Help!

RE: Help!

Sal the 1st — Fri, 14 Sep 2018 08:57:32 GMT

[quote user="Vet nurse0000"]

Why on earth do animals have to be crying out desperately in pain for pain relief to be given?? If it has had a operation/major dental work of course it will be in pain! Some animals just don't show it how we want them to for our nice little tick boxes. Some people's attitudes towards this is shocking. This whole 'let's wait and see what it's like' attitude is just wrong we shouldn't be waiting for pain to be shown it should be prevented. Once they are painful it's much more difficult to control the pain this is a fact.

[/quote]

they don't - certainly not where I work anyway, they have good analgesia as inpatients and are sent home with with them. On the flip side however we do have quite a number of clients come back and tell us that they didn't think the dog/cat/other needed them and have even had a few grumble that they never used them and had paid for something they didn't need, and one of them was the owner of the cat that had the major dental. Just my opinion but I do think there is over prescribing in this area at times

RE: Help!

James Colver Cert. Ed, RVN — Fri, 14 Sep 2018 04:32:45 GMT

Yep - some things there are simply no justifiable excuses for - witholding analgesia being one of them

RE: Help!

Vet nurse0000 — Thu, 13 Sep 2018 14:47:25 GMT

RE: Help!

FINNIGAN — Tue, 28 Aug 2018 14:22:22 GMT

my old practice still does all this, dont think its breaking any rules, just still old school

RE: Help!

jojofruits — Mon, 20 Aug 2018 17:31:59 GMT

I think Gold standard mainly refers to the RCVS practice standards scheme. They are quite specific about what they consider best practice.

RE: Help!

Sal the 1st — Fri, 17 Aug 2018 10:39:03 GMT

[quote user="Denise Cooke"]

I seem practices which sent metacam home with anything apart from a cat castrate.

[/quote]

me too - but in saying that why not cat castrates as well? It becomes difficult to have a practice rule saying animals go home with analgesia if you then exclude one group. We assess each animal as an individual and yes sometimes we get it wrong - ie the poc I did yesterday, cat had a major dental earlier in the week and as soon as the cat had gone home it tucked into a bowl of its favourite biscuits and hadn't stopped eating since, so obviously didn't need the loxicom . Even tho he had been advised soft foods only this cat was obviously not playing by the rule book.

[quote user="Denise Cooke"]

I not a lover of catgut in patient I feel we do have better sutures materials. But end of the day it's what the vet feels comfortable using.

[/quote]

exactly - it is the vet carrying out the procedure and they know what does and doesn't work for them

Robyn's point about practices doing the best they can and still remaining locally competitive is very valid.

We all do our best and we all want a decent working wage - and if you want to do everything with absolutely all the bells and whistles then great but there is only so much income coming into a practice and if you are spending it on extras then somewhere somebody is going to miss out. And I absolutely DETEST this mythical 'Gold Standard' label. Who determines what is gold standard and how does their practice differ from everybody else? All practices are different and some have different ways of doing things but just because they are different doesn't make them bad. I have seen some very efficient, very elegant, and very safe ways of doing things that may not be exactly'gold standard' but have an end result where patient, client and practice are very happy with the outcome.

It should not be a case of over complicating things and working harder and spending more - it should be working smarter and making the best possible use of resources at hand for everybody, keeping up with the times, and finding out what works best/is safest in practice for ourselves rather than following a crib sheet and forever wanting things that are just not going to be possible within the setting we are working in

RE: Help!

Denise Cooke — Thu, 16 Aug 2018 22:42:05 GMT

I think it's depends on the practice and the manager plus costs. I seem practices which sent metacam home with anything apart from a cat castrate. I feel that this is correct as alot of patient do suffer from pain but the owner may not noticed it. Due not being medical minded etc. I not a lover of catgut in patient I feel we do have better sutures materials. But end of the day it's what the vet feels comfortable using. Antibiotics shouldn't be used at less their a reason but again this is down to the practice policy. It's like should you still be sprinting the op site after scrubbing with hibiscrub. As sprint does make the patient cold. Wearing gloves when scrubbing the op site. Cloth drape doesn't really bother myself but other things do.

Times are changing.

Dee

P.s I do like a IV catheter in a patient in case of a emergency or if the patient need fluids

RE: Help!

jojofruits — Thu, 16 Aug 2018 17:13:37 GMT

Honestly? there are a few things there that would worry me too! I understand that a lot of practices may still do some of those things, but times have moved on, single use drapes, for example, are readily available and If we always did what we've always done we would never get anywhere!

ETA: I try to think.. if it were my own dog going to the vets, what would I expect? what would I accept? Probably why we try our best to keep up with gold standards in our little practice and do the best with what we have got!

RE: Help!

Robyn — Thu, 09 Aug 2018 16:31:29 GMT

As far as my recent CPD, hand scrubbing is still accepted where cost is prohibitive for disposable sponge applicators, and I *think* hibi has better residual activity than alcohol gel? I'm also under the impression that it's being phased out due to microabraisons, but cost has to be factored in much more carefully in general practice. De-fuzzed and autoclaved cloth towels are still widely used too - I always worry about re-introducing dust/fuzz, but again, we have to weigh up what we can afford. I'm not a fan of cloth drapes, but I suspect the same approach has been taken here, though it might be worth costing up some disposables and approaching whoever makes the decisions?

Routine ABs are right out but there are definitely still some bastions where this hasn't been changed yet. Definitely something to start championing imo.

As for everything else...we're about on par where I am at the moment! I would like to see methadone, more tgh pain relief, IV lines for routine ops, and more pain meds for bunnies, but adding all of that into a set price op and not making too massive a loss and staying competitive with local practices is a lot to ask. Sometimes all it takes is a champion to encourage the practice to change, but these things can take time.

RE: Help!

Ben Ogden — Thu, 09 Aug 2018 16:24:34 GMT

The shifting sands that is 'Best Practice'. Frankly I've stopped planting my flag on anything now because the next month the facts will change (cynical I know...)

If you've worked in 6 practices and reviewed procedures in all 6, i'm sure you've learnt by now they're several ways to do everything and all have pros and cons, it's just getting everyone to agree which way has the best pros and have cons you can live with.

RE: Help!

VetNurse Anon a/c — Thu, 09 Aug 2018 15:49:58 GMT

Thanks for the replies so far.

I have worked in several practices (this will be the 6th, only one referral) throughout my career and have seen many of those things in practice before but they have been gradually changed and elimated in favour of new techniques over the past few years in my experience.

We still used routine antibs, hand scrub and had never considered methadone when I first started nursing so I’m by no means saying they’re wrong, but as I’ve witnessed those things change and remain consistent in recent years I just wanted to see what others were doing to gauge where I’m just going to have to buckle down and get used to it or where change is worthwhile.

i was under the impression the WHO no longer recommended hand scrubbing due to the micro abrasions left on the hands? Is that not true or does anyone have a source? And water waste is a consideration although I suppose using reusable drapes is more environmentally friendly than disposable so you cant have it all!

RE: Help!

Alison Clare Hickman — Wed, 08 Aug 2018 21:57:59 GMT

My tip for starting any new role or job is this...

Week 1: OMG what have I done? But. Hold my peace and observe. (Unless I spot danger).

Week 2: Hey hey, it's not so mad, bad or strange and those things that puzzled me in week 1 have been explained and I'm learning new 'how to be's. Different doesnt necessarily mean wrong. Still keeping eyes and ears open and mouth shut. Learning. Getting feet under table. Acquiring trust, respect and some new skills!

Week 3: I'm in the Groove, yeah man. This is fab! My team are now asking me how I did things in my last job? Keep it low key and don't make any negative comparisons. Say I can show and tell if they'd like? Say I did do things quite differently but realise that's not necessarily better. We could compare?

Week 4: Now I'm settled in and have made friends and my colleagues have learned to trust me - I can safely present for discussion various methodologies with them. How about this? What do you think about that? Back off if they start to become overwhelmed, forge ahead if they lap it up.

Week 5: one change is agreed and (importantly) the team think it's great. They like the fact I have ideas to share but am also equally happy to adopt the practice protocols without quibbling.

Week 6: my team have asked me to look at other areas in the practice for ideas.

Week 7: where was it I used to work? Ummmm...

Works for me! X

RE: Help!

Sal the 1st — Wed, 08 Aug 2018 21:30:58 GMT

[quote user="VetNurse Anon a/c"]

So different in every practice isn’t it!

[/quote]

Sure is - but different doesn't by default make it bad. With the exception of the antibiotics what you describe is pretty common practice. Don't forget referral isn't general practice.

I know many vets who favour cat gut for ligatures because it handles better and knots better. One of the main reasons that catgut has been dropped in human surgery in favour of synthetics has little to do with tissue reaction or a synthetic being 'better' which is often cited but more to do with the risk of introducing scrapie prions.

I honestly think you may struggle if so much doesn't sit right and it may be difficult for you to raise this without sounding judgemental because it sounds like you have already made your mind up.

RE: Help!

VetNurse Anon a/c — Wed, 08 Aug 2018 19:06:01 GMT

So different in every practice isn’t it! We still scrub Up the traditional way with a sterile scrub brush and hibi.

i think it’s very short sighted and ‘dark-ageish’ To not send animals home with analgesia, especially rabbits who are obviously well adapted at hiding pain, and therefore stop eating and develop gut stasis. I also think post op pain relief for cat speys isn’t used as much as it should be when they’re sent home!

RE: Help!

James Colver Cert. Ed, RVN — Wed, 08 Aug 2018 16:30:08 GMT

As above I think you will find some of this is common / accepted practice other than prophylactic ab's, no post op analgesia and no opioids (depending on the procedure) and not having an iv for a GA.

RE: Help!

apache — Wed, 08 Aug 2018 15:52:37 GMT

Yes most of these things are still very common. I'm not moving away from catgut until forced and there is zero evidence the synthetics are any better. We tried routine methadone and didn't notice any difference so pre-op NSAID, medetomidine and buprenorphine as standard. Will top up as needed. Routinely send bitch spays home with NSAID but play others by ear (they don't generally need it). Surgical scrubbing still used by human surgeons, nothing wrong with it.

To be honest the only one I'm not happy with is the routine antibiotic use.

If you have quality published evidence showing any of the above (other than abs) is worse than the alternative then please present it here.