Home visits poll.

Re: Home visits poll.

Bob Russell — Mon, 12 Aug 2013 14:45:03 GMT

To be quite honest, after reading the full transcript of Chikosi I have little respect left for the standard of judgement of those members of the DC. I don't think I respect the particular group of 'judges' enough to be that stressed! Place me in front of a group of practicing vets of a sound calibre and I would face them much more respectfully.

If I feel. hand on heart that what I did was right and professional I would value my own moral compass and go in ready for a fight!

I think they made a complete mess of things, were making a 'political' statement and showed little wisdom.

If your gut feeling is that a visit is risky and you cannot reduce that risk to an acceptable level then you should not go! Perhaps a good test would be 'would I send a colleague on that visit?'. If the answer is no then you know the correct course.

The duty to visit must be balanced by the duty of an owner to get the animal to a place it can receive proper attention.

Re: Home visits poll.

Mark Holmes — Sun, 11 Aug 2013 18:49:23 GMT

[quote user="Elisabeth Knappett"]

I am in much the same situation as Michael I think - I have no option but to do house calls (during the day AND at night) by myself. In both my current and previous jobs I have been both verbally and physically assaulted (slapped, punched and thrown out of a house after a PTS) and yet I still do these calls. Reports to the police have met with various responses, from laughter do being told I was a 'daft bugger' for going there in the first place - how was I meant to know, I'd only been in the job 3 days!

I would like to think with experience I can now weed out the odd ones, but was still caught this week with a demand to do a house call and being told by the owner when I explained the dog would be much better seen at the clinic that I 'can't say no coz thats what it says on the net' (the dog was big and the owner didn't want it in her new BMW)....is it worth the additional stress and upset by refusing to do these calls to prove a point or risk the worry of your case being the one that the RCVS use to shake up the vetting community?

Personally, being an assistant, I say no. I stress enough already about my caseload and I don't need spurious complaints about reasonably refusing to do a visit being thrown in my face. My choice I know, but I would feel more secure if I knew that firmer guidelines were in place OR that Joe Public were more reliably informed about house visits from the RCVS. It's simply too vague at the moment.

[/quote] I think that says it all. More concern about the stress of a complaint (even IF it wouldn't come to anything) than her own personal safety, despite having been assaulted on a previous visit. Its time the duty to attend was withdrawn. I would be interested to know if anybody feels that having been assaulted once, you would have greater justification to decline a visit using heightened anxiety as justification. Or more abstractly can I having now read about somebody being assaulted use heightened anxiety to decline a visit. I could use it but would have no idea how the DC would judge the decision.

Re: Home visits poll.

Elisabeth Knappett — Sun, 11 Aug 2013 18:24:54 GMT

Re: Home visits poll.

Clive Ansell — Sat, 10 Aug 2013 09:17:28 GMT

I think the GtoPC states that safety can be taken into account, and that we are not expected to risk life or limb.

Then there is this from one of JGW's posts

Re: Home visits poll.

Mark Holmes — Fri, 09 Aug 2013 23:00:12 GMT

[quote user="Gillian Mostyn"]

[quote user="Mark Thirkell"] The current situation is that we are required by the RCVS to take the (albeit small) personal risk of attending house calls OOH. [/quote]

Not if your personal safety is at risk.

[/quote] How do you know?

Re: Home visits poll.

Gillian Mostyn — Fri, 09 Aug 2013 22:56:11 GMT

[quote user="Mark Thirkell"] The current situation is that we are required by the RCVS to take the (albeit small) personal risk of attending house calls OOH. [/quote]

Not if your personal safety is at risk.

Re: Home visits poll.

karen jones — Fri, 09 Aug 2013 22:24:24 GMT

Out of hours doctors don't do visits on own. they have someone who drives them around. Paramedics usually work in pairs and won't go into risky places without the police. I tell my staff if they are worried phone for help and advice. Their health and safety are paramount. We are a 6 vet mixed practice in a market town on Shropshire . Welsh border and I trust our nurses who take the phones when they say not sure about this person. Intuition is a good thing as is experience

Re: Home visits poll.

Mark Thirkell — Fri, 09 Aug 2013 21:50:42 GMT

[quote user="Gillian Mostyn"]

[quote user="Mark Holmes"]One day a vet will be assaulted or worse because she/he feared the RCVS more than the horny drunk who phoned.[/quote]

Do you know how very very rare assault by a stranger actually is? Scaremongering is not helpful.

[/quote]

I have been physically threatened by an unreasonable customer whilst on a house call in the early hours. He was probably intoxicated but this was not obvious when he phoned. The patient was not a clinical emergency - but symptoms where exaggerated by owner in order to make a visit seem necessary because he couldn't afford a taxi!. I qualified in 1986 and have done OOH on rota basis in every practice small / mixed; as employee or partner; hardly a novice!. Being fairly robust of stature and temperament I avoided anything more than threats. The situation could have been very different. Employers have a duty of care to their employees. The current situation is that we are required by the RCVS to take the (albeit small) personal risk of attending house calls OOH. I have always worked a "normal" day after a night on call, no matter what workload has been undertaken. Working Time Directive compliant - I suspect not! Practice policy is in accordance with GtPC in that the on call vet is prepared to make a domiciliary visit if satisfied that the patient cannot safely be brought to the surgery. Not scaremongering - uncomfortable reality!

Re: Home visits poll.

Caroline Murray — Fri, 05 Jul 2013 04:15:41 GMT

Which brings us back to the topic of the poor Scottish new grad who got disciplined as she refused to go on an after hours call fearing for her safety..

Re: Home visits poll.

Dagmar Steele — Wed, 26 Jun 2013 10:44:00 GMT

[quote user="Christopher Saul"]

Poor you, that's not nice. I hope you filed a complaint to the police against him/her for assault

[/quote]

Thanks, yes I did. One particular police officer was not very keen on it though which annoyed me very much. The others were all very sympathetic and in the end it was hassle free to do. It will end up being discarded as it's just a minor incident anyway but you all know how much these things can get to us.

Re: Home visits poll.

Christopher Saul — Wed, 26 Jun 2013 10:27:12 GMT

[quote user="Dagmar Steele"] having been assaulted at work on Friday, finding out that the culprit has filed against me because of insulting him on Saturday ([/quote]

Poor you, that's not nice. I hope you filed a complaint to the police against him/her for assault

Re: Home visits poll.

Dagmar Steele — Wed, 26 Jun 2013 08:57:30 GMT

[quote user="Emma Campbell"]

Bad night on call??!

[/quote]

No, a combination of having been assaulted at work on Friday, finding out that the culprit has filed against me because of insulting him on Saturday (I didn't, I just asked them to ring social services to clarify if the operation their dog needs will be paid for), the whole family of four suffering from food poisoning on Sunday and Monday and having a heavy migraine since Monday plus only the clients from hell at work at the moment. I bet I've forgotten some other irritants though!

Re: Home visits poll.

Thomas Johnson — Wed, 26 Jun 2013 08:46:47 GMT

[quote user="Dagmar Steele"]

[quote user="Emma Campbell"]

Ouch! Surely the point of euthanasia is to relieve suffering and not inflict it ?? Intra-cardiac injections are painful and not recommended. Why not whack a catheter in, (achievable in nearly all cases) sedate if necessary but spare the poor furries an intra cardiac injection, please. Many moons ago, when I was a student, SPVS put on a final year lecture conference (do they still do that?) . I was sadly too hungover to attend an early morning lecture called 'Never be Casual about Killing' but the title made a huge impression on me nonetheless. We should strive to give all animals in our care a good death when their time comes.

[/quote]

Seems I didn't make myself clear - I only inject after giving anesthesia. In this case I don't "inflict suffering". I would never do such thing and rest assured, I never get more flowers and sweets than for my pts. If you read carefully what I've written it should be clear that I don't run in peoples houses, wrestle the poor dog to the floor, jam a needle in it's heart and take a pervert kind of pleasure seeing the life drain from their eyes (sorry, I am being sarcastic today for several reasons)

[/quote]

Don't worry, I thought it was quite clear from your first post on this that you were sedating/anaesthetising them before giving the intracardiac injection.

Re: Home visits poll.

Dagmar Steele — Wed, 26 Jun 2013 08:01:35 GMT

[quote user="Emma Campbell"]

[/quote]

Re: Home visits poll.

Evelyn Barbour-Hill — Wed, 26 Jun 2013 00:28:39 GMT

[quote user="Mark Holmes"]Once you have iv access, the nurse or whoever can stop restraining so tightly, the dog relaxes, the whole thing is much nicer, and less stressful.[/quote]

Maybe you shouldn't be "restraining so tightly" in the first place?

On house visits i'd rather let the owner cuddle the dog and raise the vein with my own thumb.

Dachshunds in dingy corners, I just won't do.

Even in the surgery, if the dog's jerking or struggling, I'll back off, let the nurse just help cuddle it, use my thumb for the vein. Suddenly everything gets easier.

And i've got dinky little hands with forearms more like Olive Oyl's than Popeye's.

Cats? After many years of veins, it's a kidney for me.

Re: Home visits poll.

Glen McIntosh — Wed, 26 Jun 2013 00:22:02 GMT

[quote user="Mark Holmes"] You know what? I spent 10 years doing it off the needle and wondering why people used catheters, then started using catheters and its so much better. Once you have iv access, the nurse or whoever can stop restraining so tightly, the dog relaxes, the whole thing is much nicer, and less stressful.

[/quote] Yes, same for me. I used to think catheters were a pfaff but since I have started using them regularly for euthanasia I wouldn't go back. I put on a primed extension line so that I am 2 or 3 feet away from the animal and nobody needs to restrain the animal at all, so the owner can hold the animal or whatever. Also there are no screaming or crying animals from extravasation of pentobarb or having to try for several veins while the owner is wailing beside you. Much better for all concerned. But you need to place the iv catheter away from the owner and you need an experienced assistant, so might not be as useful on a house visit.

Re: Home visits poll.

Mark Holmes — Tue, 25 Jun 2013 23:42:37 GMT

[quote user="Michael Woodhouse"]

[quote user="Anthony Todd"]

Never understood why you need a catheter surely it's just one injection of pentobarb?

Agree about intra cardiac, strangely ,in cats anyway, intra renal seems pain free.

[/quote]

Maybe to stop the dog pissing down your leg when you try to get it into the plastic bag?

I have never seen the need for an IV cannula either - it is easier to inject off a needle that prat about. Also why I only sedate if absolutely necessary. I would only inject into the heart in a sedated dog. I find you occasionally get a vein that blows after you get a few mls of pentoject in either because they are old and fragile or the dog moves. I will sometimes finish them off into the heart.

[kidneys in cats everytime]

[/quote] You know what? I spent 10 years doing it off the needle and wondering why people used catheters, then started using catheters and its so much better. Once you have iv access, the nurse or whoever can stop restraining so tightly, the dog relaxes, the whole thing is much nicer, and less stressful.

Re: Home visits poll.

Michael Woodhouse — Tue, 25 Jun 2013 23:23:28 GMT

[quote user="Anthony Todd"]

Never understood why you need a catheter surely it's just one injection of pentobarb?

Agree about intra cardiac, strangely ,in cats anyway, intra renal seems pain free.

[/quote]

Maybe to stop the dog pissing down your leg when you try to get it into the plastic bag?

[kidneys in cats everytime]

Re: Home visits poll.

Anthony Todd — Tue, 25 Jun 2013 23:03:21 GMT

[quote user="Emma Campbell"] Why not whack a catheter in,[/quote]

Never understood why you need a catheter surely it's just one injection of pentobarb?

Agree about intra cardiac, strangely ,in cats anyway, intra renal seems pain free.

Re: Home visits poll.

Anonymous — Tue, 25 Jun 2013 22:23:27 GMT

[quote user="Dagmar Steele"]

It depends on how you do it. I'm very good at disguising what I do and people don't mind. They mind if the dog doesn't go to sleep peacefully or starts taking deep breaths after being injected (which sometimes happens if you inject iv. and do it too fast). Going iv is fine as long as you can still find a vein and the dog isn't struggling, but if you lose the vein in the process you'll have the dog complain which is more stressful for the owner than giving sedatives im. and the actual Pentobarbione ic. Same goes for dogs I have sedated first. If I have to crouch on the floor in very dingy light and it is some small dachshund-like dog it might take ages to find a vein - then I'll inject in the heart. I'll always decide from case to case. In cats for example I prefer the kidneys over the heart.

[/quote]

Re: Home visits poll.

Thomas Johnson — Tue, 25 Jun 2013 10:28:53 GMT

[quote user="Mark Hedberg"]

It's a slightly raised expense, but i almost always sedated before euthanasia. I was willing to trade a slightly weaker vein for a dog or cat that was sitting there with a whacked out grin on their face. It cut back on 'unexpected reactions' considerably, and most owners rather liked the idea. (one owner wanted some too - long story!)

[/quote]

I often sedate i/m before euthanasia, and I sedate the majority of the ones I do on home visits. I find that if I sedate them with medetomidine, butorphanol and acepromazine I rarely have any problems finding a vein.

Re: Home visits poll.

Mark Hedberg — Tue, 25 Jun 2013 09:41:49 GMT

[quote user="Dagmar Steele"]

[/quote]

Re: Home visits poll.

Dagmar Steele — Tue, 25 Jun 2013 09:06:19 GMT

Re: Home visits poll.

Anthony Todd — Tue, 25 Jun 2013 08:54:14 GMT

[quote user="Thomas Johnson"]With euthanasias at home do you usually have the owners present when you inject into the heart? What sort of reactions do you getfrom them? [/quote]

My boss did this to an old, much loved lab. when I was a student. got the heart first time, but the dog let out the most horrible eerie scream I've ever heard so never, again, for me.

But an old poodle did exactly the same when I injected it I'V in front of the entire Italian family ,and every remote relative, so it may just happen sometimes.

Stabbing into the heart doesn't look very good though.

Re: Home visits poll.

Thomas Johnson — Tue, 25 Jun 2013 08:42:19 GMT

[quote user="Dagmar Steele"]I do all my home pts on my own. If snappy or wriggly dog muzzle or pull lead through something and give anesthetics first. Then inject into heart. I can do most surgeries on my own too like dog spays and so on but would need help with gastric torsion and the like. Nothing to do with wanting a second person for company in certain areas especially at night though. I have just been assaulted in the surgery two days ago and was glad there were other people present, otherwise it might/would have been another story!

[/quote]

Sorry to hear you were assaulted, hope you're doing okay.

With euthanasias at home do you usually have the owners present when you inject into the heart? What sort of reactions do you getfrom them? I've only done it once in a dog with the owner present, I'm not sure it's something most owners here would want to see. I've done a lot of home euthanasias on my own, and I would usually sedate them, and then use a rubber band and artery forceps as a tourniquet and inject the pentobarbitone i/v.