VPIS..., how about having our own?

Re: VPIS..., how about having our own?

Alexander Campbell — Mon, 08 Nov 2010 15:09:21 GMT

Absolutely right. The VPIS grew out of what used to be called "Guy's Poisons Unit" which used to asnwer calls from vets on an ad-hoc (and entirely unfunded!) basis up to about 1992 when we formally styarted the VPIS service. This unit also offered many other toxicology services to the NHS, to industry, internationally etc.

The Guy's & St Thomas' Foundation Trust still support their Medical Toxicology Unit, and including the VPIS. However, as a non-nhs resource the VPIS has to cover its costs to ensure this remains the case!

Re: VPIS..., how about having our own?

Maisy — Fri, 05 Nov 2010 22:00:06 GMT

[quote user="Phrin SVN"]

I've just looked at the VPIS website briefly, and am genuinely interested, and baffled as to why they have a 'Guy's and St Thomas' NHS' logo on their page?!

[/quote]

I think it's part of the toxicology unit based as Guys and St Thomas trust?

Re: VPIS..., how about having our own?

Phrin Vernon RVN — Fri, 05 Nov 2010 21:48:34 GMT

I agree that the VPIS do a great job, and I have seen a fair few cases which would have left the vet scratching their head if it wasn't for the fact they had access to the VPIS

I've just looked at the VPIS website briefly, and am genuinely interested, and baffled as to why they have a 'Guy's and St Thomas' NHS' logo on their page?!

Re: VPIS..., how about having our own?

Sandra Taylor RVN, MBVNA — Fri, 23 Jul 2010 23:33:47 GMT

Hi Alexander,

Thankyou for your informative reply. I do have to say when it is explained in that way it makes it much easier and understandable for the profession to appreciate the service you provide. And yes I do get you are a business to and need to make a living. Thankyou for taking the time to explain to all of us.... me in particular. At least now when explaining to clients the charge, I myself can be more informed.

Re: VPIS..., how about having our own?

Alexander Campbell — Fri, 23 Jul 2010 17:25:04 GMT

Hi Sandra

I am glad you think this is a good idea - we are working hard on this project in the hope that something will be available next year. Of course the information we use to answer enquiries is based on all our past cases, what is published in the peer reviewed literature and books - this is all collated and then we produce a set of internal guidelines for the staff to use. These are also reviewed by our veterinary consulatants to make sure they are are a balanced with a view to best practice, practicality and cost effectiveness. These sheets are regularly updated. The advice we provide is therefore based on a consensus approach. It is a shortened version of these documents that will be made available.

Of course these projects in themsleves cost money alas....

With regard to fees - believe me - if we could find a way of reducing the charges we would. We did ask in the consultation if vets would like us to consider answering calls direct from the public but the overwhelming majority (>93% in fact) said no. So we abandoned any thought of that.. The fact remains though that we have, like your businesses, have to cover our costs. We do not want to stop being 24 hours - what would be the point when about 50% of our enquiries come out of hours? Based on the number of enquiries the cost per enquiry was set as low as it could be.

In the past small veterinary businesses often used to register for the year - at £175 and then use us once. The larger groups often paid about £700 for the year and used us 150 times. It seemed to us it was this was extremely inequitable - as we did not feel the small businesses should in effect be subsidizing the big ones. The most equitable way was therefore to move to a charge per enquiry - which means that the larger groups and heavy users will be paying a bit more, but the small businesses considerably less. There will obviously be winners and losers and we cannot please everyone - we know!

What we hope to do by putting some basic information is to help prevent unecessary attendances - so in particular we will provide information on the things that we do not think are too much of a problem. In that way you will be able to check, advise owners over the phone and then all is sorted. Then you can reserve your case credits for those instances where there is less certainty.

Nobody here would want cost to be the reason why we were not consulted and why animals might not receive optimum treatment. However, I agree with one of the earlier comments that having the werewithal to cover expenses for pets is part of responsible animal ownership. We do have a problem in the UK becuase our own healthcare on the NHS is paid for by our taxes and people have no real idea of the costs of medicines and procedures. In the USA for example people have health insurance because they have essentually to pay for their own healthcare. That is part of their culture. You may be interested to know that the ASPCA animal poisons center in the USA charges 65$ per enquiry - considerably more than we charge. That's presumably why they also insure their pets to the extent they do.

So please be assured we are doing our best to keep our costs down. We cannot reduce them further as the result would be limiting the hours we are open or disappearing altogether and those options are not going to help animals at all!

Thanks for all your supportive comments about the VPIS everyone!

Re: VPIS..., how about having our own?

Sandra Taylor RVN, MBVNA — Thu, 22 Jul 2010 23:52:54 GMT

At the moment we are working on several projects to try and make some species and breed specific outline information on our most common enquiries available to subscribing practices. These

Now I like this idea. But can I also say, that what I was trying to get across albeit in a roundabout way... we confer on a lot of issues on here, some we take as truth some ... well not so. I personally take a lot with a pinch of salt, it's the same in practice you ask one vet advice.. and another and you get 2 different stories...,, or in a lot of cases a "whole new world" as it were..... ok are you all still following me or I am just blethereing? now. I feel I can decifer whats what, but obviously some on here wont, so I appreciate the input from other members. I pride myself on taking down correct details especially where meds etc are involved, but after reading this appreciate also that some may not.

I do think that a lot of animals will suffer though through this charging process, and thought something however little could be done to help those who may not be fortunate enough to afford these charges, even if we did not take the advice as "read" on here. so far we have a had a lot of clients refusing tmt due to the cost.... surely that cant be right! something has to be done

Re: VPIS..., how about having our own?

paula morgan — Thu, 22 Jul 2010 19:26:21 GMT

well said Polly x

Re: VPIS..., how about having our own?

S-J — Thu, 22 Jul 2010 09:37:45 GMT

Re: VPIS..., how about having our own?

Anonymous — Thu, 22 Jul 2010 09:23:17 GMT

THAT'TS WHAT I WAS TRYING TO SAY BUT I'M NOT AS ELOQUENT OR VERBOSE AS THAT... LOL SORRY FOR CAPS MY PHONE BROWSER DOESN'T LIK THIS PAGE SCRIPT!!

Re: VPIS..., how about having our own?

Honeybadger — Thu, 22 Jul 2010 07:31:15 GMT

Re: VPIS..., how about having our own?

Polly P — Thu, 22 Jul 2010 03:33:09 GMT

Alexander makes a very valid point... The VPIS people are professionals in their own right, they have the info at hand, and the training and knowledge to be able to interpret all incoming data from owners and practices accordingly. As we all know, what is good for one animal/ situation/ person, may be harmful to another.

How often do we, as nurses (or student nurses, or vets, or anyone else in practice) get frustrated because a client took something they found on the internet, or were told by someone, or that they know 'from experience,' above the advice of the veterinary professionals, and potentially cause harm to an animal because of it?

I think this is the same scenario.

The VPIS guys are professionals in their field, if it was easy for a nurse to have that knowledge and be able to advise unequivocally on the subject without consulting with them, then they would not exist.

As this profession as a whole (Veterinary nursing) is fighting right now to be recognised for the protection of the title, and to get the general public to appreciate the role that nurses fill and the knowledge and training that VN's have, so we should offer the same respect to other professionals in the field n support roles or specialist services like this one.

Re: VPIS..., how about having our own?

paula morgan — Wed, 21 Jul 2010 22:32:37 GMT

Ditto Sal x

Re: VPIS..., how about having our own?

Sal the 1st — Wed, 21 Jul 2010 19:24:23 GMT

Re: VPIS..., how about having our own?

Alexander Campbell — Wed, 21 Jul 2010 17:03:43 GMT

I think it would be helpful to give you all a VPIS perspective on this.

It's a lengthy one!

When we receive telephone enquiries at VPIS we try to tailor the advice to the specific case referred to us based on the history you all provide so expertly. There are many variables in toxicology cases, and the advice provided will be determined by dose, species (sometimes breed), time since exposure, duration of exposure, past medical history, age etc. Therefore advice provided for one case, scenario or animal type might not be appropriate for others. Doses and recommendations for drugs used in therapy may differ between animals.

We occasionally have comments that advice can differ when we get enquiries about the same case - and every time this happens it is usually because the history provided has been different and has led us to make slight variations in advice. That is why we routinely record enquiries.

In addition, as you know, we follow up most of our enquiries by questionnaire. Vets are really good at returning these, and this means data are constantly being updated to reflect increased knowledge. For example our internal documents on xylitol have been revised some 19 times in the past 2 years!

Therefore there is a danger that if you keep your own files these may quickly date, and the advice may not be pertinent for all cases. We all know the adage about cats not being small dogs - well with this system there may be a danger that you might inadvertently use advice inappropriately. For example - one paracetamol tablet would not be a problem in a small dog but could kill a cat.

At the moment we are working on several projects to try and make some species and breed specific outline information on our most common enquiries available to subscribing practices. These plans are in development and will be announced in due course. These data will be available electronically, and these can be updated by us as and when necessary to ensure advice is always the most current.

One has to be very careful with information about toxicity one places on a public forum as there are people about who may mis-use this. There was an outcry last autumn when a journalist wrote an article detailing how much antifreeze was toxic to cats and almost incited people to try their hand at poisoning. There were some localised outbreaks of malicious poisoning in some areas of the country after this. One has to be very careful.

There is some limited information already available on our new website (www.vpisuk.co.uk), and we now produce a quarterly newsletter. We'd love feedback on this and requests for other additions you'd like.

**************

One person asked why we'd changed our charging structure. The reason was that the VPIS activity was always heavily subsidised by other sections of the unit of which VPIS is a part. A re-organisation has meant this cross subsidy can no longer occur. VPIS has had to "grow-up" and we have to cover the costs of providing this genuine 24 hour service or we cannot continue.

In addition low volume users were often paying quite large sums of money for very few enquiries under the old system whereas big group practices were in some cases paying about £3 a call, and were getting these low rates at the expense of low volume users. This was unfair. The new structure is designed to be more equitable, though heavy volume users do get some discount.

The online payment system allows each practice to review all enquiries made from it, and the systems have facilities for invoices for clients to be generated.

There was an extensive consultation with the profession with questionnaires being sent to practices direcly and via BVA and BSAVA and other major veterinary bodies. There was excellent feedback and the changes were made to best accomodate respondents wishes.

****************

In Europe and in the USA there are poisons centres that answer enquiries about human poisoning. Some provide some limited animal advice but most do not actively promote themselves to the public or veterinarians and do not collect data and research in this area. In the USA there is also the ASPCA's Animal Poisons Control Center with which VPIS collaborates closely on an academic level. They too charge per enquiry (at a rate slightly higher than our own in fact). Their advice in terms of management will be designed to be compliant with USA Veterinary Medicines Regulations. They will have extensive knowledge of USA products and flora and fauna as we do about the UK experience. However, we find our dialogue and data sharing is extremely helpful.

Local knowledge and connections are important - we can feedback to the UK veterinary associations and bodies like the VMD or NOAH if we feel there are issues of concern. Enquiries handled by bodies external to the UK may not have such strong links or the legal requirements to report. Valuable data could be lost in this way.

I know you will think that I would say this, but the UK is lucky to have a dedicated veterinary poisons service such as the VPIS. Very few other countries have such options. It is your data that enhance our knowledge base and ensure our advice is constantly refined. If fewer cases were received and followed up then our knowledge will not advance. (it is a valid point that this follow up costs money - VPIS pay the postage for these questionnaires.)

I am sure most of your clients would not begrudge paying for ensuring their animals get advice that is pertinent for their individual cases. If you were a patient in a hospital would you want to receive treatment from someone who'd looked at a file to see how other pateints were managed? I think not!

I should stress we do not aim to make a profit on this activity - we have to cover the costs of providing the cover 24 hours a day 365 days a year with someone in the office at all times, and to cover for our research materials and office costs. The service is run on an extremely tight budget. The staff are very dedicated and have a huge collective experience - all of us have worked here for over 6 years and many for 15 years or more. I myself have been here for almost 22 years!

Please remember - the VPIS has gradually developed as an expert system for you - the experts. I think we should try and keep it that way!

Re: VPIS..., how about having our own?

Sal the 1st — Mon, 19 Jul 2010 21:20:51 GMT

no probs I thought it was down to me having a barmy moment

or maybe that should read another barmy moment!

Re: VPIS..., how about having our own?

Anonymous — Mon, 19 Jul 2010 21:16:09 GMT

[quote user="Sal (the 1st) Holesworth VN CMH Chyp (M)PNLP"]

[quote user="StephB"]

[quote user="Sandra Taylor RVN, MBVNA"]

I do get what you are getting at Steph, and I am not suggesting we print off stuff from VPIS and post it here... that would be fraud.

What I am suggesting is, if someone calls VPIS.. ie today for instance for a toxic dose for a said medication/active ingredient, for a dog/cat/weight /breed etc, how long since consumption etc, what are the symptoms if any/ and what is the reccommended tmt.

I am not for a minute suggesting we take over from VPIS, all I was suggesting was having a bit of info that we could share, and put in our own poisons folders, because lets face it we dont update them every minute. If there is something in your inhouse folder, then who actually calls the VPIS if they have the info in front of them.

And by the way the VPIS have put their prices up because they are no longer government funded I believe, so thats why the cost is now falling to the client.

[/quote]

Sorry, i just don't agree Sal. but i do appreciate what you're trying to do and say.

[/quote]

I am getting a bit confused here? and it doesnt take much to confuse me at this time of night what did I say?

[/quote]

fixed

Re: VPIS..., how about having our own?

Anonymous — Mon, 19 Jul 2010 21:14:11 GMT

[quote user="mrs mac"]

Sorry to barge in - Steph are you getting your Sandras and Sals mixed up?!

Sorry, Im in one of those 'I see random things' mood.

[/quote]

yes i'm very

Re: VPIS..., how about having our own?

Sandra Taylor RVN, MBVNA — Mon, 19 Jul 2010 21:03:06 GMT

Steph, it's Sandra not Sal... , Sal is in agreement with you and yes they could probably cut cost somewhere, but asking them to get rid of a beloved pet because they lost a job through no fault of their own... that would be like asking someone to get rid of one of their kids.. it's not gonna happen.

Now I am off to watch BB so as much I would love to continue this interesting debate, I will have to get back to you later, BB is calling

Re: VPIS..., how about having our own?

Mac Feather — Mon, 19 Jul 2010 21:01:43 GMT

Sorry to barge in - Steph are you getting your Sandras and Sals mixed up?!

Sorry, Im in one of those 'I see random things' mood.

Re: VPIS..., how about having our own?

Sal the 1st — Mon, 19 Jul 2010 21:01:22 GMT

[quote user="StephB"]

[quote user="Sandra Taylor RVN, MBVNA"]

I do get what you are getting at Steph, and I am not suggesting we print off stuff from VPIS and post it here... that would be fraud.

And by the way the VPIS have put their prices up because they are no longer government funded I believe, so thats why the cost is now falling to the client.

[/quote]

Sorry, i just don't agree Sal. but i do appreciate what you're trying to do and say.

[/quote]

I am getting a bit confused here? and it doesnt take much to confuse me at this time of night what did I say?

Re: VPIS..., how about having our own?

Anonymous — Mon, 19 Jul 2010 20:56:52 GMT

[quote user="Sandra Taylor RVN, MBVNA"]

[quote user="StephB"]

Can i just add. I think it's a lovely idea to have free access to said information, yes... but i just dont think it's ethical to the times. we have a lot of people losing their jobs already we should keep the ones we have sacred and try to help minimise costs in more legal manners. not stepping on others toes.

[/quote]

And I agree, but what about owners who are skint, and who in the link thread have not bothered to treat their pets because they could not afford the cost of the VPIS?

[/quote]

yes but how long do we support their negligence? how long to we allow them to have pets when they can't afford them? how long do we let them not suffer the consequences? there has to be a limit surely? possibly education is what is needed? putting up public notices of the prices for the treatment using VPIS and what sort of situations would require the use of the VPIS services? Making points in puppy parties and first/second vaccs? losing jobs or not, if they can't afford to keep their animals then they need to make some adjustments or changes that may or may not include rehoming the animal or selling their 42" flat screen TV... or not feeding their children McDonalds...etc We all have the power of making decisions in good and bad times in our lives. These are hard times yes, but shit our great and grand parents went through real hard times. You make priorities and you deal. We can't save them all Sal, and you know me well enough to know i would try if i could!! but we have to put our foot down somewhere. If they can't afford the vet they can't afford the pet. :(

Re: VPIS..., how about having our own?

Sandra Taylor RVN, MBVNA — Mon, 19 Jul 2010 20:52:58 GMT

So are you saying that every owner that calls in where the dog has eaten a box of chocs.... you call VPIS? in an ideal world yes, but in reality.... I dont think so.

Re: VPIS..., how about having our own?

Anonymous — Mon, 19 Jul 2010 20:50:10 GMT

[quote user="Sandra Taylor RVN, MBVNA"]

I do get what you are getting at Steph, and I am not suggesting we print off stuff from VPIS and post it here... that would be fraud.

And by the way the VPIS have put their prices up because they are no longer government funded I believe, so thats why the cost is now falling to the client.

[/quote]

I think going off a book that possibly hasn't been updated since possible recent changes that you wouldn't know of unless you rang VPIS is a little negligent. if i knew that a vet or vet nurse did that and didn't make sure they had the most up to date details about something and just used what they thought would work from previous calls and then my pet died. i would not be a happy bunny. not to mention there are new changes in medicine where using a more up to date medicine might reduce some prolonged symptoms or damage to the tissues or organs. Sorry, i just don't agree Sandra. but i do appreciate what you're trying to do and say.

Re: VPIS..., how about having our own?

Sandra Taylor RVN, MBVNA — Mon, 19 Jul 2010 20:47:55 GMT

[quote user="StephB"]

[/quote]

And I agree, but what about owners who are skint, and who in the link thread have not bothered to treat their pets because they could not afford the cost of the VPIS?

Re: VPIS..., how about having our own?

Anonymous — Mon, 19 Jul 2010 20:45:41 GMT