, only be sent where (a) the client has given clear and specific consent, and (b) they were given the opportunity to opt out of email marketing at the time their email address was collected, and each time an email is sent. Consent should be freely given and there should be a specific opt-in by the client. It is not acceptable to rely on a pre-ticked box or infer consent from silence. There should be systems and processes in place to keep the consent up to date and veterinary surgeons and veterinary nurses should comply promptly if the individual withdraws their consent).
Monitor and take note of feedback from clients. Feedback is likely to be clients’ personal data unless it is truly anonymous, and should be covered in the practice’s privacy policy (further information about this can be found in Chapter 9).
Ensure that clients can easily find out the names of staff, eg badges, notice boards, web site etc.
Have protocols known to all relevant staff for dealing with members of the public.
Have a complaints procedure.
Record all complaints received and the responses to the clients.
(N.B. Complaints will be considered personal data, so veterinary surgeons and veterinary nurses should ensure that there are procedures in place to ensure that such correspondence is only retained as long as is necessary, and they may also consider anonymising it. The practice’s privacy policy should include this information, to help ensure that this type of personal data is processed fairly, lawfully and transparently).
Have an effective communication system within the practice.
Provide a privacy policy to clients and put effective procedures in place in order to respond properly if clients exercise their rights under the GDPR (i.e. the right to access their personal data, the right to rectification and erasure, the right to be forgotten, the right to restrict processing, the right to data portability and the right to object to the processing of their personal data).