Patient safety evidence, curated for veterinary teams.
Access specialist-reviewed resources on incident reporting, near miss visibility, safety culture, second victim support, systems-focused review, and learning from patient safety events.
Evidence you can trust. Tools you can use. Impact you can measure.
Resource library
Safety Learning Series
Your Safety Culture Isn't Your Mission StatementIt's what happens in the ten seconds after someone says they made a mistake.
The Safest-Looking Hospitals Are Sometimes the Ones Learning the LeastAdverse events measure your luck. Near misses measure your learning.
If We Stop Blaming People, Don't We Lose Accountability?Judge the behavior, not the luck of the outcome.
Careful Is Not a SystemTell a veterinary team to be more careful and you will get almost nothing.
A Report Is Not a FixReporting opens the loop. Closing it is the work.
The Second Person the Event HarmedAn adverse event harms two people. Support both.
Evidence library
Research library
The published evidence on patient safety in veterinary medicine, gathered in one place and grouped by subject.
Every entry links to the publisher's own version of the paper. The summaries are written by us in plain language, so you can tell whether something is worth your time before you follow the link.
35 papers across 9 subjects, newest first
- Open access
- free to read and freely licensed
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Safety culture and incident reporting were not invented in veterinary medicine. They were developed in nuclear power, offshore oil and rail, then adopted by human healthcare long before they reached veterinary practice.
- Safety culture: philosopher's stone or man of straw?
An introduction to a special issue on safety culture by researchers at Loughborough and Aberdeen, and one of the most cited papers in the field. It traces the term's origins to the International Atomic Energy Agency's report on Chernobyl in 1986, and its subsequent use in the Piper Alpha and Clapham Junction inquiries, before asking whether the concept had outrun the evidence for it. The authors separate safety culture from safety climate, describing culture as an organisation's personality and climate as its more changeable mood, then review how each has been studied through case studies, comparisons of high and low accident sites, and workforce questionnaires. They also flag a caution that recurs throughout this library: a low accident rate can simply reflect a low reporting rate, and several organisations celebrated as exceptionally safe were later found to have concealed accidents.
Read the full paperDOI 10.1080/02678379808256861All rights reserved
The scale of the problem, and the large outcome studies that give these risks a denominator.
- Breed-specific anaesthetic mortality in cats: an analysis of 14,964 cases
This prospective study across 198 centres examined whether breed or head shape affects anaesthetic death risk in cats, covering 14,964 anaesthetics. Overall anaesthetic-related mortality was 0.63%, rising steeply with ASA class, from 0.07% in ASA I cats to 33.33% in ASA V. Once ASA status was accounted for, most breeds were no riskier than domestic shorthairs, but Persians remained at roughly double the risk. Brachycephalic breeds as a group carried higher adjusted risk, while moderate brachycephaly on its own did not.
Read the full paperDOI 10.3390/ani16020196CC BY
- Patient safety events cause harm across a variety of veterinary care settings: a global retrospective analysis
This study analysed 64,404 patient safety events reported electronically from 2,284 veterinary facilities across five multisite practice networks in the US and Europe during 2021 and 2022. Most events were near misses or caused no harm (73%), but 6.1% were judged to have caused major harm or death. Patient handling and medication-related incidents were the most common categories, while anaesthesia and sedation accounted for the largest share of events ending in major harm or death. Cats and exotic species were more likely than dogs to experience harm, and the authors conclude that errors occurred at a predictable, measurable rate across every setting studied.
Read the full paperDOI 10.2460/javma.24.08.0523CC BY-NC
- Anaesthetic mortality in dogs: a worldwide analysis and risk assessment
A prospective multicentre cohort study following 55,022 dogs anaesthetised at 405 veterinary centres worldwide. Anaesthetic-related mortality was 0.69%. Age, obesity and a higher ASA physical status score were all associated with increased risk. The finding with the clearest practical implication is that 81% of deaths happened after the procedure rather than during it, which places the risk in recovery rather than induction.
Read the full paperDOI 10.1002/vetr.3604CC BY-NC-ND
- Medical Errors Cause Harm in Veterinary Hospitals
Researchers reviewed 560 incident reports submitted to voluntary reporting systems at three hospitals: a small animal teaching hospital, a large animal teaching hospital, and a multi-specialty private practice, over a three-year period. Drug errors were the most frequently reported problem at all three sites, followed by communication failures. Most errors reached the patient without causing harm (45%), but 15% did cause harm, and 8% of harmed patients suffered permanent injury or died. This was one of the first studies to put hard numbers on how often veterinary patients are harmed by error.
Read the full paperDOI 10.3389/fvets.2019.00012CC BY
- Reducing error and improving patient safety
A Veterinary Record commentary marking the point at which patient safety began to be taken seriously in the veterinary profession. Tivers traces the concept from the 1991 Harvard Medical Practice Study, which found that 3.7% of hospitalised human patients suffered harm and that 13.6% of those incidents ended in death, through to the WHO Surgical Safety Checklist and the evidence that it reduces surgical complications and mortality. He notes how thin the veterinary evidence was at the time, and that the profession had no formal system for recognising or reporting error, with fear of blame a significant barrier to discussing mistakes. He closes by arguing that clinical governance, audit, and collaboration across multiple practices to build shared datasets are how patient safety moves from concept to reality.
Read the full paperFree author manuscriptDOI 10.1136/vr.h5653No reuse licence
What practices find when they are given somewhere to report, how meetings turn incidents into learning, and how routinely kept records can surface safety signals on their own.
- Categorising reported errors and incidents from morbidity and mortality meetings (M&Ms)
Researchers retrospectively analysed de-identified summaries from five years of morbidity and mortality meetings (2018–2023) at an Australian small animal teaching hospital, covering 68 cases. The most common error categories were oversight (25.0%), drug errors (19.2%), and iatrogenic and staffing errors (16.3% each). Just over half of cases resulted in temporary harm, but 20.6% ended in death, euthanasia or permanent harm. The most frequent recommendations were better communication and record keeping, more staff training, and ensuring the right equipment was available. The authors show that this categorisation can be shared usefully without breaching the confidentiality on which M&M meetings depend.
Read the full paperDOI 10.1111/avj.13426CC BY-NC-ND
- Developing electronic health records as a source of real-world data for veterinary pharmacoepidemiology
Spontaneous reporting by veterinary professionals is the foundation of drug safety surveillance, yet most adverse events are never reported. Using electronic health records from the SAVSNET first-opinion network, this proof-of-concept study investigated five drug–adverse event pairs, identifying drug exposure from structured treatment data and the adverse events from unstructured free-text clinical notes. Purpose-built dictionaries became more precise once expanded using word vectorisation and expert review. Because these datasets support cohort studies, they allow absolute incidence and relative risk to be calculated, which spontaneous reports alone cannot provide.
Read the full paperDOI 10.3389/fvets.2025.1550468CC BY
- Developing consensus for definitions of key veterinary-specific quality improvement terms
A panel of 50 UK veterinary practice stakeholders worked through a four-round modified eDelphi process to agree plain-English definitions for quality improvement terminology. Of 14 terms, consensus was reached on 10, with four left unresolved. Ninety per cent of the agreed definitions were new or amended versions proposed by panel members rather than adopted wholesale from human healthcare. Shared vocabulary is a precondition for quality improvement taking hold, which is why this fairly dry paper matters more than it first appears.
Read the full paperDOI 10.1002/vetr.1174CC BY-NC
- Type and impact of clinical incidents identified by a voluntary reporting system covering 130 small animal practices in mainland Europe
This analysis covered 2,155 incident reports submitted voluntarily by 130 small animal practices across mainland Europe. Incidents caused harm in more than 40% of reports. Medication-related incidents were the most frequently recorded type at 40%, treatment-related incidents most often caused harm at 55%, and anaesthesia-related incidents were the most severe, with 18% ending in the patient's death. Most reports came from hospital wards, and cats were harmed significantly more often than dogs.
Read the full paperDOI 10.1002/vetr.1629CC BY-NC
- A survey of veterinary professionals in Sweden: adverse event reporting and access to product safety information
Sweden's Medical Products Agency surveyed 412 veterinarians and licensed veterinary nurses about how they report suspected adverse drug events. Although most respondents complied with the legal requirement to report directly to the agency, not every adverse event they observed was actually reported, and estimates suggest that over 90% go unreported generally. Respondents said reporting needed to be quick and easy, ideally built into the electronic medical record, and that feedback after reporting mattered to them. The authors note that nursing staff are an underused route to improving reporting rates.
Read the full paperDOI 10.1002/vro2.18CC BY
Whether people feel able to raise a concern or admit a mistake, how leadership behaviour shapes that, and the ethical pressures practitioners describe.
- 'Just part of the job': understanding work-related injuries and safety culture in companion animal veterinary practices
A survey of 647 UK veterinary employees found that 77.6% had been injured at work during their career, with 60.2% of nurses and 58.3% of veterinarians injured in the previous year alone. Animal-related injuries were the most common type, occurring most often during cat restraint, anaesthetic recovery and clinical examinations; needlestick injuries made up 15.8%. A quarter of vets needed more than a week to recover, yet fewer than 10% took any time off, citing a sense of duty, the extra workload it would create for colleagues, or simply wanting to get on with it. Most injuries went unreported, which the authors characterise as a poor safety culture marked by presenteeism and the downplaying of risk.
Read the full paperDOI 10.1111/jsap.70039CC BY
- Understanding error culture in veterinary medicine: a survey among veterinarians across German-speaking countries
This survey of 1,102 practising veterinarians across German-speaking countries is the largest study of veterinary error culture to date. More than three-quarters (78%) had been involved in at least one incident where an animal suffered permanent harm or died, and 68% had disclosed an error of their own. Time pressure, a hectic working environment and inexperience were consistently named as the factors behind errors, whatever the respondent's vantage point. Over half said no formal reporting system existed where they worked, 75% dealt with errors through one-to-one conversations, and only 4% reported having anonymous reporting available.
Read the full paperDOI 10.3389/fvets.2026.1784869CC BY
- Understanding error culture in veterinary medicine: a survey among veterinary support staff
The companion study to the veterinarian survey, this captured 205 veterinary support staff across German-speaking countries, a group almost entirely absent from the patient safety literature. Errors were most often linked to billing, team interaction, and handling or restraining animals, with time pressure, high workload and communication problems named as the main contributing factors. While 68% said they spoke up openly in everyday work, 31% felt safe to report an error only sometimes, rarely or never, and 16% admitted deliberately not disclosing an error. Fully 81% said no structured error management system existed in their workplace.
Read the full paperDOI 10.3390/vetsci13030265CC BY
- Hospital safety culture in Australia: a nationwide survey using a safety attitude questionnaire
A nationwide survey of 669 Australian veterinary care professionals used the Safety Attitudes Questionnaire to measure six dimensions of safety culture: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions. Positive responses were highest for stress recognition (63.4%) and lowest by a wide margin for working conditions (25.4%). Managers reported significantly more positive attitudes than veterinarians and nurses across several dimensions, including teamwork climate and perceptions of management. The gap between how leadership and floor staff experience the same workplace is the study's central finding.
Read the full paperDOI 10.1111/avj.13474CC BY
- Navigating veterinary error disclosure: humble leadership and safety attitudes in Australian practices
This cross-sectional Australian survey measured humble leadership, psychological safety, safety climate and attitudes towards disclosing errors. Hospital directors rated both their own humble leadership and psychological safety highest, while safety climate was viewed more positively by full-time employees and those in teaching hospitals. Humble leadership and psychological safety were strongly correlated, and both independently predicted positive attitudes toward error disclosure. The practical implication is that whether people own up to mistakes depends heavily on how their leaders behave.
Read the full paperDOI 10.1002/vetr.5816CC BY-NC-ND
- Ethical challenges experienced by veterinary practitioners in relation to adverse events
This qualitative UK study drew on 12 focus groups and 20 interviews with veterinary practitioners about the ethical difficulties surrounding adverse events. Before an event, practitioners found it ethically hard to navigate acceptable boundaries of care, decision-making autonomy, their own scope of practice, how to use evidence, and whether to speak up about safety concerns. Afterwards, the challenges shifted to questions of appropriate accountability, how to communicate with owners, and how to prioritise emotional and technical support for themselves and colleagues. The authors argue that patient safety strategies will not work unless they address these ethical pressures directly.
Read the full paperDOI 10.1002/vetr.3601CC BY-NC-ND
- Assessment of Safety Culture at a Veterinary Teaching Hospital in the United States
This study adapted an existing veterinary safety culture questionnaire for a US academic hospital and surveyed faculty, house officers and professional staff confidentially online. Factor analysis showed the adapted instrument held together well, though the groupings differed slightly from the original. Respondents were broadly positive about safety culture across most domains, with specific weaker areas identified for improvement. The paper is useful mainly as a validated starting point, giving other US hospitals a tested instrument and baseline data to measure themselves against.
Read the full paperDOI 10.3389/fvets.2021.638764CC BY
What happens to the clinician after an incident, why the effects persist, and which forms of support people actually want.
- 'You're not a good vet if things go wrong': the dark side of veterinary identities
This qualitative study drew on 51 interviews with 39 vets in a UK small animal group, asking them to talk about difficult cases and perceived mistakes. It examines the 'feared identity', meaning the picture of yourself as flawed, failing or failed, that sits behind the professional identity vets aspire to. Most vets externalised blame for apparent misdeeds, but some described unrelenting self-blame, and the study shows how these feared identities drive self-denigration. The authors suggest that critically examining professional and organisational norms could create environments where vets recover from difficult experiences rather than being defined by them.
Read the full paperDOI 10.1002/vetr.71022CC BY
- Peer support after clinical incidents: adopting the RISE program
RISE (Resilience In Stressful Events) is a peer support programme developed for human healthcare, in which trained responders focus on the emotional care of the person rather than the details of what went wrong. This study tested whether it transfers to veterinary settings and found it both acceptable and feasible, needing only minor adaptations such as veterinary-specific examples. Unlike most of the literature, which documents the problem, this is a study of something that might fix it. The authors argue structured support systems like RISE could improve mental health and retention as well as care quality.
Read the full paperDOI 10.1371/journal.pone.0341324CC BY
- Assessment of support structures for second victims in veterinary anaesthesia: building on insights from an international survey, Part 2
The follow-up to Part 1, using the same 303 respondents to ask what support actually exists after an incident and what people want instead. A quarter said incidents are never discussed in their department, 35.3% found the culture at morbidity and mortality meetings negative, and immediate 'hot debriefs' were used by only 37.7%. Over half felt their organisation offers inadequate resources for recovery, and 26.5% felt supervisors tended to blame individuals. What people wanted was modest and specific: a respected peer to talk to (86.3%) and a quiet place to do it (70.5%).
Read the full paperDOI 10.1016/j.vaa.2025.03.016CC BY
- Personal resilience, good leadership, and a psychologically safe culture mitigate the impact of patient safety events
This survey of 2,182 US veterinary professionals, including veterinarians, technicians, assistants, client service staff and managers, measured second victim experience, resilience and team psychological safety. Most respondents had been involved in at least one patient safety event in the previous 12 months, with the highest rates among veterinarians (79%), managers and directors (74%), and veterinary technicians (67%). Roughly half of the veterinarians, technicians and assistants involved in an event said at least one had caused serious harm. Personal resilience, good leadership and a psychologically safe team all reduced the personal toll these events took.
Read the full paperDOI 10.2460/javma.24.09.0620CC BY-NC
- Psychological, physical, and professional impact on second victims in veterinary anaesthesia: a cross-sectional international survey, Part 1
This international survey reached 303 veterinary anaesthetists, trainees and nurses across 31 countries, and 70% had encountered a patient safety incident in the previous six months alone. The aftermath was widespread: 62.7% reported fear of further incidents, 56.1% diminished confidence, 46.7% practising more defensively, and 43.3% sleep disturbance. Around 69% questioned their own competence and their ability to care for animals. About 38% had considered leaving anaesthesia altogether, and more than half had thought about leaving their job because of the stress.
Read the full paperDOI 10.1016/j.vaa.2024.10.140CC BY-NC-ND
- Understanding veterinary practitioners' responses to adverse events
This mixed-methods study combined 12 focus groups and 20 interviews with a natural language analysis of 572 posts written by veterinary professionals in a members-only Facebook group about their involvement in adverse events. Practitioners' responses broke down into experiencing stress, externalising facts and feelings, morally contextualising the event, and using it to drive personal and professional improvement. Compared with posts about euthanasia or health certification, adverse event posts showed lower authenticity scores and more moralising, future focus and interpersonal conflict. The authors suggest that peer-to-peer reflection helps prevent normal distress from tipping into something pathologised, but that the gap between wanting to be open and actually being open still needs work.
Read the full paperDOI 10.1371/journal.pone.0314081CC BY
- Veterinary healthcare needs to talk more about error
This commentary makes the case that the same errors that harm patients also harm the clinicians involved, and that handling incidents with empathy benefits both. The authors walk through a real case of a serious medication error and how it was managed, using it to illustrate what a system-based approach to improvement actually looks like in practice. They set out what a strong safety culture requires: risk is acknowledged, people can report without fear of punishment, and the organisation commits to fixing the system rather than the individual. It is a good orientation piece for anyone new to the topic.
Read the full paperDOI 10.1111/jvim.16554CC BY
Evidence on surgical and anaesthetic checklists in veterinary practice, including what happens to infection rates and why implementation is harder than design.
- Surgical safety checklists in UK veterinary practice: current implementation and attitudes
This survey of 513 UK veterinary professionals found that 70% used surgical safety checklists. Among those who did, 87.1% used one for every surgical procedure, 61.1% had a written standard operating procedure covering their use, and 19.1% adapted the checklist for different procedure types. Practices that did not use checklists were more likely to be outside the Practice Standards Scheme, to lack RCVS hospital status, or to be mixed first-opinion practices. It gives a clear national baseline for where checklist adoption actually sits.
Read the full paperDOI 10.1002/vetr.2484CC BY-NC
- Effects of a surgical checklist on decreasing incisional infections following GI foreign body removal in dogs
Two groups of dogs undergoing surgery for gastrointestinal foreign body removal at a single US hospital were compared: 201 operated before a surgical checklist was introduced, and 101 consecutive cases operated with one. The five-step checklist covered giving antibiotics before the first incision, scrubbing the incision, placing a second drape before entering the gastrointestinal tract, changing gloves once the gut was closed, and using a fresh pack and table for abdominal closure. Surgical site infection fell from 19.9% to 11.9%, a statistically significant reduction. Combined gastrotomy and enterotomy, enterotomy alone, and known self-trauma were all significant predictors of infection. Five of the six dogs that licked or chewed at their incision developed one.
Read the full paperAll rights reserved
- Development and implementation of a perianesthetic safety checklist
A panel of anaesthesia specialists, residents and doctoral students used a Delphi process to build a three-part perianaesthetic checklist covering sign in, time out and sign out, modelled on the WHO surgical safety checklist and introduced over five weeks at a small animal hospital. Six months on, direct observation of 69 cases showed the checklist was printed in only 32% and used in 41%. Of those surveyed, 14 of 19 thought it improved communication and 15 of 19 reported better patient management; 9 of 19 said it had prevented mistakes, with 77% of those relating to omitted antimicrobial prophylaxis. A second push three months later improved sign-out compliance significantly, a useful illustration that implementation rather than design is the hard part.
Read the full paperDOI 10.3389/fvets.2018.00060CC BY
The two error types that recur most across the literature: getting the drug wrong, and getting the interpretation wrong.
- Editorial: Monitoring and reducing errors in veterinary radiology
A short editorial introducing a collection on error in veterinary radiology. It frames diagnostic error as an inherent feature of radiological practice rather than an aberration, arising from perceptual or cognitive failure, from methodological and technological limits, or from systemic pressures such as workload. Diagnostic error is barely represented elsewhere in the veterinary patient safety literature, which makes this a useful orientation piece. Being an editorial, treat it as a starting point rather than primary evidence.
Read the full paperDOI 10.3389/fvets.2026.1805635CC BY
- First opinion practice electronic health records are a useful source of descriptions of medication errors
Researchers searched UK first-opinion electronic health records for evidence of medication errors, flagging 6,665 records automatically, reviewing 2,847 by hand, and confirming 1,023 as genuine medication errors. Of those, 29.5% caused mild harm to the patient, 2.8% moderate harm and 0.2% severe harm. Errors clustered at the administration stage (51.4%), and within that, dosing errors dominated at 68.1%. The wider significance is methodological: it shows that records practices already keep contain a detectable signal about patient harm, without anyone having to file a report.
Read the full paperDOI 10.3389/fvets.2025.1560652CC BY
- Medication errors in veterinary anaesthesia: a literature review
This review pulls together what is known about medication errors in veterinary anaesthesia, a setting recognised in human medicine as carrying unusually high medication risk. It separates general contributing factors such as distraction, fatigue, workload and supervision from those specific to anaesthesia, including the need to calculate doses by body weight, giving several drugs in quick succession, and preparing syringes in advance. Medication errors are among the most commonly reported errors in veterinary medicine generally. A good single entry point to the medication safety literature.
Read the full paperDOI 10.1016/j.vaa.2024.01.003No reuse licence
Communication failures inside the team as well as with clients, and what owners say they want when something goes wrong.
- German cat and dog owners' views on veterinary error handling
This qualitative study interviewed 23 German cat and dog owners about their experiences of perceived errors in their animals' veterinary care. Owners described feeling helpless, uncertain and anxious when they believed something had gone wrong. What they wanted was open and honest communication, empathy, and to have their concerns taken seriously rather than deflected. It is the only paper in this library that captures the client's perspective directly, which makes it a useful counterweight to the profession-facing research.
Read the full paperDOI 10.3390/ani15202981CC BY
- Uncovering the 'messy details' of veterinary communication
This study examined written records from 100 settled cases of alleged veterinary professional negligence involving dogs, analysing them thematically and triangulating with input from Veterinary Defence Society claims consultants. Communication problems played a contributory role in 80% of the cases examined. The problems that showed up most often were ones the existing literature underplays: communication within teams rather than with clients, and the way communication interacts with the wider working environment. The authors argue effective communication is a collective competency that systems achieve, not something individual clinicians can be trained into on their own.
Read the full paperDOI 10.1002/vetr.1068CC BY-NC-ND
How patient safety is taught, and what students carry into practice with them.
- A human factors and systems-thinking approach to veterinary patient safety education
This teaching paper argues for building human factors and systems-thinking principles into veterinary curricula, shaping not only what is taught about patient safety but how it is delivered. The authors set out a two-stage curriculum mapping process to help educators embed these principles as a habit of thinking for students and faculty alike. They are candid about the barriers: inconsistent terminology, substantial faculty development needs, assessment difficulties, and existing regulatory and licensing requirements. It is the clearest available statement of the systems-thinking frame applied to veterinary education.
Read the full paperDOI 10.3138/jvme-2024-0009All rights reserved
- Medical errors: experiences, attitudes and perspectives of final-year veterinary students in the USA
This survey compared incoming and outgoing final-year students at Washington State University. Among the 70 respondents, 85.7% had been present during a medical error and 60% reported having caused one. Outgoing students agreed less strongly that errors should be documented in the patient record or that all errors should be disclosed, while incoming students felt more distress about the career implications. The two groups also framed error differently: outgoing students saw it as something actionable, incoming students as something emotional. The authors conclude that students need clearer teaching on disclosure and documentation before graduation.
Read the full paperDOI 10.1002/vetr.1735CC BY-NC-ND
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Last verified 8 August 2026.
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