When Routine Becomes Risk: Medication Safety in Everyday Veterinary Practice

April 2026
In this VETgirl online veterinary continuing education blog, Sarah Ambrose-Kuhl, Manager of Medical Quality with BluePearl Pet Hospitals, discusses how routine practices can become risky and the importance of implementing strategies to maintain medication safety in everyday veterinary practices. Mistakes can happen. Learn ways to reduce their occurrence!

By Sarah Ambrose-Kuhl, Manager of Medical Quality, BluePearl Pet Hospitals

I’ve always been one to gravitate towards just a little bit of chaos at work, participating in a CPR code or accepting the challenge to get the hemoabdomen patient into surgery as quickly as possible. But if we think about our regular days in veterinary medicine, they are far more mundane, consisting of tasks that can feel monotonous and routine. We’ve all heard the jokes that more mistakes are made on our ‘slow days’, when we’re just moving through the motions. But routine tasks in the veterinary hospital can quickly become vulnerabilities. Medication safety is one of those areas where our everyday responsibilities can quietly become risky if appropriate and effective safeguards aren’t in place. Medication mistakes may arise from communication gaps, unclear labels, limited drug availability, and fast-paced environments that stack against us. Research in both human and veterinary medicine continues to demonstrate that medication errors are among the most common types of medical mistakes, revealing that this is not an isolated problem and that our workflows need stronger safeguards. While these errors may not result in the most severe harm for our patients, they are the most frequent in occurrence.

The “5 Rights” of medication safety principles are taught throughout school and may even be posted on your hospital bulletin board, but in a clinical setting, medication administration is more complex than it seems on paper. The pathway for a drug to reach a patient is complex and involves many steps. A drug must be prescribed, prepared, dispensed, administered, and then monitored for effect. And this complexity allows for multiple areas in the process to go wrong. It’s our responsibility to put systems and safeguards in place to prevent these missteps from ever reaching our patient. When we improve how medications move through our hospital, we can reduce the chance of errors before they happen.

But thinking outside of our workflows, the medication itself can even pose a risk. Drugs with similar names, similar packaging colors, or multiple strengths are easy to confuse. We typically pull up multiple vaccines at one time making it easy to administer one using the wrong route or location. Other medication risks can come from our environment as team members are multi-tasking, rushing, or just tired. We know that incorrect doses can be given due to misinterpreted or misheard prescriptions orders or the wrong patient receives a drug because there are two patients named “Bella”. Medication mistakes are not the result of people who don’t care, they are caused by gaps in the system that make the right action difficult to complete. As we think about coworkers involved in medication errors, we also need to take into consideration their well-being, knowing that the feeling of responsibility when involved in a medical error takes a toll on our mental health.

Image courtesy of Sarah Ambrose-Kuhl, CVT

A safety-forward pharmacy would offer minimal distractions, clear role responsibilities, and organization of drugs to minimize risk. Rather than overwhelming yourself as you stand in front of your open drug cabinets, I would recommend starting with small, achievable goals. You might begin by choosing to focus on only high-risk drugs that have a low margin of safety. This would include different insulin formulations, potassium chloride vials, or controlled drugs. Another area of focus could be a specific error that seems to repeat itself in your clinic – like species-specific medications being mixed up. You could even choose to focus on a single drug, perhaps the incorrect dose of gabapentin being dispensed is common. Identifying which area you would like to focus on allows you to break down what the workflow looks like from start to finish. Taking a critical angle, asking questions, and gaining a variety of perspectives can allow you to identify the cracks in the process. Once we find those cracks, we can begin to identify what to fix!

Here are examples of actions that may help improve medication safety. This is not a checklist to be completed but is a list of ideas that you can select from and adapt to meet your clinic needs.

• Use ‘High Alert/Caution’ labels on drugs with a low margin of safety
• Have a fellow team member independently double check high-risk drug dosage
• Use dog/cat stickers to identify species-specific medications
• Store look-alike or sound-alike drugs physically apart from one another
• Separate vaccines by species or route on different fridge shelves
• Leverage bins, dividers, and visual alerts when separation is not possible
• Never administer an unlabeled syringe
• Assign one person each day to manage drug dispensing
• Create a pharmacy quiet zone to allow for counting and calculations
• Avoid verbal orders (lovingly known as ‘air orders’)

Image courtesy of Sarah Ambrose-Kuhl, CVT

Once you’ve selected your area for improvement and executed your action items, remember that any changes made on the floor should be tracked to gauge effectiveness. A simple approach is to set a reminder for 15 days or 30 days after a change is introduced and touch base with those using the new system frequently. Much of our continuous improvement in patient safety and medication safety follows the pattern of the Plan Do Study Act (PDSA) cycle. We try something, evaluate it, and then we refine it. We can plan and make changes, but if we’re not coming back to assess and adjust those changes, we may unintentionally be creating more difficult and inefficient workflows for our teammates—something that may trigger disengagement. The importance of the follow up is critical for continued collaboration and shared learning on the clinic floor.

Image courtesy of Sarah Amrose-Kuhl, CVT

As the medication safety conversations start, it’s the perfect time promote the importance of an overall culture of safety within our workplace. A safe workplace is one where associates can discuss mistakes without the fear of punishment. Medication-related errors are by far the most common incident in veterinary medicine, and open conversations will help us strengthen our systems and protect our patients. If we can provide an environment where associates are comfortable talking about these mistakes, we can improve both our systems and patient care. As we take on the challenge of organizing our pharmacy area, we must simultaneously promote a no-blame mindset and recognize that when an error happens, it’s the system, not the individual, that we need to examine. This is exactly where we can strengthen the culture of safety in veterinary medicine.

References

Wallis J, Fletcher D, Bentley A, Ludders J. Medical Errors Cause Harm in Veterinary Hospitals. Front Vet Sci. 2019;6:12. doi: 10.3389/fvets.2019.00012.
Larson M, Low R, Adler JA, et al. Patient safety events cause harm across a variety of veterinary care settings: a global retrospective analysis. J Am Vet Med Assoc. 2025;263(7):1-9.