schedule 3 and professional conduct for veterinary nurses

RE: schedule 3 and professional conduct for veterinary nurses

jojofruits — Fri, 15 Apr 2016 18:10:22 GMT

Oh my god this drives me nuts.. its really clear that we are RVNS are NOT permitted to do this.. even if its inconvenient!

I've been qualified since 1995 and I wouldn't dream of it until I hear otherwise...

if its a grey area in practice then they need to look it up!

xxx

RE: schedule 3 and professional conduct for veterinary nurses

Zoe Sharp — Mon, 11 Apr 2016 23:01:30 GMT

I really do love this forum I feel I can look up anything I've been concerned about and feel supported that I am right to have such concerns. Today me and another RVN were asked to induce and anaesthetic whilst the vet was writing up their notes afew rooms away. I held the dog for induction and asked the other RVN whether we were legally allowed to do this as ( I know there's possibility the law could change) and she replied we are doing it under vets direction with the vet available which in the scent of an emergency I would have had to exit throught two doors to get to her and be heard. I've never been expected to induce anaesthetics and have been qualified 2.5 years and working in practice 8 years. I do worry at times us newer nurses are over cautious compared to the more experienced ones but also am thankful how much our code of conduct and where we stand by the law is really drummed into us nowadays. If anyone has any advice on where I should seek advice if I have concerns regarding these types of issues Id be greatful for some direction :) x

Re: schedule 3 and professional conduct for veterinary nurses

Paulette — Sat, 11 Feb 2012 19:05:51 GMT

Hey Angiy, very much agree that even though sometimes it is hard, it is so important to say when you are unhappy/untrained in something and need help/don't want to do it. Agree with everything you said except I think the sentence below means we can't give 'top-ups' of propofol/alfaxalone and i guess even triples in rabbits because it is administering incrementally to maintain anaesthesia. Re propofol infusions/syringe drivers I think you are right it is not us being 'mini-vets'. I think if a VS asks a VN to change the rate this is us monitoring anaesthesia and acting as the hands of the VS to maintain anaesthesia (why this doesn't appear to specific amounts of anaesthetic agent I don't know!). That's how I interprete it anyway. Let me know what you think xxxxxxxxx

Thank you for your message below which has been passed to me for response. The advice contained in Advice 19 on anaesthesia is clear in relation to ‘top ups’ in that:

3)b) Administering medicine incrementally or to effect, to induce and maintain anaesthesia may be carried out only by a veterinary surgeon.

Re: schedule 3 and professional conduct for veterinary nurses

Angiy Michael — Sat, 11 Feb 2012 18:25:02 GMT

Which confirms what I was saying..you can administer set bolus doses..and induce with set bolus doses..this also applies to Triple combination. This has ALWAYS been the case since I have been in practice folks..so some examples where nurses may do this ( some of you may actually be doing this without thinking about it ie giving triple) , topping up anaesthesia at veterinary direction by giving a set amount, administered a blous dose of anaesthetic induction agent - propofol, domitor, triple, saffan, etc etc. and once again as mentioned before using infusion pumps and syringe drivers to administer bolus doses of propofol/diazemuls etc . I don't advise nurses to do ANYTHING they do not feel confident to do, regardless of whether it is legal..if you aren't confident and feel you need more training to do something you are legally allowed to do..say and don't do it. We are legally allowed to do aural haematoma repair but I wouldn't expect that a nurse would just go ahead and do that unless sufficiently confident and trained and directing VS have a responsibility to know what their nurses competencies are too. That said I would not class looking after patients on propofol syringe drivers etc as being a "mini" vet..I would say that that is something that is very much in a experienced nurses remit if you work in that sort of environment. XXX

Re: schedule 3 and professional conduct for veterinary nurses

Paulette — Fri, 10 Feb 2012 21:24:27 GMT

No problem Alison :) Like I said it is so hard to speak up sometimes-I wish I had the guts to express any concerns in a constructive way everytime with every vet/nurse!

I emailed the RCVS re VNs administering propofol/alfaxalone to induce anaesthesia and this is the reply I have had today. Hope it clears up any confusion!

Dear Paulette,

Thank you for your message below which has been passed to me for response. The advice contained in Advice 19 on anaesthesia is clear in relation to ‘top ups’ in that:

3)b) Administering medicine incrementally or to effect, to induce and maintain anaesthesia may be carried out only by a veterinary surgeon.

Maintaining anaesthesia is the responsibility of the veterinary surgeon and paragraph 3)b) does not allow any other person to make a judgement about the amounts of anaesthetic agent to be administered to induce or maintain anaesthesia. Paragraph 3)a) allows listed or registered veterinary nurses or student veterinary nurses to administer a specific quantity of anaesthetic agent to induce anaesthesia only. However paragraph 3)c) allows suitably trained people to assist a veterinary surgeon with the maintenance of anaesthesia by moving dials on the veterinary surgeon’s direction.

Administration of medicines more generally by registered or listed veterinary nurses, (such as for sedation or pre-medication purposes) must be directed by a veterinary surgeon under Schedule 3 to the Veterinary Surgeons Act 1966. This means that the quantity of medication must be directed or finally checked by the veterinary surgeon.

It may be that in practice a veterinary nurse will be asked to calculate the dose and draw up the medication where directed by a veterinary surgeon, however, where this occurs, the quantity must be checked before administration by the prescribing and directing veterinary surgeon.

Student veterinary nurses carry out Schedule 3 activities in accordance with paragraph 7 of Schedule 3. This requires that student veterinary nurses:

· Only undertake any medical treatment or minor surgery (not involving entry into a body cavity)

· Are directed by the veterinary surgeon with care of the animal in the course of training

· Are directed by the veterinary surgeon employing them or another veterinary surgeon acting on behalf of their employer

· Are supervised by a veterinary surgeon or registered or listed veterinary nurse

· Only undertake surgery under direct, continuous and personal supervision by a veterinary surgeon or registered or listed veterinary nurse

Definitions of direction, supervision and direct, continuous and personal supervision established by the RCVS are as follows:

· 'direction' means that the veterinary surgeon instructs the veterinary nurse or student veterinary nurse as to the tasks to be performed but is not necessarily present;

· 'supervision' means that the veterinary surgeon is present on the premises and able to respond to a request for assistance if needed;

· 'direct, continuous and personal supervision' means that the veterinary surgeon or veterinary nurse is present and giving the student veterinary nurse his/her undivided personal attention.

Please let me know if you require any further clarification.

Kind regards,

Simon Wiklund

Advisory Manager and Secretary to the Advisory Committee

Re: schedule 3 and professional conduct for veterinary nurses

Alison Clare Hickman — Fri, 10 Feb 2012 09:51:05 GMT

your words are a gift to me. Thanks. x

Re: schedule 3 and professional conduct for veterinary nurses

Paulette — Wed, 08 Feb 2012 20:47:05 GMT

[quote user="Alison Clare Hickman"]

This has all made very affirming reading. I am glad I have had the courage to stand up to a (previous) employer and state that, as it was not within my legal remit as an RVN, I should not give induction anaesthetic to effect. So I did not do it, ever. I was ridiculed for being too health & safety conscious and too 'new' to the profession to understand what the job entailed 'in the real world'. Let's say I moved on very quickly from that job!! Phew.

[/quote]

Hi Alison

Yes well done you for standing up to them! It is so hard sometimes to approach this sort of subject and rightly refuse any tasks you are not happy with. If something is illegal then you should be applauded for pointing this out, not ridiculed and made to feel that you are too picky and over precautious. Unfortunately I have also been in a position during a locum placement where I felt unhappy to perform scale and polish on a 15yr old Yorkie (with a very dirty mouth!) whilst also monitoring the somewhat less than smooth GA and just grabbing a vet to extract a few teeth as one walked past. When I refused to do so (I also asked if someone would monitor the GA) I was huffed and puffed at and an SVN was handed the task. I was made to feel inexperienced and unhelpful when really all we are ensuring is that the animal's health and welfare and working within the law are priority. Unfortunately those that do not consider themselves 'too new to know what everyday practice is like' will no doubt continue to work outside of the law and put unnecessary pressure on colleagues and carry on doing what they have always done unless people like yourselves do their best to try and change things for the better.

Re: schedule 3 and professional conduct for veterinary nurses

Alison Clare Hickman — Wed, 08 Feb 2012 09:31:08 GMT

Re: schedule 3 and professional conduct for veterinary nurses

Paulette — Mon, 06 Feb 2012 21:55:04 GMT

[quote user="xhappysvn21x"]

[quote user="Paulette"]

Hi SazzleRVN :) Have you read Angiy's earlier post? As she and happy svn state and as I understood it to be that QVNs or SVNs under direct supervision may administer a prescribed quantity of propofol as a bolus only. May this be to induce anaesthesia for surgery or in the case of a seizure. Yes I do agree that this poses danger as the prescribed quantity may well be more than the individual patient requires.

Sal 1st did you find out anymore re the ANAC course?

WilkoAnnie can appreciate how much it must take you to prep on this overwhelming and confusing subject!!!

[/quote]

starting to doubt my own comment now Norbrook say:

For induction and maintenance of general anaesthesia using incremental doses to effect.... and
For induction of general anaesthesia where maintenance is provided by inhalation anaesthetics.

But doesnt state bolus, but it does give different administeration doses for different uses, e.g. premedicated, unpremedicated, maintenance and guidance for incremental use.

We dont have a syringe driver, usually a suitable dose and administer over the 10-30 seconds. I agree confusing subject, not worth risk if you ask me, more of a VS duty anyway, dont fancy being a mini vet.

[/quote]

Hello thanks for looking further into this. See this is the thing. It says incremental doses to effect for induction and maintenance-assuming like eg in BALs or overseas clinics where no inhalation gases are used. It does not state incremental to effect for induction where maintenance is by inhalation gases so I assume from this that the doses for unpremedicated and premedicated patients can be used by nurses to induce anaesthesia to be maintained by an inhalation gas-not when maintenance is by propofol 'top-ups'. However I assume that a VS may prescribe a set quantity for a nurse to administer as a 'top-up' when the VS feels it is necessary. I completely agree it should not have to be assumed-it should be clear in black and white. I have worked in a hospital where senior nurses on a daily basis administer propofol to induce anaesthesia for routine procedures under the instruction of a VS and know they would not do anything without having researched the legalities into it first. I am going to email the RCVS myself to see what they say on this and let you all know what they say! Hopefully they will give me a clear answer!!!

Re: schedule 3 and professional conduct for veterinary nurses

bongo — Mon, 06 Feb 2012 21:43:10 GMT

I still stand by my comments. although this very thread is an example of a point which needs to be made clearer!!

Re: schedule 3 and professional conduct for veterinary nurses

xhappysvn21x — Mon, 06 Feb 2012 00:44:43 GMT

[quote user="Paulette"]

Sal 1st did you find out anymore re the ANAC course?

WilkoAnnie can appreciate how much it must take you to prep on this overwhelming and confusing subject!!!

[/quote]

starting to doubt my own comment now Norbrook say:

For induction and maintenance of general anaesthesia using incremental doses to effect.... and
For induction of general anaesthesia where maintenance is provided by inhalation anaesthetics.

But doesnt state bolus, but it does give different administeration doses for different uses, e.g. premedicated, unpremedicated, maintenance and guidance for incremental use.

Re: schedule 3 and professional conduct for veterinary nurses

Paulette — Sun, 05 Feb 2012 19:07:56 GMT

Sal 1st did you find out anymore re the ANAC course?

WilkoAnnie can appreciate how much it must take you to prep on this overwhelming and confusing subject!!!

Re: schedule 3 and professional conduct for veterinary nurses

bongo — Sun, 05 Feb 2012 17:38:31 GMT

[quote user="xhappysvn21x"]

[quote user="sazzle RVN"]

VN's are not allowed to administer propofol or any kind of incremental anaesthesia to effect. The VS needs to do this.

[/quote]

the advice note 19 (october 2007) am reading states the advice on monitoring and maintening of anaesthesia remained as follows:

inducing anaesthesia by adminsteration of specific quantity of medicine directed by a veterinary surgeon may be carried out by a veterinary nurse, or with supervision, a student veterinary nurse, but not by any other person.

administering medicine incrementally or to effect , to induce and maintain anaesthesia maybe carried out only by the veterinary surgeon.

so unless this has been updated, then we can... but on risky grounds.

[/quote]

but propofol is administered incrementally or to effect, to induce and maintain anaesthesia...........

Re: schedule 3 and professional conduct for veterinary nurses

wilkoannie — Sun, 05 Feb 2012 16:47:50 GMT

Yes this is why I am glad I am still in practice, i can go in and ask the vets and other nurses questions then and again research it myself otherwise like you said I wouldn't know the right answer. There are some really good students in the class that research things well and i ain't afraid to say I learn from them to..  Xxx

Re: schedule 3 and professional conduct for veterinary nurses

xhappysvn21x — Sun, 05 Feb 2012 15:53:43 GMT

[quote user="wilkoannie"]I only teach 6 hours a week and the amount of time that goes into preparing takes me a long time ESP with subjects like schedule 3 which is very unclear! I don't know the answer to everything the students ask but I will encourage them to find out for homework and the best answer gets a prize or we get to leave a little bit earlier which they like if they all come back with good answers or we research the answer in the Libary.. What I don't like is when the students don't get no support or are unhappy.. Or when lecturers just make things up. It's a demanding job and I don't get a spare two minutes but it is all new to me and I work all week in a practice and have 2 young children. I am hoping that i will get the same subjects each year so then I just need to tweet things. Schedule 3 may be a simple subject one day If the rcvs get their act together.

[/quote]

I like what you are saying annie, our class does the same, but the tutor comes across as if she is making things up, b***s*** through the answer; and has been caught out before many times. i think that encouraging them to find out for homework is great, as long as the tutor does it too, because unless the student is told if the homework is correct or incorrect then the student is in no better position in understanding the question, and sometimes becomes more confusing because many of the class has a different angle to the question.

i think the future amendments to veterinary surgeons act and professional conduct will make things clear soon but in the mean time, common sense and high wits is needed.

Re: schedule 3 and professional conduct for veterinary nurses

xhappysvn21x — Sun, 05 Feb 2012 15:13:22 GMT

[quote user="sazzle RVN"]

VN's are not allowed to administer propofol or any kind of incremental anaesthesia to effect. The VS needs to do this.

[/quote]

the advice note 19 (october 2007) am reading states the advice on monitoring and maintening of anaesthesia remained as follows:

administering medicine incrementally or to effect , to induce and maintain anaesthesia maybe carried out only by the veterinary surgeon.

so unless this has been updated, then we can... but on risky grounds.

Re: schedule 3 and professional conduct for veterinary nurses

wilkoannie — Sun, 05 Feb 2012 15:01:43 GMT

I only teach 6 hours a week and the amount of time that goes into preparing takes me a long time ESP with subjects like schedule 3 which is very unclear! I don't know the answer to everything the students ask but I will encourage them to find out for homework and the best answer gets a prize or we get to leave a little bit earlier which they like if they all come back with good answers or we research the answer in the Libary.. What I don't like is when the students don't get no support or are unhappy.. Or when lecturers just make things up. It's a demanding job and I don't get a spare two minutes but it is all new to me and I work all week in a practice and have 2 young children. I am hoping that i will get the same subjects each year so then I just need to tweet things. Schedule 3 may be a simple subject one day If the rcvs get their act together.

Re: schedule 3 and professional conduct for veterinary nurses

bongo — Sun, 05 Feb 2012 13:45:10 GMT

[quote user="Julie"]

[quote user="Paulette"]

I did not look into this for my dissertation (annoyingly I have only just thought of it!) it would be interesting to find out if 'trainees' who are not RCVS enrolled are permitted to draw up drugs eg premedications etc in practice. Also forgot to say about anaesthesia induction. Only veterinary surgeons are permitted to administer incremental doses of an anaesthetic eg propofol 'to effect'. However QVNs may administer a set prescribed amount and SVNs may do this with supervision (although it can be argued this is dangerous as a vet may prescribe a calculated dose for a particular animal, but it may turn out this animal does not require the full calculated amount). You should stress that a veterinary surgeon should always be within calling for help distance and be able to assist immediately should they be required, so if a nurse feels they need help during surgery or if they feel the patient does not need the full propofol dose etc they can get help, guidance and assistance from a VS immediately. No other persons are permitted to induce animals for anaesthesia. It does not state if SVNs may be supervised by a competent QVN or by a vet only, again this would be interesting to find out (same with supervising minor surgery, I think competent QVNs can supervise them but not sure). I do feel the RCVS need to tighten up their guidance a bit and be more specific.

[/quote]

Are you sure that this is correct? I was under the impression that VN's could not administer propofol. Will have a look and see if I can find the paperwork that was shown to me.

[/quote]

sorry was supposed to quote this in my post

Re: schedule 3 and professional conduct for veterinary nurses

bongo — Sun, 05 Feb 2012 13:44:04 GMT

VN's are not allowed to administer propofol or any kind of incremental anaesthesia to effect. The VS needs to do this.

Re: schedule 3 and professional conduct for veterinary nurses

xhappysvn21x — Sun, 05 Feb 2012 12:37:40 GMT

the whole class do feel the same, and complaints have been made by all of us and also ignored. At the moment I am concentrating in finishing this course, its flying by as it does. But afterwards I will make sure my complaint is heard, because it made me so annoyed and ruined the excitement of veterinary studies. I am a swot, I usually love studying but this was the scariest thing I have ever done, and it should have been different!!

And it shouldnt happen to other students that pay to learn the career they love.

Re: schedule 3 and professional conduct for veterinary nurses

Louise B — Sun, 05 Feb 2012 11:34:12 GMT

[quote user="wilkoannie"]Is your lecturer qualified to teach does she have the cert ed or pgce? I personally find that appalling if you ask a question and the teacher dosnt know they are there to guide you into how you can find out if they don't know. It takes me days and weeks to prepare for one day teaching as I do a lot of research onto my subjects and we do lots of activities. I am sorry you feel like this! Where are you being taught? Is there someone you can talk to if the rest of the class feel like you. Let me know if i can be of Any help Xxx[/quote]

It is great that you spend that much time preparing but it is physically impossible to spend days preparing for each lecture - the full time lecturing commitment is normally 18 - 20 "contact" hours/week. Even if you spent only one day (8 hours) preparing for a 1 hour lecture you would spend 160 hours / week (20 x 8) preparing plus 20 hours actually delivering the lecture and that's before you add in the marking of assignments, etc. As there is only 168 hours in a week you'd have to capable of 'turning back time' to achieve this

I do take your point though about commitment and it sounds like you are a very dedicated lecturer which is fab for your students. I think the point I want to make though is lecturers are only human and there will always be questions that the lecturer doesn't know the answer to. I work in education too and spend alot of time preparing too (far more than I paid to do but that is the nature of the beast when you work in education!) but I would be the first to admit that I cannot know everything. I actually really enjoy it when the students push me beyond the edge of my knowledge as it means they are really engaging with their studies (which is more than half the battle won). What I think is unacceptable is for the lecturer to 'pretend they know to save face'.

Re: schedule 3 and professional conduct for veterinary nurses

Sal the 1st — Fri, 03 Feb 2012 09:51:52 GMT

I was actually backing you up re the vaguaries of the RCVS!

Re: schedule 3 and professional conduct for veterinary nurses

wilkoannie — Fri, 03 Feb 2012 08:48:40 GMT

I am just stating the answer I got, if it's on a syllabus that your students are working from then you as a practice can look into it. I asked for a query as I am teaching and we have a non trainee with us. I am not out for an argument on this. I only asked for help with my teaching. I ain't getting into any debates about this as i think that is a different subject if someone else wants to bring it up. I don't want a debate. I am just saying how difficult it is to teach when you don't get the right answers from the rcvs. No i ain't telling just you either. I was saying in general what I found out. Please let's not argue over this and phone the rcvs yourself I really don't need this. Thanks

Re: schedule 3 and professional conduct for veterinary nurses

Sal the 1st — Fri, 03 Feb 2012 02:25:28 GMT

[quote user="xhappysvn21x"]

Am a SVN Sal, I am shocked how much I have had to teach my self because the tutor is not bright or doesnt careless or maybe just doesnt have the suitable time to do a suitable job of teaching the class. I understand that it must be difficult with the recent sylabus changes but it aint that different to teach. I have asked many questions in class and the tutor has said 'I dunno'. I have felt as if i have wasted valuable time going to college because i learn more at home. Shocking yes.

[/quote]

Thank you for this - I know this is happening quite frequently.

I do have some sympathy for tutors, it isnt easy I have done it myself , Its not easy preparing for a class and then delivering to students and I am not ashamed to admit that I have answered a question with 'I am sorry I dont know' - but then I will make a point of finding out. I would rather somebody did that than gave out the wrong information

This is an example of what I have come across. Trainee sorry Student nurse comes back from college and tells me we should be using dilute hibiscrub to flush ears which I had always been taught was an absolute dead cert no no because it is damaging to the ear drum and in the event the ear drum is perforated either prior to flushing or during the process of flushing is very dangerous. So I asked them to check with their college next time they were there. They came back and said they had checked and that yes that was definitely right and that yes you could definitely use dilute hibi to flush ears and it was safe.

I double checked the precautions on the manufacturers label just to check I hadnt dreamt it and it does definitely say that it should not come into contact with mucous membranes, meninges, brain or middle ear.

I photocopied the manufacturers data sheet and sent it back to the college and student comes back and tells me I am still wrong. I checked with a vet school and no they wouldnt use it and then I contacted the college with my concerns. They got back to me after I sent another letter a couple of weeks later (by this time the student is getting a bit hacked off because apparently their tutor is now giving them the evils because I am asking questions). I eventually spoke to the tutor myself and they informed me that they taught this on the basis of a BSAVA lecture they had attended and this was the current accepted practice, and implied that my information was out of date. Turns out we had both attended the same lecture a few years previous but our recollections differed, my recollection was that hibiscrub was mentioned as a 'not to be used' instead of a 'to be used'. In the finish I tracked down the person who gave the lecture and confirmed it with them that hibiscrub should not be used.

I am not being bloody minded and I wasnt out to cause problems for anybody I just wanted to make sure that what the student was being taught was correct and that animals were being treated appropriately, it was simply a mistake and nobody is perfect we all make mistakes but that mistake was repeated for at least 2-3 years.How many students went through that course and took that back to their practices and how many practices just accepted this as the done thing? Did anybody fail an exam as a result of it? Did any animals suffer as a result of it? And why was I made to feel so bad just for querying something?

Re: schedule 3 and professional conduct for veterinary nurses

Sal the 1st — Fri, 03 Feb 2012 01:11:42 GMT

[quote user="wilkoannie"]

I phoned the other day for advice on lay staff giving antepsin, koagel etc and they just replied lay staff shouldn't be giving medicines but if your vet thinks the member of staff is competent then they can. So I said so they can administer schedule 5 drugs but not 2, 3 and 4 and all I got was they shouldn't really! Not a good enough answer is it?

[/quote]

well something isnt right here. Two nurses assistants where I currently work are hoping to do the ABC Animal Nursing Assistant Course run through Myerscough.

http://www.myerscough.ac.uk/?page=course-search&action=factsheet&reference=2011194&query=&html-title=ABC%20Animal%20Nursing%20Assistant%20%E2%80%93%20Correspondence%20Course%20(On-Line)

so are you telling me that the unit that covers 'deliver basic treatments to animals' is something they shouldnt be doing - would really like to know this before the practice shells out 750quid per person