disciplinary issue - advice please?

Re: disciplinary issue - advice please?

Gillian Mostyn — Tue, 07 Aug 2012 10:40:00 GMT

[quote user="J G Wray"]Nope, nurses do, but the meds don't leave the counter in dispensary until signed off or handed over in person by a vet.[/quote]

So do the the nurses have access to the POM-Vs or do they not? Do you not trust your staff? I do, which is why this matter was taken so seriously by the practice.

[quote user="J G Wray"]I'm surprised you hid behind "Anon "[/quote]

Not hiding. Protecting the identity of the staff member concerned until the matter was concluded - afterall, they may have been found to be innocent of any misconduct.

[quote user="J G Wray"]I'm also surprised you see no reason for review and remedial action for the mis-supply, by you of a POM-V. If a non practice member had got hold of a POM-V would you expect the source to look at their processes? [/quote]

Of course if a MOP had got hold of a POMV then the matter would have been different. But it wasn't, it was a student RVN. And I'm now pretty sure the rest of the practice are fully aware of the implications of their actions if they choose to do anything similar.

You are being deliberately provocative so unless you have anything new to say, I will not be taking part in any more debate. The matter is concluded, it was a stressful event for all the practice and one I no longer wish to discuss with you.

Re: disciplinary issue - advice please?

J G Wray — Tue, 07 Aug 2012 09:10:35 GMT

[quote user="Gillian Mostyn"]

so, if I understand correctly, the vet has to count out and dispense all meds?

[/quote]

Nope, nurses do, but the meds don't leave the counter in dispensary until signed off or handed over in person by a vet.

[quote user="Gillian Mostyn"](By the way, I find it amusing that you didn't get involved in this thread until after I admitted I was the OP. Coincidence???)[/quote]

Glad you can find something amusing about your predicament at last. I'm surprised you hid behind "Anon ". I'm also surprised you see no reason for review and remedial action for the mis-supply, by you of a POM-V. If a non practice member had got hold of a POM-V would you expect the source to look at their processes?

JGW

Re: disciplinary issue - advice please?

Gillian Mostyn — Tue, 07 Aug 2012 08:31:10 GMT

Our stock room is internal - no windows and only one door.

[quote user="J G Wray"]During the day I carry the DD keys for release of all drug.[/quote]

Our RVNs also carry a key for the DD as they need to be able to administer prescribed meds to the in-patients.

[quote user="J G Wray"]Stock takes are done using PDAs, not the PMS and are scheduled into the working day. If you don't carry much stock then stock take does not take long.[/quote]

It isn't just stock takes themselves, it is all stock control. e.g. rotation of stock, putting away new orders, checking expiry dates, restocking of medicine pots, giving out repeat prescriptions, receptionists giving out worming tablets - the list goes on and on....

[quote user="J G Wray"]No drugs leave the dispensary unless a vet dispenses directly to adjacent consulting rooms or in a sealed and labelled outer envelope.[/quote]

so, if I understand correctly, the vet has to count out and dispense all meds?

[quote user="J G Wray"]Anyway, what action are you taking, beyond suspending a staff member to reduce your problem?[/quote]

we don't have a problem.

[quote user="J G Wray"]Then you can report the matter and your remedial action to VMD rather than RCVS[/quote]

er - thanks - I'll bear that in mind. I am sure they'd love to hear about it ....

(By the way, I find it amusing that you didn't get involved in this thread until after I admitted I was the OP. Coincidence???)

Re: disciplinary issue - advice please?

Michael Woodhouse — Tue, 07 Aug 2012 00:07:06 GMT

[quote user="J G Wray"]FILO[/quote]

*shrug*

Re: disciplinary issue - advice please?

Rob Loxley — Mon, 06 Aug 2012 21:53:58 GMT

[quote user="J G Wray"]How did the trainee nurse have a key to the area where any/all POM-Vs are kept? Is this allowed under PSS for instance?[/quote]

There is no legal problem (or PSS issue) with trainee nurses having access to where POMVs are stored, however more thought needs to be applied to safe custody of CDs and 'likely to be abused' drugs (ketamine for instance) to comply; and obviously the Vet Med Regs put controls on who can dispense POMs.

Re: disciplinary issue - advice please?

Bob Russell — Mon, 06 Aug 2012 15:33:24 GMT

POM-V's need to be kept away from clients and casual thieves (we have just had a £3.50 cat tag nicked from the waiting room!!) but staff members have to have access.

We rely on a degree of common sense but the drugs that are most at risk of misuse are locked away and only the vet and nurses can access them easily. We have more than scheduled drugs locked away!

The rest of our medicines are on open shelves in the dispensary area, not Fort Knox but very visible to staff. Theft of these is unlikely to be anything more than an economic loss to the practice.

Any staff member found 'misappropriating' anything knows what the consequences are likely to be - their P45! It is sad when previously trusted members of staff let themselves and the practice down!

Re: disciplinary issue - advice please?

J G Wray — Mon, 06 Aug 2012 15:29:22 GMT

[quote user="Gillian Mostyn"]What system do you use?[/quote]

The one approved by the AMI inspection.

In one practice we have a dispensary room with internal bars on the external window and both doors locked with mortice locks, the keys to which go in the safe along with the DD cupboard keys. During the day I carry the DD keys for release of all drug. No drugs leave the dispensary unless a vet dispenses directly to adjacent consulting rooms or in a sealed and labelled outer envelope. This works if, like me you are FILO, or if not working weekends the vet is.

The other practice has locking cupbards and a security venetian blind. The key goes in the safe, but same rules apply otherwise operated by my Co-directorwho is also FILO.

Stock takes are done using PDAs, not the PMS and are scheduled into the working day. If you don't carry much stock then stock take does not take long.

Anyway, what action are you taking, beyond suspending a staff member to reduce your problem?

[quote user="Gillian Mostyn"]

[quote user="J G Wray"]Is this allowed under PSS for instance?[/quote]

I have no idea, not being a member.

[/quote]

Then you can report the matter and your remedial action to VMD rather than RCVS

JGW

Re: disciplinary issue - advice please?

Gillian Mostyn — Mon, 06 Aug 2012 14:38:25 GMT

[quote user="J G Wray"]How did the trainee nurse have a key to the area where any/all POM-Vs are kept?[/quote]

All POMV drugs are kept in a locked store room (yale lock), which all vets, nurses, receptionists and students have a key to. They need this for many reasons, not least of them that they do all the stock control! Thus the room is locked unless it is in use - all day. I find this system safer than a room which is open whenever the practice is open, which I think would carry a greater risk of theft from someone other than a key holder, as the door could possibly be accessed from the waiting room.

What system do you use?

[quote user="J G Wray"]Is this allowed under PSS for instance?[/quote]

I have no idea, not being a member.

Re: disciplinary issue - advice please?

J G Wray — Mon, 06 Aug 2012 13:25:57 GMT

[quote user="Michael Woodhouse"]There's nothing wrong with the content of the poster. Equally there is nothing wrong with the farmer having in his possession a bottle of appropriate treatment for likely scenarios on farm. The two options don't have to be independent. I am more than happy advising a farmer on a weekend or OOH what is the best treatment for a conditions out of what he has available[/quote]

Point 7 about being able to justify actions and keep accurate records of outcomes looks a little difficult to me when dispensing antimicrobials like this.

There is no doubt that our LA brethren could screw the pitch for all of us. They are exhorting us all to follow "rational" and "responsible" practice, the implicit criticism being that what went before has always been irrational/irresponsible, perhaps empirical. This rankles with me, however I recognise the necessity of the exercise as a strategic aim. What the pious have not done is discuss implementation.BVA are set to produce "protocols" which may help some of our LA brethren, but since they are in a minority I think it behoves BVA and by their offices VMD/Defra/EEC/RCVS to raise the matter of clinical dilemma for general practitioners in companion animal practice.

GPs have similar clinical dilemmas, but they are discussing it and their representative bodies are not being sanctimonious about it. BVA would rather stifle any discussion, who knows why, but there it is. Bringing pressure to bear on your regional rep to at least get this discussed is a starting point. Using the BVA members survey is another.

[quote user="Michael Woodhouse"]Our cleaner has access to the whole practice. [/quote]

Oops

[quote user="Michael Woodhouse"] We are in a long thin building so you have to go through the dispensary to get to kennels, theatre and the office. She's not allowed to take stationary how is this different? It's only things that are locked up that she couldn't access.[/quote]

Since when did telling someone not to do something..........Are your drugs secure?

JGW

Re: disciplinary issue - advice please?

Michael Woodhouse — Mon, 06 Aug 2012 12:25:34 GMT

[quote user="J G Wray"]

That's rich. The BVA has produced an 8 point plan

http://www.bva.co.uk/public/documents/BVA_Antimicrobials_Poster.PDF

This, as ever with BVA is produced by LA practitioners and requiring all to conform.

[/quote]

There's nothing wrong with the content of the poster. Equally there is nothing wrong with the farmer having in his possession a bottle of appropriate treatment for likely scenarios on farm. The two options don't have to be independent. I am more than happy advising a farmer on a weekend or OOH what is the best treatment for a conditions out of what he has available.

[quote user="J G Wray"]PS How did the trainee nurse have a key to the area where any/all POM-Vs are kept?[/quote]

Our cleaner has access to the whole practice. We are in a long thin building so you have to go through the dispensary to get to kennels, theatre and the office. She's not allowed to take stationary how is this different? It's only things that are locked up that she couldn't access.

Re: disciplinary issue - advice please?

J G Wray — Mon, 06 Aug 2012 07:28:12 GMT

[quote user="David Mills"]I'm not sure it's necessarily a Good Thing. But I think equally it's a realistic thing. Try telling a farmer that he has to pay a visit fee for a sheep with pneumonia on a Sunday afternoon; you'd be left with no clients quite sharpish. I think it's rather a SA perversion this chest-banging POM-V stance. [/quote]

Dear Mr Mills,

That's rich. The BVA has produced an 8 point plan

http://www.bva.co.uk/public/documents/BVA_Antimicrobials_Poster.PDF

This, as ever with BVA is produced by LA practitioners and requiring all to conform.

If you have a problem with this then start the debate on what's missing from this almost pious approach to the use of POM-Vs ( not just antimicrobials) our own representatives are taking, which is the "clinical dilemma". Once that is aired the BVA can move on from its current position to assisting practitioners in implementing their high ambition and most importantly educating our clients, the public about the regulatory straijacket we have imposed on ouselves.

That would take this thread from an undefying but hopefully singular problem to a discussion of something which affects us all.

JGW

PS How did the trainee nurse have a key to the area where any/all POM-Vs are kept? Is this allowed under PSS for instance?

Re: disciplinary issue - advice please?

Gillian Mostyn — Sun, 05 Aug 2012 18:16:45 GMT

erm..yep - I was the OP. Have been on holiday for 2 weeks so have just found your post....

Thanks for the advice. I did find the BVA helpline/legal advisors very useful and did go through the process as recommended. Unfortunately the matter was ultimately resolved by the staff member being dismissed.

Not a nice situation but ultimately it was the only decision we could take, for various reasons.

Re: disciplinary issue - advice please?

Sally Burnell — Fri, 03 Aug 2012 15:41:39 GMT

[quote user="An On MRCVS"]

I have had a problem at work this morning and would appreciate some advice.

....

What would you do?

[/quote]

Hello,

This may be a bit late for your current situation - sorry for not spotting it sooner - but BVA has produced a series of short videos for members on the disciplinary process. The videos are free of charge and provide a useful overview of what to expect if you are either conducting or facing a disciplinary procedure at work. The series covers

Starting the disciplinary process: the investigation
Inviting the employee to a disciplinary meeting
The disciplinary meeting
Making your decision and taking action
What to do if you are facing a disciplinary

The videos can be accessed here

As well as our legal helpline (which I'm really glad you found useful) BVA also offers all members a free mediation service, where a trained mediator can attend a meeting to try and help resolve an employment issue.

For more information on BVA's legal services visit www.bva.co.uk/legal

Good luck,

Sally

Re: disciplinary issue - advice please?

Neal Palk — Sun, 15 Jul 2012 09:14:43 GMT

[quote user="Julian Earl"]

[quote user="Bob Russell"]

To be quite honest I would normally document a formal written warning and give a good verbal bo**ocking. It is very easy to take medicines for granted and there are times when staff can get blase about handling them. It sounds as if there are more problems here with this member of staff.

A member of staff is unlikely to have much of a legal leg to stand on at tribunal but was it theft? Was it dispensed and paid for?

Theft is always an easy one for instant dismissal! Taking POM's without permission is a criminal offence!

Speak to your legal adviser. BVA members have access to a free helpline and many practice insurance policies have similar helplines.

Unless there are mitigating factors sounds like she really ought to go!

[/quote]

But instant dismissal is not possible according to our advisors; you could find the member of staff with her hand in the till, injecting ketamine, and indulging in a sexual act on the front desk in front of the clients and you still have to go through the correct stages for a dismissal.

[/quote]

You need competent advisers - if you're getting that advice whoever is giving it needs to be well insured!

Re: disciplinary issue - advice please?

James Laidlaw — Sat, 07 Jul 2012 10:22:54 GMT

We are in a constant struggle between using our judgment and avoiding the judgment of our governing body... I know Alet will have a concern in this case as staff given too much free reign can start acting beyond their capacity, and while this seems like a fairly minor incident, things can very quickly spiral out of control. I ha a nurse take over a case for 2 or 3 months dispensing and prescribing and acting as a vet when she clearly wasn't. Was she doing the right thing? Of course not, but most of the drugs she chose were correct from experience. Just because someone knows what to give doesn't mean they can give it. I'd trust almost every nurse I've ever worked with to calculate a dose of metacam and administer it SQ, but POM-V drugs should only be given following a clinical assessment. I also don't think LA and SA practice are comparable. Having worked in both they are very different entities and the practice habits in large animal clinics shouldn't be applie to small animal work.

Re: disciplinary issue - advice please?

Lorna McHardy — Sat, 07 Jul 2012 09:36:26 GMT

[quote user="Alet Engelbrecht"]

The double standards I eluded to, is that many of us said that we were quite happy to give telephone advice without seeing an animal (and sometimes advising human drugs), but in this case where it is a person and animal well known to the practice, people are criticising the vet, even though this vet was in a much better position to judge the situation than a routine OOH call.

[/quote]

If they're not the same people, no double standards. Your comment was directed at all those who questioned or criticized the vet's actions. Disagreement with my point of view is fine, but I don't like being accused of having double standards.

And I wasn't trying to be patronizing, I was trying to lighten the mood... it appears not to have worked, so having made my point, I'll apologize for appearing to be patronizing, and go away.

Re: disciplinary issue - advice please?

Alet Engelbrecht — Sat, 07 Jul 2012 07:23:20 GMT

[quote user="Michael Woodhouse"]No. Think this is the first time I have joined a thread without my own input.[/quote]

Sorry, Michael - did not mean to attack you in any way. I was grateful for the link - and although I still don't advise it, I now will be more understanding of other vets doing it. Equally, I think you have immediately grasp the crux of the matter, so thanks and well done.

[quote user="Lorna McHardy"]In this case? Given only the information in the OP, I'd have said I'd see the animal, or if unable to do so, would have suggested calling another vet. That's why I asked why the dog hadn't been seen. Since then, the information has been expanded and the question answered, to which I responded, if I remember correctly, "fair enough". Since then, the discussion has generalized, as they do. Do keep up [/quote]

I am not quite following your logic - my whole point in my first post in this thread was that we cannot criticise the vet as we did not have all the information. In that post I said that I would do the same thing in certain circumstances. Since then, the OP has expanded the initial post, yet after your 'fair enough', I started losing your argument, hence my direct question which you now answered. There is no need to become personal or patronising. I have no double standards, I do not tell owners to give paracetamol or else, and I could never understand where this advice came from when I get clients telling me that the vet said so. Thanks to Michael enlightening me, I now know and I have stepped down from my 'high horse'.

Re: disciplinary issue - advice please?

Michael Woodhouse — Sat, 07 Jul 2012 01:43:01 GMT

[quote user="Lorna McHardy"]And has Michael been calling for this vet to be disciplined, let alone been ready to crucify him?[/quote]

No. Think this is the first time I have joined a thread without my own input.

Lets get real, if the dog isn't on steroids or another NSAID a shot of metecam is going to do no harm. (TBH if it is on steroids or NSAIDS I'm not convinced a single shot would do any harm - I have used steroids and NSAIDS a number of times with informed consent and zero problems).

I would be in no rush to see a dog with a cut pad OOH unless the owners really wanted me to. If I saw the dog myself I would likely give antibiotics for a dirty wound on a foot anyway and I suggest that the combination the nurse went for would be the practices 'usual'.

I have said it before there doesn't seem to be much comradery in this industry. Everyone seems to be wanting to 'report' each other for their lapses in judgement or because they have a different viewpoint.We'd be collectively a lot stronger if we could provide a united front.

Ok she shouldn't technically have done what she did, but a quiet word to explain what is wrong with this should be enough. Unless the OP is looking for an excuse to 'get rid'.

Re: disciplinary issue - advice please?

Lorna McHardy — Fri, 06 Jul 2012 22:42:50 GMT

[quote user="Alet Engelbrecht"]

So Lorna, what would you have done?

[/quote]

In this case? Given only the information in the OP, I'd have said I'd see the animal, or if unable to do so, would have suggested calling another vet. That's why I asked why the dog hadn't been seen. Since then, the information has been expanded and the question answered, to which I responded, if I remember correctly, "fair enough". Since then, the discussion has generalized, as they do. Do keep up

[quote user="Alet Engelbrecht"]

My statement about double standards stem from the 'CASCADE' thread: <snip quotation from Michael Woodhouse>

[/quote]

And has Michael been calling for this vet to be disciplined, let alone been ready to crucify him? That's what I mean about conflating posters and posts.

I also note, incidentally, that you were the one pointing out that advising clients to give their dogs paracetamol without seeing it is "against the cascade, potentially harmful... and technically illegal", yet you're now up in arms because somebody questions why this particular dog wasn't seen before being prescribed a POM. By your own argument (though not by mine, because I think they're two different things), that makes you the one with the double standards.

[quote user="Alet Engelbrecht"]

Bottom of page 18 if you don't believe me

[/quote]

I not only believe you, I remember the thread. My point is that it's not reasonable to accuse everybody who voices an opinion you disagree with of double standards, when no such are evident that I can see.

Re: disciplinary issue - advice please?

Alet Engelbrecht — Fri, 06 Jul 2012 21:05:47 GMT

[quote user="Lorna McHardy"]Speaking for myself, I am happy to give advice over the phone where appropriate and still find an absolute refusal to do so regardless of the nature of the phone call totally unreasonable. That does not include dispensing POMs to animals I haven't seen unless there's a very good reason (which would be rare), and I'm pretty sure I've never said otherwise. It also doesn't include telling people it's ok to just give their pet some paracetamol - I might tell them a dose if they absolutely refuse to bring the dog in and insist they're going to feed it something I've told them I can't be sure is safe - or as safe as drugs ever are - and isn't licensed for their dog regardless of my advice. Where's the double standard?[/quote]

So Lorna, what would you have done? It is a Sunday afternoon and you are on your way back from a weekend camping trip or whatever takes your fancy. One of the 1st year trainees phone for advice - her dog has cut its footpad - she has been employed by the practice for about 5 years and has done several injections and bandages supervised and unsupervised. Her dog is an adult crossbreed for example, possibly even adopted through the practice - she talks about it a lot at work and it comes with her to work about once a month. She asks whether it is ok for her to go to the practice for some bandaging materials - the foot is bleeding and the dog is limping. You are not available to see the dog, you will only be back much later that evening. The alternative is a trip to Vets Now where she has no staff discount or privileges or a superstore with drugs and bandaging materials.

My statement about double standards stem from the 'CASCADE' thread:

[quote user="Michael Woodhouse"]

[quote user="Alet Engelbrecht"]My question is not really about the out of hours element (incidental), rather the giving of advice that clients run with and duplicate for every other problem, because 'the vet said so'... which is actually against the cascade, potentially harmful to the animal and even though no prosecutions yet, technically illegal.[/quote]

I frequently get people to administer aspirin or paracetamol to their animals OOH. I get them to read me the concentration of active from the packet.

The VMD broadly support that this is ok:

Medicines commonly found around the home - Sometimes a veterinary surgeon may judge there is a need to alleviate a pet's discomfort until a home visit can be made or the animal brought to the surgery. It would be unlikely that action would be taken if in such circumstances a home remedy, e.g. aspirin, were to be recommended.

Bottom of page 18 if you don't believe me

Linky

[/quote]

This is not your average client - it is a trainee that have been involved in the day to day workings of a veterinary practice for 5 years. She is deemed trustworthy enough to have the practice keys and alarm codes, even though not the most motivated employee according to the boss (AnOn). The question about why the dog was not seen by the vet that was contacted initially, had been answered. So would you then suggest to take the dog to Vets Now - when you know very well that they are going to apply a bandage and give a licenced NSAID?

Re: disciplinary issue - advice please?

Lorna McHardy — Fri, 06 Jul 2012 20:28:09 GMT

[quote user="David Mills"]

I think its a perversion in that its been brought about by mollycoddled SA clients whose rationality goes out of the window when it comes to their pets - how many times do things sound like they're dying on the phone and they bounce into the clinic when seen? I think it feeds the ego of the vet who then insists on seeing everything, whereas LA practice is - by nature of being a production business - is more rational in its approach to the use of medicines by lay people. Its a difference, I suppose, between what is best practice - C/S for every bacterial infection - and realistic practice or what people will pay for. Its realism, pragmatism, whatever you want to call it the same way as people who refuse to give telephone advice are the opposite, unreasonable alternative of this. The OP's vet did the right thing, and I think it rather funny that people are uppity about the antibiotic part of this (like they would have given any thing else).

[/quote]

I'm unconvinced by your correlations or your conclusions. I agree about the difference between best practice and realistic practice - although I might not always agree with everyone about what constitutes best practice - and the balance is not going to be the same for everyone.

If I think it's going to need medication dispensing, or any other form of veterinary attention, I'll tell the owner it needs to be seen, and I'll err on the side of caution. Otherwise, sooner or later, I'll miss something vital. That, to me, would be best practice, and it doesn't strike me as particularly unrealistic, either. Would you be happy to dispense POMs to owners for animals you've not seen? In terms of doing a decent job, that is what seems to me unrealistic. I do not think it unrealistic to expect owners to pay for a consultation fee in order to get the correct treatment for their animals.

Owners don't necessarily know, that's why they phone us... I've seen just as many that didn't sound that worried and then brought in a pet close to death and were shocked to hear it. If I think it'll need medication, but not necessarily straight away, I'll advise bringing it in during normal hours. If I'm sure it doesn't need medication, or any other veterinary attention, I'll advise accordingly.

Of course, the owner may refuse my advice in this context, but there's not a lot I can do about that... and as the above really isn't particularly unreasonable or unrealistic, it doesn't happen very often.

Re: disciplinary issue - advice please?

David Mills — Fri, 06 Jul 2012 20:06:37 GMT

[quote user="Lorna McHardy"]

If dispensing POMs without seeing the patient is not a Good Thing, it's a poor argument for doing it. Realism might be a better argument, but it's still against the rules, and not necessarily in the best interests of the patient, which is more to the point.

Why is wanting to see your patients before dispensing POMs to them a "perversion"? What do you see as a better, less perverted approach?

[/quote]

Re: disciplinary issue - advice please?

Lorna McHardy — Fri, 06 Jul 2012 19:52:44 GMT

[quote user="David Mills"]

[quote user="Lorna McHardy"]

[quote user="David Mills"]

Of course it is. Anyone who has spent any time in mixed practice knows that farmers are routinely dispensed antibiotics, pain killers and everything else under the sun without the animal ever being seen.

[/quote]

And if that is true, it's a Good Thing why?

[/quote]

Well, it is true. I'm not sure it's necessarily a Good Thing. But I think equally it's a realistic thing. Try telling a farmer that he has to pay a visit fee for a sheep with pneumonia on a Sunday afternoon; you'd be left with no clients quite sharpish. I think it's rather a SA perversion this chest-banging POM-V stance.

[/quote]

Why is wanting to see your patients before dispensing POMs to them a "perversion"? What do you see as a better, less perverted approach?

Re: disciplinary issue - advice please?

Lorna McHardy — Fri, 06 Jul 2012 19:52:41 GMT

[quote user="David Mills"]

[quote user="Lorna McHardy"]

[quote user="David Mills"]

[/quote]

And if that is true, it's a Good Thing why?

[/quote]

Why is wanting to see your patients before dispensing POMs to them a "perversion"? What do you see as a better, less perverted approach?

Re: disciplinary issue - advice please?

David Mills — Fri, 06 Jul 2012 19:46:24 GMT

[quote user="Lorna McHardy"]

[quote user="David Mills"]

[/quote]

And if that is true, it's a Good Thing why?

[/quote]