Safety in the consult room

Re: Safety in the consult room

Anonymous — Wed, 01 Apr 2009 09:44:43 GMT

Dear Martin,

You answer lies within your text. You should never examine an animal at close quarters that you are "trying to control".

You cannot rely on any animal's lack of previous aggression. Any pet can attack at any time - so apply a belt and braces safety approach to each one - always.

No proper control - NO close quarters examination. Simple.

By the way, rely on a trained assistant to control a patient for examination/treatment, NEVER rely on a client, otherwise H&S would have a field day if anyone got injured without proper professional control.

Best regards,

Bluesky.

Re: Safety in the consult room

Utlendigur — Fri, 27 Mar 2009 15:19:38 GMT

I think you get used to picking up on the dog's body language. I generally don't pounce on the dog as soon as it walks through the door, but spend a few minutes getting the history from the owner while the dog relaxes, then get down to their level. I have refused to examine or treat animals that are trying to bite and the owner has refused to let me muzzle them and/or let a nurse restrain them (usually small snappy toy dogs clutched to large bosoms). I have also requested parents of small out-of-control kids take them out of the consulting room on occasions - better that than have them tip the sharps bin over their heads or similar. It always amazes me how oblivious many parents are to their childrens behaviour and you simply cannot do an effective consult if you are having to remove the child from the cupboard, remove sharp objects from its grasp, stop it dropping the scissor lift table - all the while mum or dad is chattering away as if the kid doesn't exist

Re: Safety in the consult room

listhestar — Thu, 19 Mar 2009 10:05:52 GMT

[quote user="Gillian Mostyn"]

[quote user="Rudolph"]Basically, treat everything like it might bite you and you won't go too far wrong :)[/quote]

my opinion exactly!

[/quote]

I am liking this one. I had a dog giving me the 'eyes' the other day, just in for a booster-guy had no control. I requested muzzle and then when dog went to bite me owner blamed the muzzle (I was just listening to the heart, hadn't met the dogs eyes and wasn't towering over him). I guess that decision was down to me reading the dogs body language and learning from previous mistakes!

Re: Safety in the consult room

Mike Martin — Thu, 05 Mar 2009 12:28:52 GMT

[quote user="Ian Mostyn"]

I offered him the option of contacting the police and getting a marksman to shoot the dog when he suddenly changed his mind and allowed the muzzle.

[/quote]

[:'(]

Crying with laughter. I love it.

Re: Safety in the consult room

Alex Avery — Wed, 04 Mar 2009 18:49:26 GMT

my only "skin breaking" bite to date was also just listening to a chest and there was no warning, lucky it was just my arm and not too bad but it did make me more nervous for a week or so. If the animals is really uncontrolable to do any meaningful examination even when muzzled then sedation is generally the next step.

while personal safety is an obvious issue I also worry about the owners on occasion. In my mind unless EVERY animal was muzzled or a nurse held all animals during every examination then there is no way that risk of owner injury can be completely avoided. I wonder how many people attempt to sue the vet if they get bitten or scratched? I imagine there would be no case to answer if there was no history of animals "violence" and the person involved was advised to go and see there GP but then I am no lawer and the thought of a summons through the door does make you think.

I then think of the safety of jobs like TB testing and risk of hand crush injuries etc but that is a moan for another day!

Re: Safety in the consult room

Ian Mostyn — Tue, 03 Mar 2009 13:43:38 GMT

no 255 - You did very well, he bit the vet quite badly last year when he did that (after you have finished)

I have refused to vaccinate 2 dogs in the past, both Yorkies. They were on the end of leads, circling, snapping and spreading urine and faeces around the place. Both owners were terrified of their dogs and certainly couldn't handle them. Most clients seem to accept a muzzle if you ask politely, it doesn't hurt after all. If they refuse and I am seriously concerned about my safety, I will refuse to examine the animal but that has only happened twice. I did have one guy bring his GSD to be PTS as it had savaged a couple of people. He refused to muzzle the dog and I couldn't sedate it safely so I refused to PTS. I offered him the option of contacting the police and getting a marksman to shoot the dog when he suddenly changed his mind and allowed the muzzle.

More of a worry to me, apart from people's backs, is kennel guarding. It is more difficult to predict a kennel guarder and that seems to be when most injuries happen. Nothing serious yet fortunately, but more of a concern. As a partner I will always take the lead in dealing with the dangerous ones, someone needs to be in charge and give the instructions. Snares and chemical sedation usually do the trick. Personally I think personal safety must come above RCVS guidelines but just about all of the time we can achieve both.

Ian

Re: Safety in the consult room

Stephen Ashman — Mon, 02 Mar 2009 19:16:24 GMT

no 254: oh yes he can be a bit funny [what about telling me that before the event!]

Re: Safety in the consult room

Gillian Mostyn — Mon, 02 Mar 2009 17:51:31 GMT

No. 4563 Sorry my dog bit you, but he's just scared /in pain/ badly behaved, therefore I'll give it a cuddle and tell it well done! Afterall, it was trying to be brave!

Re: Safety in the consult room

Evelyn Barbour-Hill — Mon, 02 Mar 2009 16:47:02 GMT

Phrases that irritate me during evening surgery, no. 5241:

"It's all right, he won't bite you"

(My silent answer: no, he won't, I shall make damn sure of that)

No. 5356: "I suppose you you get bitten quite often"

Stare them in the eyes and say blankly "No".

Re: Safety in the consult room

Gillian Mostyn — Mon, 02 Mar 2009 14:29:54 GMT

[quote user="Rudolph"]Basically, treat everything like it might bite you and you won't go too far wrong :)[/quote]

my opinion exactly!

Re: Safety in the consult room

Rudolph — Mon, 02 Mar 2009 14:10:31 GMT

Hi there,

[quote user="Martin McDowell"]However to a new graduate this might seem as unfair - what does he/she know about how to perform a relatively safe examination. How does she/he know all the little tricks on avoiding getting hurt.[/quote]

Surely that's the whole point of EMS? A great deal of my time in EMS was spent helping restrain animals for the vet to examine, blood test, or whatever. You learn pretty quickly what might bite and what probably won't. There's no 100% guarantee method - I'm sure everyone has had their fair share of close calls - but I don't think a lecture on how not to get bitten will make a huge difference.

If you have any doubt - muzzle. Costs nothing, doesn't hurt the animal. Great for cats too, for bloods! If you can't muzzle and the dog looks like it will bite then sedate or try again another day. If the owner doesn't look reliable tell them you're going to have an assistant restrain the animal. Don't make it an option. Better still, send them out to the waiting room (great for taking bloods or cutting nails) by telling them that the fewer people in the room, the calmer the animal will be. Then you can muzzle the animal and do what you need without the owner getting in the way.

Basically, treat everything like it might bite you and you won't go too far wrong :)

Re: Safety in the consult room

Shams Mir — Sun, 01 Mar 2009 22:00:46 GMT

You are right, Evelyn; my method would certainly be a problem if the open door leads to outside of the surgery!

There may not be a panacea for the threat of getting bitten in the consulting room.

But it would be interesting to know more about the factors contributing to this real problem, its implications and possible solutions.

I would love to see more colleagues contribute to this discussion.

So, over to you, please.

Re: Safety in the consult room

Evelyn Barbour-Hill — Sun, 01 Mar 2009 20:30:41 GMT

If I did that, well, some of my owners: it would take a solid five minutes to get them to understand the instructions and another solid five to get them to actually do it; and as soon as I took my attention away for a second they would let go and the dog would be through the open door.

Sorry, I don't mean to sneer at your advice Sunny, I think it's good and you've put some thought into it. My approach is slightly different, but the main thing is to take your time and have sympathy with your patient. So if you are an assistant in one of those ghastly practices with five minute appointments, in-out, in-out, here's a tube of ointment, pay at the desk, ka-ching, you are already handicapped.

Assistants: if the consulting room is too small or the facilities are inadequate and you get injured as a result, your employer is liable. Ultimately you can sue.

Wait a minute, what am I saying? I'm an employer! Oh noooo.......

Re: Safety in the consult room

Martin McDowell — Sun, 01 Mar 2009 20:20:04 GMT

Hello again

Thank you for the posts you have sent and by all means, please send more if you would like to add your thoughts to the discussion.

I am convinced this is not a straight forward problem. Someone had mentioned that the safety is our responsibility which, as a consequence, gives us the "power" to dictate under which circumstances we will conduct the examination. However to a new graduate this might seem as unfair - what does he/she know about how to perform a relatively safe examination. How does she/he know all the little tricks on avoiding getting hurt.

I was educated in Ljubljana, but I am sure my colleagues from UK vet schools haven't received any useful training on the matter. Until you get actually bitten it is hard for a young vet to perceive that even a relatively placid animal can become aggressive in a slit second. you probably only become aware of it after it happens.

I know this is quite often the case as I have seen it with many of my colleagues in the past.

I think there should be some sort of CPD or something included in the vet health&safety about this.

When reading the RCVS GPC it makes me a bit mad how they forget to realy emphasise this. H&S is mentioned only to briefly.

Re: Safety in the consult room

Shams Mir — Sun, 01 Mar 2009 11:46:40 GMT

Interestingly, this is one amongst a number of concerns raised in an artcile entitled "Why vets need union assistance" in February 2 issue of Veterinary Times.

Most of the veterinary publications I get generally get into the paper recycle bag pretty quickly but as the above article captured my attention so much that I decided to keep it. Clearly it is coming handy righ now to qoute from it.

The article, however, correlates aggressive behaviour of dogs to the small size of consulting rooms and states:

"The most compromised space in a practice is often in the consulting rooms, which can be small, smelly, stuffy and sweaty, and without proper ventilation. Some practitioners need to "fold" larger dogs to be able to turn them around, due to the cramped nature of their working environment. No wonder even otherwise placid dogs become aggressive in defence when we approach them in such small spaces. There is no room to back off if a dog decides to have a go at you."

However much I agree with above, my practical advice would be to postion dogs, especially larger one, in such a way that they have an unobstructed view of an open door (an escape route) while you are examining them. This provides the dog with a sense of freedom even in a small space. I generally request the owner to stand backing the wall of the consulting room holding the dog by the collar with their right hand, the dog facing the opened door on the back of the consulting room. After allowing the dog to sniff my hand and a stroking on its head, I move to the back of the dog and approach the dog's head and rest of the body from the back. This works for me very well, with occasional exceptions.

We do not deseve to get bitten (for life)!

Sorry for this long narrative, but I hope it helps.

Re: Safety in the consult room

Gillian Mostyn — Sat, 28 Feb 2009 21:00:01 GMT

I have worked with a female vet left with serious facial scarring from a run-in with a GSD. As far as I am concerned, if I have any doubt about the temperament of the dog or the ability of its owner to restrain adequately, the dog gets muzzled. I have a dog (border collie). I trust her completely with my small children and cannot ever envisage her biting in any situation. But if I was asked to muzzle her for any reason, such as a nurse holding her for me, I would have no problem doing so. It doesn't hurt them! If the owner refuses to muzzle the dog, or allow me to do so, then as far as I am concerned they are risking me and my staff and that is unacceptable. How many times do you look at a dog, know enough about their body language to know it is waiting for its opportunity, and yet the owner refuses to believe you until it actually bites? In my consulting room I decide on the appropriate restraint, and clients can go elsewhere if they are unhappy with that. Having said that, if the situation is handled well, and I explain to the owner that I will be able to carry out a far more thorough examination if the dog is secured properly, then most owners are happy.

Re: Safety in the consult room

Stephen Ashman — Sat, 28 Feb 2009 20:03:53 GMT

I have previously refused to vaccinate a dog because I got the impression the dog was a danger to me, and the owner refused to allow me to muzzle the dog; we could reach no compromise. If I'm not sure of the owner's abilities I ask a nurse for help.

Re: Safety in the consult room

Evelyn Barbour-Hill — Sat, 28 Feb 2009 19:53:39 GMT

It's your safety, and it's also definitely your responsibility for the safety of others present. You can go as far as you like with your demands.

You can also go as far as you like with your demands for reasons to do with convenience or just personal preference. You are not obliged to examine or treat anything, beyond emergency. You are only constrained by a need to remain courteous (unless excessively provoked!) and to ensure that an animal does not unduly suffer; and of course by commercial considerations; and if you are an assistant, by what the boss will say.

I have refused to continue the examination if the owner does not switch his mobile phone off, and if the owner does not stop swearing. Certainly I have requested all the relatives, gawpers and hangers-on to leave the room. Students often come in such mobs I can barely move. Accompanying children can be fine, but little ones can be dangerous and older ones (usually male) sometimes wind the dog up or else lounge about making dick-headed comments.

The most common situation I suppose is when there is a stroppy dog and the owner is unwilling or unable to control it. What I do depends on the situation. I might insist it stays in for sedation, or that it comes again another day with someone who can hold it, or some other compromise solution.

However, the incident you describe seems to come under the heading of "hazards of the job". The dog had shown no signs of aggression, you weren't doing anything painful and you had taken precautions anyway. Do I gather from your brief description that the owner wasn't holding it properly? As I understand it (I am open to correction) in law you cannot rely upon the owner to do anything, so if you do trust the owner it's your risk. Which means of course that you are entitled to do anything you wish to minimise the risk.

When young and agile we mostly like to be seen as bold and brave. With advancing years and accumulated experience (scars!) we see no shame in being extra careful.