Embracing the power of checklists with Stephen Cital

What do two pain-management and anesthesia experts talk about when they get together? It all starts with checklists. Tasha McNerney interviews Stephen Cital about how the field has changed from the old-fashioned belief that “animals don’t feel pain” to where we are today.


In veterinary medicine, at the intersection of research and practical applications in pain management, you will often find veterinary technician specialist Stephen Niño Cital RVT, RLAT, SRA, CVPP, VTS- LAM (Res. Anesthesia). A fierce advocate for elevating the standard of care for patients and technical staff, alike, Stephen isn’t afraid to push necessary conversations into new territories (usually because he has the data to back that s**t up).

Stephen has been instrumental in advancing practical approaches to pain management and, together with AAHA, has released a series of checklists to help everyone in the practice recognize and treat pain in more effective ways. I recently sat down with Stephen to talk about these new resources—and more, of course—since we’ve been friends for more than a decade.

Tasha McNerney:  Why do you personally think checklists are a valuable tool when it comes to anesthesia safety? 

Stephen Niño-Cital: Well, if you’re like me and have severe ADHD, checklists are extremely helpful to make sure all the details are taken care of. And even if you aren’t like me, checklists have been proven in many human healthcare studies to decrease errors and improve quality of care. 

TM: You and I both meet a ton of folks from all over, from a wide variety of clinics. In vet med we do seem to lack consistency, and unfortunately there’s no hard rule saying folks must fill out an anesthesia monitoring sheet—but why do you think they should? What usually stops them from filling one out, especially when it comes to patients that are “just under sedation?”

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SNC: I’m going to push back a little bit and say that there may not be many well-understood or defined requirements to keep an anesthetic monitoring sheet across the nation, but we have seen in the last decade veterinary medical boards evolve on what is deemed “appropriate medical records.”

Monitoring the patient with a record of events is also very helpful in the event something less than optimal was to occur, not only from a legal standpoint, but also to learn from for future events. 

TMc: Another cool thing is the In-Home Pain Assessment forms are translated into Spanish: Why was this a labor of love for you? How will this expand access to care?

SNC: I must give credit to my husband Camilo Moor Niño for the translations—my Spanish is a bit rough still. I did want to include this sheet in Spanish though (and hopefully many other languages) because we never know how well our clients understand the huge amount of information given to them. This is especially true if English is not their first language or preferred language at home. Whenever possible we should try and meet people where they are. I’m hoping this Spanish version does that and increases the level of care for their pets.

TMc:  We have been friends and colleagues for so long—almost 12 years! We have literally traveled across continents together in the name of progressing pain-management practices. How have you seen pain management improve over the lifetime of your career?

SNC: I came into this professional on the tail end of “animals don’t feel pain” and “we need pain to make them stay quiet.” So, thankfully, a lot [has improved]. I still hear this bogus assertion from time to time, but I am happy that we have so many more studies available disproving this thought process and giving us options to treat pain in animals. We also have awesome educational initiatives spearheaded not only by veterinarians—but people like you, Tasha McNerney! If I recall correctly, you are the person behind September being Animal Pain Awareness month?

TMc: OK, true. I did have a hand in that initiative. It’s amazing that now it’s like a real thing and hopefully increasing awareness of signs of animal pain. What are some of the more recent advances in pain management that you are most excited about?

SNC: There are a handful that stick out to me: One is the creation of validated pain scoring systems for various species to help us better recognize pain in animals. 

Others would be things like NOCITA (liposomal encapsulated bupivacaine) and the use of integrative techniques like plant-based medicine (cannabinoids) and physical rehabilitation. I don’t have a ton of experience with anti-NGF drugs yet, but I do think these types of medications will help in really difficult-to-manage chronic pain cases.

TMc: I love your candor and have told you this on several occasions. Why do you feel it is important to speak up against the status quo in vet med? Have you seen any positive changes come from it?

SNC: Oh boy! Thank you for using the term “candor” instead of some other words people throw at me from time to time. I understand being honest and direct can be uncomfortable, it still is for me sometimes depending on the situation and person. However, I do think practicing radical candor is critical to keep things moving in the right direction, or when correcting something that is just plain wrong.

With that said, I do think many people still need to learn what radical candor and constructive feedback is, and to not be so defensive all the time. I think part of my success is taking that feedback and learning from it. It’s often not personal. But I get it, veterinary staff put up with so much that we can be a bit emotionally triggered, or as my brilliant friend Melody Martinez might say “activated.” So yes, to answer your question I do think it is very important to speak up.

When speaking up, we also must do so appropriately. I have learned over the years how to do this better, but I am still definitely a student. There will be times where a simple kind email or text message will work, or sometimes a more assertive approach is needed like calling someone or something out—which may include a more public forum—but only after exhausting direct methods.

I know this terrifies so many veterinary colleagues. When I was younger, I had colleagues try to parent me and say, “we shouldn’t do that to each other as veterinary professionals.” What I say to that is: Malarky! Nowadays I speak with intention—intention to stop bad medical practices or false information, to stop inadvertent harm to animals, and to hold people and organizations accountable. We see all too often things being let go to avoid discomfort or conflict, which only perpetuates or even, in a sense, endorses bad behavior. I’m not here for it anymore.

See samples of Stephen’s new series in the AAHA Store, including:

Stephen Niño Cital is a multi-credentialed veterinary technician specialist with a passion for anesthesia, pain management, and cannabinoid medicine. He has authored multiple articles and contributed to several textbooks, including acting as the lead editor for the first cannabinoid medicine textbook, titled Cannabis Therapy in Veterinary Medicine by Springer Nature. He serves on multiple boards and is a strong advocate for veterinary technician advancement along with minority representation. Stephen’s primary leadership roles are the COO of the Veterinary Anesthesia Nerds and Executive Director for the Academy of Laboratory Animal Veterinary Technicians and Nurses. He is a lab manager at Stanford University in the department of neurobiology in addition to a clinical pain practitioner and partner at Remedy Veterinary Specialists. For more information, please see www.StephenCital.com.

Tasha McNerney BS, CVT, CVPP, VTS (Anesthesia and Analgesia) is a certified veterinary technician from Glenside, Pennsylvania. She is also a certified veterinary pain practitioner and works closely with the IVAPM to educate the public about animal pain awareness. McNerney has authored numerous articles on anesthesia and analgesia topics for veterinary professionals and pet owners.

Photos courtesy of Tasha McNerney and Stephen Cital

Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.

 

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