Admitting Patients

Re: Admitting Patients

Jill Macdonald — Tue, 19 Aug 2014 14:32:10 GMT

I love it when these old topics get re-visited!

Mark - not sure re evidence, but surely there's no question that knowing an animal's resting/'unaffected by pre-med drugs' TPR has to be a good baseline to start with. Clearly nimals that are pyrexic, or have cardiac or respiratory abnormalities shouldn't be undergoing anaesthesia. It's such a simple pre-admit check, that I can't see it can be argued as a waste of time.

As another side point - I think it's so important that we are gaining proper, informed consent from our owners for both the anaesthesia and the surgical side of things. I think all too often, a quick run throught the sheet and then a signature is gained - it should be noted that if anything goes wrong, this doesn't constitute informed consent in law... Our clients have the right to know what those risks are.

Re: Admitting Patients

Nick Shackleton — Mon, 18 Aug 2014 19:38:24 GMT

Anaesthesia should be taylored to the patients needs. This includes basing it on a clinical assessment and what surgery/procedure is being performed. For example a patient undergoing orthopaedic surgery is going to require far more pre-op pain relief than a patient endoscopy or radiographs. We always discuss our preop assessment with the vet in charge of the case and raising any concerns prior to preceeding with premedding said patient. We have a charge nurse who decides the order of the list in collaboration with surgeons to ensure good flow of patients through theatres as well as radiography etc. reducing bottle necks and trying to ensure animals are not anaesthestised for longer than required. Anyway, I digress.

Re: Admitting Patients

funkyfish — Mon, 18 Aug 2014 12:23:35 GMT

Do you blanket premed everything? Does the vet say which premed to give which animal or does every animal get the same?All premeded at the same time or 40mins pre op? Don't think students should be selecting premed drugs and doses.

Re: Admitting Patients

fairy — Sun, 17 Aug 2014 19:34:53 GMT

I agree with Steph. We have had a couple with bradycardia that we have decided to refer to a cardiologist rather than put under GA. Also had a couple with pyrexia that have gone home with a/b rather than have GA

Re: Admitting Patients

Steph Worsley — Sat, 16 Aug 2014 20:29:43 GMT

I don't know any websites as such but it is common sense that you need to check TPR prior to performing anaesthesia..at the very least you then have a baseline value for during and post op values. I have looked in a couple of my books which may be of use to you if you have access to them: lane and cooper's veterinary nursing and the bsava manual of anaesthesia and analgesia they both have pre-op assessment sections

Re: Admitting Patients

Luke Frewin — Sat, 16 Aug 2014 19:56:42 GMT

Does any one know of any websites that have evidence that taking heart, resp and temp on admits is a benefit??

Currently trying to convince the stubborn vets at my practice that this is beneficial to the patient's health??

Thanks people

Mark

Re: Admitting Patients

lizabarf — Wed, 31 Aug 2011 21:31:04 GMT

does anyone have a day sheet that shows what has been done with the animal throughout the day? My boss has asked me to make up a sheet that lists everything that has been done eg pobs, ivft etc but I have done a couple and they are not really what he's looking for but he is struggling to make it clear what he wants. if anyone has a template i could look at I would be most greatful!

Re: Admitting Patients

Steph Worsley — Wed, 31 Aug 2011 20:26:58 GMT

Bizzy I have one, not sure if I have it on this comp or if it's just at work (seperate for cat and dog, will email them to you

Re: Admitting Patients

Cloudy Weather — Wed, 31 Aug 2011 17:57:39 GMT

I think that is a great idea, our practice are not currently asking question like that but so many people ignore behaviour when accessing animal welfare. I had a case once where I came in on night duty and there was a cat which had not urinated for some time,I simply rolled up a towel to act as a step into the litter tray and the cat got in. Corner sloping litter trays are ideal for geriatric patients or those with restricted movement. Also notice that many dogs will not urinate or defecate until they are in a quiet secure grassy area. It is much easier to work with a patient when you understand its individual needs and requirements, how to approach it, and how to provide an environment in which you can keep in calm enough to perform basic procedures.

Re: Admitting Patients

Honeybadger — Wed, 31 Aug 2011 16:05:12 GMT

Does anyone have a set list of questions that they ask at admission? I'm trying to make one so that we can gain a bit more info on patients such as food/toileting preferences to make their stay more comfortable. Would love to see some examples.

Re: Admitting Patients

Dax — Thu, 07 Apr 2011 10:53:18 GMT

Thanks everyone for your replies

The system has now been changed for the better :-)

Re: Admitting Patients

NIckie — Sat, 26 Mar 2011 18:18:04 GMT

In my practice the nurses do all the admits, any referrals have usually been well discussed between the referring vet and the vet to be on duty that day so these are also admitted by the nurses, any surgical referrals we get the nurse brings in the 8 o'clock vet to speak to the client. This seems to work, although our referralls are often from practices that do not have a scope/scanner or digital x-ray. All patients are checked over by the vet prior to pre-meds being given, if bloods are being taken the vet will check the patient over at this time so that the patient can be given pre-med if bloods all clear. Our vets would baulk if they had to admit ops for the day! It makes much better use of your nursing team and free's up the vet on duty for those 8o'clock walk-ins that are always an 'emergency'!

Re: Admitting Patients

suzie17 — Sat, 26 Mar 2011 10:39:22 GMT

in my practice the nurses and one vet do the admits the nurses ask all the general questions and give the pre med but the vet gives them a health check.

the svn's do the admits but just the 2nd year not the first year.

Re: Admitting Patients

Beth Roberts — Sat, 26 Mar 2011 08:44:33 GMT

Second year nurses and Q/RVN's do admits in my practice. But the animals must have been seen by a vet in the previous month and not be a referral (unless a direct transfer from another vet via ambulance or by prior arrangement). On the consent form there are questions such as has the animal been starved, last season for a bitch, any known medical allergies or problems, when medications were last given if relevant. If the animal is having pre GA bloods or heart scan then no premed is given, any concerns there are always at least 2 vets in the building to ask. Otherwise our standard premed is given to routines and the animal is placed in a kennel. Dentals are not given premed first thing as they are never done until the afternoon and our ortho/major soft tissue ops are not until surgeons have list for day planned and most are given physeptone rather than vetergesic.

On an aside, our ops list is run by a senior nurse each day, the order of the ops and which vet is doing each one is decided by them. For things like ortho ops and referrals then the vet concerned is consulted as to preferred order, but routines are done on order they were given premed. We currently have 2 theatres, a dental table, prep table and x-ray area all with anaesthetic machines so we can have quite a lot going on at once (as well as scanning).

I have worked there a year, and I am yet to see there be an issue/problem arising from the nurse admit system and the nurses are happier in this practice than any other I have worked in due to having more responsibilities and being used properly!

Re: Admitting Patients

Katie Drew — Thu, 24 Mar 2011 09:05:11 GMT

We have a form that is filled in before admit or at time of first consultation with vet, then operation is booked in. It has all findings recorded on it, including temprament, medications, hr, rr etc. If bloods are needed prior to g.a. Worries concerns (e.g heart murmurs)etc. Works really well. Then nurses have a good understanding of the patient before we admit. Then do a quick check/exam on the day of admit/op.

Re: Admitting Patients

Susan Jackson — Wed, 23 Mar 2011 19:57:35 GMT

Hi I agree with Nikki and Shelly, always admitted patients but full TPR. I did a check list once for the SVN's to use as a guide but they were always checked. The heart check was always a heart rate the VS should always check the heart and the patient prior to giving pre-meds. I know so many don't. It was only for admitting routine ops like spay's and castrate's so they should have been seen at least a few times for vaccines etc. If not the Vet would check.

Re: Admitting Patients

Nick Shackleton — Wed, 23 Mar 2011 18:15:08 GMT

In my previous job nurses used to admit everything. once admited either a nurse or itern would perform a TPR , CRT and MM colour. flagging anything to either vet in charge of case or our anaesthetist. Nurses would then calculate premed drugs and then get it countersigned (also checking TPR results at same time) by one of the vets, either intern, anaesthetist or surgeon in charge of case.

the drugs are drawn up checked by another qualified memeber of staff and then given.

Re: Admitting Patients

shelly jefferies — Wed, 23 Mar 2011 17:33:11 GMT

Our nurses admit everything and do a pre-op check including HR,RR,temp,CRT,MM and hydration, all animals then have a heart check by a vet or by a suitably qualified nurse. !st year students do do the nurse checks but alway double checked by somebody else and know to allert somebody if temp or something is abnormal, they shouldn't be doing heart checks on their as not experienced enough to notice problems, also if something does go wrong will put great pressured on them. Most definately shouldn't be premeding things unless 1) somebody suitable has checked the patient, 2) somebody else has checked the doses and drawing up of the drug.

Re: Admitting Patients

Nikki Armstrong — Wed, 23 Mar 2011 16:50:35 GMT

[quote user="Dax"]

1. I feel that we should also be checking Temp and resp

2. I'm not convinced that SVNs should be making decisions on the health of a patient and giving premeds.

What do you think

[/quote]

Hi Dax

Im not even working in practice at the moment but I agree with you - 1st Year SVNs should not be admitting patients, giving premeds and making decisions like this - what if they miss something important , it could be disastrous-potentially dangerous if unsupervised ( pre meds) , or at least very annoying for the owner if the vet disagrees with the 1st yr VNs health check and decides not to operate that day as the animal is not fit, and the owner has to collect and come back another day?

I would definitely also agree with taking temp and resp.

but like I say Im not even working at the mo in practice -

If a supervising member of staff is in with the SVN,Then of course it is good practice for them to do this admitting, but they shouldnt be left to do it on their own.

Its bad enough having to do scary emergency night duties alone as an SVN - it certainly trains you to think on your feet at 3am, but really the big decisions and responsibility need to be with the Vet, or at very least the most qualified / head nurse.

PS please can somebody in Manchester give me a job!