what is an non RVN allowed to do?

Re: what is an non RVN allowed to do?

Rob Loxley — Tue, 22 May 2012 16:19:21 GMT

So the owners of the diabetic dog can never go on holiday and put the dog in kennels or leave it with friends to inject? I suppose we could hospitalise it here for 3 weeks until they get back from Australia!

Re: what is an non RVN allowed to do?

Mark Holmes — Mon, 21 May 2012 17:15:09 GMT

Does it say something about the British that we are having this discussion. My recollection of other countries is that the law is interpreted according to such things as the weather, bank holidays and if it happens before or after midday.

There is no wonder we are over regulated if we accept regulation so easily. I am going to go and stand on a stool for no other reason than to spite the H+S laws as well.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 17:11:47 GMT

Maybe the law is too strict-but it's still the law -bit like the cascade

Wynne

Re: what is an non RVN allowed to do?

Mark Holmes — Mon, 21 May 2012 17:07:06 GMT

[quote user="Michael Woodhouse"]

Wynne, so it is appropriate for a farmer to inject his cow with penicillin but not his horse?

So long as we are directing treatment I can't see a problem.

[/quote]

I think the farmer could inject HIS cow and HIS horse but a livery yard owner would not be able to inject someone else's. There was a discussion about whether the livery owner was employed and that may depend on his tax situation etc etc.

This is where draconian interpretation becomes ridiculous. It should be simply at the Veterinary Surgeon's discretion who they delegate administration of drugs to. If I feel somebody is competent enough to administer a drug according to my instruction then so be it.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 17:02:15 GMT

It's because the law allows exemption for owners, and in the case of farm animals for bona fide employees of the owner It's fine for a farmer to inject his own horse or dog but in the case of non farm animals the injection must be given bya veterinary surgeon, or listed /registered VN or VN student enrolled with Royal College , the owner or an immediate family member of the owner. That's the law I'm not saying it's sensible for livery yard owners to be forbidden from injecting clients horses I'm just saying that's how it is

Wynne

Re: what is an non RVN allowed to do?

Michael Woodhouse — Mon, 21 May 2012 16:51:03 GMT

Wynne, so it is appropriate for a farmer to inject his cow with penicillin but not his horse?

So long as we are directing treatment I can't see a problem.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 16:28:00 GMT

I thought the rule book was clear-you just don't let anyone do anything they're not supposed to do-for example in this case I would have automatically chosen TMS not penicillin simply because there would be no legal problems with asking a livery yard owner to administer If the entire profession stuck strictly tothe law the public would know they'd get the same answer from all of us-so wouldn't bother asking us to stretch things for their sakes

Wynne

Re: what is an non RVN allowed to do?

Bob Russell — Mon, 21 May 2012 16:10:51 GMT

[quote user="Hannah Wynne Richards"]

The trouble with flexible interpretations of the law is what if something goes wrong, it ends up in court, and the magistrates interpret it strictly?

Wynne

[/quote]

Laws, especially 50 year old ones are rarely clear cut and get 'interpreted' by case lore. As far as I know there has been little or no fine tuning of what is and isn't allowed to be delegated within practice premises so the guidance has either come from the RCVS (largely opinions of staff there) or DEFRA/MAFF/whatever this years initials are.

Without flexible interpretation the rule book has to be clearer. Roll on the new VS Act!

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 15:52:35 GMT

The trouble with flexible interpretations of the law is what if something goes wrong, it ends up in court, and the magistrates interpret it strictly?

Wynne

Re: what is an non RVN allowed to do?

Bob Russell — Mon, 21 May 2012 15:51:38 GMT

Is an i/m injection an act of surgery yet a s/c is not?

I admit I have not studied the VS Act for some years and I am prepared to be corrected but I don't remember this level of detail in the Act. There have been a number of guidelines and interpretations from a variety of sources.

My view is that any injection should be under the guidance and control (if not direct supervision) of a veterinary surgeon but that would have the effect of preventing any Tom, Dick and Harry from implanting microchips!

Re: what is an non RVN allowed to do?

Mark Holmes — Mon, 21 May 2012 15:27:32 GMT

[quote user="Hannah Wynne Richards"]

That's because legally it's an act of veterinary surgery,and therefore forbidden to anyone not a veterinary surgeon (1966 Act ) except for certain narrow and defined exceptions-1 of which is for listed or registered VNs

Wynne

[/quote]

The problem with legal defined narrow exceptions is that they don't take into account the whole bunch of "what ifs" as described and not envisaged by the authors of the original legislation. I am fairly certain that they didn't actively consider the situation where a horse might require treatment at a livery yard and consider the benefits of a vet being required to administer the drug. All laws should be considered in the spirit of their intention rather than the letter. The intention of the ACT was to improve welfare by ensuring a vet is responsible for the medical and surgical care of an animal. The vet does not need to administer the drugs to achieve this. I would argue that a draconian interpretation of the letter of the act does not achieve its intention.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 15:14:10 GMT

Wynne

Re: what is an non RVN allowed to do?

Mark Holmes — Mon, 21 May 2012 15:11:15 GMT

[quote user="Bob Russell"]Differentiating between s/c and i/m injections seems pretty pointless to me. Both techniques need to be taught (remember Truda vaccinating a cat on TV?) and both can be done badly. Someone can be taught to safely do i/m injections very easily but I have to admit it is not something that staff here are particularly keen to do[/quote]

And both carry very little risk relative to the risk of mis-dosing. Something that is just as possible orally, a procedure anybody is legally entitled to carry out. It seems to me that undue reverence is given to the act of injecting be it sc or im.

Re: what is an non RVN allowed to do?

Bob Russell — Mon, 21 May 2012 14:40:03 GMT

[quote user="Hannah Wynne Richards"]

I think the only way to get a definitive answer on this one would be to ask a lawyer

Wynne

[/quote]

Ask a lawyer and they will tell you that the court must interpret the law! How many straight answers do you get from a lawyer?

The high lighted text stating that i/m injections are not to be given by non-VN's is an opinion only. It is not the law! Interpretation by the RCVS would similarly be an opinion but it may be held up in court and treated with more weight should a case end up there.

Differentiating between s/c and i/m injections seems pretty pointless to me. Both techniques need to be taught (remember Truda vaccinating a cat on TV?) and both can be done badly. Someone can be taught to safely do i/m injections very easily but I have to admit it is not something that staff here are particularly keen to do.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 09:59:14 GMT

I think the only way to get a definitive answer on this one would be to ask a lawyer

Wynne

Re: what is an non RVN allowed to do?

Mark Holmes — Mon, 21 May 2012 09:29:04 GMT

[quote user="Hannah Wynne Richards"]

I don't thinkso-not unless the animals owner pays Employers NI for them-and they recieve a salary or wage and have an employment contract I think it would come down to whether Inland Revenue recognised them as employees or self-employed

Wynne

[/quote]

I think if you pay for somebody to act on your behalf it would be sufficient for this example. You cannot have an issue of drugs administration being dependant on somebody's tax status.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Mon, 21 May 2012 08:51:44 GMT

Wynne

Re: what is an non RVN allowed to do?

Michael Woodhouse — Sat, 19 May 2012 19:40:32 GMT

[quote user="Wren"]

If only an owner is allowed to inject an animal (barring exemption for farm-workers) where does this leave a livery/competition yard owner/racehorse trainer injecting a client's horse with penicillin? Generally they are more competent at injecting the horse than the horse's owner and, especially in the case of the racehorse, the owner may never even set foot on the yard.

[/quote]

If you go to the actual act:

Part I Treatment and Operations which may be Given or Carried Out by Unqualified Persons1

Any minor medical treatment given to an animal by its owner, by another member of the household of which the owner is a member or by a person in the employment of the owner.

I would have thought that a I/M injection into a horse or farm animal would fall into that category. The trainer or livery yard owner is receiving payment from the horse owner so could be in the 'employment'?

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Wed, 16 May 2012 13:32:44 GMT

The law doesn't have to be logical-that's the problem very often-but it's still risky to break it

Wynne

Re: what is an non RVN allowed to do?

Wren — Wed, 16 May 2012 12:40:09 GMT

[quote user="Hannah Wynne Richards"]

I don't think it would be acceptable-because the injection would be im or if crystapen iv not sc

Wynne

[/quote]

I'm not sure whether the quoted passage above refers to all animals or just small animals? Certainly we don't use subcut injections in horses (although they are increasingly in use for farm animals) at all.

I find it hard to believe that it's illegal for the stud-owner of the mare I've just seen (superficial wound) to give it 5 days of penicillin injections on my direction. The only licensed oral alternative is TMP-S and that's four times the cost and not always practical.

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Wed, 16 May 2012 11:41:30 GMT

I don't think it would be acceptable-because the injection would be im or if crystapen iv not sc

Wynne

Re: what is an non RVN allowed to do?

Niall Taylor — Wed, 16 May 2012 11:39:06 GMT

[quote user="Wren"]If only an owner is allowed to inject an animal (barring exemption for farm-workers) where does this leave a livery/competition yard owner/racehorse trainer injecting a client's horse with penicillin? Generally they are more competent at injecting the horse than the horse's owner and, especially in the case of the racehorse, the owner may never even set foot on the yard.[/quote]

I would have thought that if the VS has done a risk assessment and is happy for the livery staff member to inject the horse that would be acceptible. If the owner directs someone else to do it without mentioning it to the VS then they are potentially on shaky ground if anything goes wrong (but hopefully this wouldn't backfire on the VS).

Niall

Re: what is an non RVN allowed to do?

Niall Taylor — Wed, 16 May 2012 11:34:26 GMT

I've managed to track down a more nuanced interpretation of Schedule 3 and what unqualified persons are and are not allowed to do. It is written by that well known VN spokesperson Anne On and can be found in VN standard August 2010 on pages 4 and 5. The relevant bit reads as follows:

What can unqualified practice staff do?

As there is no specific legal dispensation for a veterinary surgeon to delegate to a lay person employed by a veterinary practice, any such delegation may need to be justified and is a matter of professional judgement in any individual case following risk assessment.

The RCVS recognises that in certain circumstances it may not be in the public interest to take regulatory action where the delegation to a lay member of practice staff is reasonable in all the circumstances, does not put the animal at risk and does not amount to more than minor medical treatment of the sort which an owner could undertake. The RCVS has indicated that, out of hours (for example, when the on-duty nurse is alone in the practice at night), any nurse may be directed by a veterinary surgeon to administer uncomplicated oral medications or subcutaneous injections.

Intramuscular or intravenous injections, invasive procedures such as the introduction of an IV catheter or the passage of a urinary catheter, are all examples of medical procedures that should not be delegated to a lay person.

What can be delegated?

As mentioned earlier, the Act does not provide a list of minor surgery and medical treatment that can be delegated. This is because it would be impossible to say with any certainty that a given procedure would, in every event, be safe to delegate. Whilst Schedule 3 does not provide a definitive list of permitted delegations, three key factors ought to be considered:

The nature of the procedure (or treatment), ie its level of complexity
The individual animal concerned, ie species, condition, likelihood of complications, owner's wishes
The qualifications of the person being delegated to, ie Listed or enrolled student veterinary nurse (or in the case of a minor treatment, a lay person), specific training, experience, confidence, willingness to accept delegation and the availability of someone more qualified to step in if needed

Should a delegation decision become the subject of litigation, or a professional conduct complaint, a court (or an RCVS investigation) would consider the 'reasonableness' of the veterinary surgeon's actions. A clearly reasoned decision, taken having followed a logical and well-documented process, should therefore be behind every delegation of a veterinary treatment or procedure to a non veterinary surgeon.

So there you have it - lay persons including ANAs and unsupervised SVNs can give tablets and do sub. cut. but not i/m or i/v injections.

The Veterinary Surgeons' Act can be found here btw: http://www.rcvs.org.uk/document-library/veterinary-surgeons-act-1966/

Cheers,

Niall

P.S. - Thanks Mark

Re: what is an non RVN allowed to do?

Hannah Wynne Richards — Wed, 16 May 2012 09:04:43 GMT

Technically breaking the law

Wynne

Re: what is an non RVN allowed to do?

Wren — Wed, 16 May 2012 07:04:35 GMT