Routine admittance...

Re: Routine admittance...

Bethany Leonard - Williams RVN — Tue, 07 Apr 2009 15:17:20 GMT

Ok our S.O.P for admits are : all patients are admitted between 8am - 8.30am, we have admit forms with the exact procedure and all legal bumf on it and estimate for the procedure that the client is asked to read and we expalin the costs and go through the procedure again to make sure they know what we are doing whit thier pet, we recommend pre-anaesthetic blood on any patient over the age of 2 - we have also come across some surprising results on young animals by this basioc screening - we weigh, TPR all patients and get vet to double check once they arrive at 8.30/9am - most patients have been seen eiher the day before or within a few days for complete check over (except perhaps elective neuters) all patient have iv catheters placed prior to pre-med (if they allow us that is ) - that is how we are supposed to do it - but obviously we take each patient as they come and adjust what needs to be done accorind to individual needs.

Re: Routine admittance...

Cat Woman — Mon, 06 Apr 2009 21:18:44 GMT

He sounds like a joy to work with!!

Re: Routine admittance...

Jax — Mon, 06 Apr 2009 21:02:12 GMT

Yeah he is an older style vet (which explains alot), wouldnt have nurse/ vet meetings as we have enough trouble with our practice meetings, he throws all his toys out of the pram, and gets louder and louder, talks faster and faster and ignores everyone if you dont completly agree with anything he says... He does not give anyone a chance to express their opinion and even if he does shut up for 5 seconds he buts in and shouts you down!! All while the boss is sitting there just ignoring the fact he is being rude to all the other members of staff.

But despite all that, we are standing our ground!! Thanks!

Re: Routine admittance...

Zoe Archer — Mon, 06 Apr 2009 15:06:16 GMT

Is this vet old by any chance??? could you maybe suggest having a nurse/vet meeting thats what we do in our practice to talk through underlying issues or alterations that need to be made to the day. You are doing your job well and are being very thorough so don't back down or feel pressured. He will have to wait and thats that. It sounds like his heart isn't in the job and its his duty as a vet to ensure that all animals are checked thoroughly and now that we are regulated you should definately stand your ground.

Re: Routine admittance...

Jax — Wed, 25 Feb 2009 22:10:58 GMT

Hey ST... i would love to say that to him, will let you know when/if i do!!

And thankyou Paula (SaskiaVN) I will keep at it!!

Re: Routine admittance...

starbucks — Wed, 25 Feb 2009 18:28:50 GMT

We admit patients between 8.30 and 9.40am at ten minute intervals, the vet is on site from 8.30. Our admit includes weighing the patient. We reccommend pre op bloods in every patient over the age of 8, most clients agree, if i had my way we would pre op bleed alot more patients, not just the senior ones! whilst the surgical and non surgical nurse admit their patients, the blood nurses take pre op bloods and run them. When the vet has finished consulting, he will do a pre op check on each patient including HR, RR, and look at blood results, assess if need fluids, ring owners if neccessary etc. according to the vet we pre med patients as and when they say. I think our system works really well and luckily we havent had an arsey vet trying to rush us or say we are delaying them!!!

Re: Routine admittance...

Sandra Taylor RVN, MBVNA — Wed, 25 Feb 2009 17:45:06 GMT

Just tell him you would never dream of telling him how to do his job, and would like that same courtesy regarding yours

Re: Routine admittance...

Emma Clark — Tue, 24 Feb 2009 23:10:16 GMT

We admit from 8-30 until 9. This is meant to be for routine procedures or animals that have seen the vet within the last few weeks. We weigh them, tpr, go through the consent form, offer pre-op bloods. Aninmal then goes into a kennel, bloods are taken if 'o' has agreed. Vets turn up at 9. All animals admitted by a nurse are checked by a vet before we give any pre-meds so will have 2 tpr's done. Vet admits the rest of the ops from 9-9.30. We try and premed the first few routine procedures as soon as possible so they are ready when the vets comes through at 9.30.

Re: Routine admittance...

Saskia Quinn — Tue, 24 Feb 2009 23:02:28 GMT

Every single patient that comes in to the practice, even for routine surgery, sees the vet. Once they are admitted to kennels, they are 'mine' so to speak, as I know the vet will have done the tpr and listened with stethescope etc. At 9.30 I pre-med the first op (at my own discretion) Normally a cat castrate is knocked at the same time as a bitch spay is pre-med'd etc. This is always the way it has been in my practice so I am happy to continue doing so as I am either in work at 8.30 or 9am. If 8.30 I do kennels, if 9am I start doiing pre-meds. If there is an animal requiring a pre ga profile, then I often have to wait until the consulting vet is free as he will be the one doing the surgery as I can't take bloods on my own or sometimes if I am lucky, I will grab one of the other vets before they go on call.

Jax, I would say continue to do what you do best and if the said vet is not happy - tough. Its a close call, as Sal said between a dead animal that could have been prevented and by doing pre anaesthetic/general health profile to start with. You keep at it girl, its obvious you are doing a great job!

Re: Routine admittance...

Fiona Leathers — Tue, 24 Feb 2009 22:42:48 GMT

I am the only nurse, receptionist, cleaner..........I sometimes have students but they don't start til after the admits. We've not been open that long & its not feasible to have another full time member of staff, yet!!

When I've got students I would like them to do TPRs but sometimes there just isn't time or they're not capable or the patient isn't helpful!!

Re: Routine admittance...

Jax — Tue, 24 Feb 2009 22:38:59 GMT

Bouncyfi, you hit the nail on the head there... all he wants to do is op and go home!! Are you the only nurse in the practice??

And yes i will stand up for what i believe in.... Consider foot down... probably untill vet screams and shouts... but will try!! Hehe!!

Re: Routine admittance...

Fiona Leathers — Tue, 24 Feb 2009 22:34:55 GMT

I would love to do TPR for every patient but there's only me admitting, answering phone, reception etc etc so you can only do what you can manage.

Generally I would admit, weigh, kennel - IF there are another pair of hands I would take bloods. I don't pre-med until the vet is on the premises.

If the vet doesn't like pre-an bloods then tell them to stop offering them!! The practice will lose money & the vet can get the sack! At the end of the day, it is their responsiblity to ensure the practice makes money & if they're not happy about doing the work, then they should be in different job. They should be concerned over the welfare of the animals not just wanting to get finished up & away!

Re: Routine admittance...

Steph Worsley — Tue, 24 Feb 2009 22:29:40 GMT

in normal practice on admittance i would always do tpr etc you never know if they are starting with something..the only times i didnt were if the vet had seen them literally the night before and did it all.

i always offered bloods but it was down to the client..obv higher risk groups it was strongly advised!

I would carry on doing it no matter what, i'm sure the surgery would prefer you taking the extra time to do x, y and z than ending up having to face the RCVS after complaints from clients when something went wrong which could have been avoided with routine checks! Plus if you are RVN you need to stand up for what you believe.

Re: Routine admittance...

Jax — Tue, 24 Feb 2009 22:28:12 GMT

Hi Jenny T....

We also admit from 8.30-9, Theatre nurse is in at 8.15 and ward nurse at 8.30... The practice are not happy to pay us anymore to come in earlier which is ridiculous!!!

Basic nursing... thats exactly it... even the head nurse said no cause she does not want to deal with the vet chucking his toys out the pram!!!

I think im just going to start putting my foot down as as you said either ignore him or just say im doing this and will be with you once i have finished!!

Thanks for your advise! X

Re: Routine admittance...

Toni — Tue, 24 Feb 2009 22:25:18 GMT

The animal will see the vet prior to a GA if it has not been seen for +6 months. But usually we go through admit form, animal goes to prep area, preop check by RVN with p/o bloods and IVF if requried (advise it on everything but strongly on senior), then vetergesic and into a kennel. We plan the ops list for the vets and then start premeding with ACP/ Diazepam/ or whatever is needed 20 mins prior to induction.

I agree with mention MONEY ££$$$ as this quite often works with my boss.

Re: Routine admittance...

Jenny T — Tue, 24 Feb 2009 22:23:43 GMT

TPR and weigh everything admitted. It's basic nursing. Bloods, iv fluids etc as necessary (and I would do bloods on all g/a's in an ideal world).

We have picked up so many problems over the years from these basic health checks- some potentially very serious.

Your clients expect this basic level of care for their pets, and it only takes a few minutes to do. I've also had the odd vet who felt they were being delayed. Just ignored them. It's me who would carry the guilt if something went wrong and I knew I didn't pick it up because I had not done my job properly.

Maybe you could do your admits a bit earlier? We admit 8.30am - 9am. Vets arrive from 9am.

Re: Routine admittance...

Jax — Tue, 24 Feb 2009 22:19:16 GMT

Haha.. Sal thats a really good point... will mention that next time!! X

Re: Routine admittance...

Sal the 1st — Tue, 24 Feb 2009 22:16:11 GMT

well if they cant see that this is important (rather have a live animal with a known problem than a dead one with a 'killer secret') you could try pointing it out another way - i/v catheters, bloods and subsequent treatment if there is any required all generate income.. from experience the mention of money usually tips the argument in your favour!

Re: Routine admittance...

Nick Shackleton — Tue, 24 Feb 2009 22:13:26 GMT

Hi there.

I perosonally think pre-op checks are a good idea. We admit the animals, weight them. An itern then gives them a clinical exam prior to pre-med. We only do bloods if adviced by the vet in charge of the case.