Continuity concerning hospitalised patients

Re: Continuity concerning hospitalised patients

Neil Wheadon — Thu, 16 Oct 2014 14:24:01 GMT

[quote user="ChrisBVSc"]+1 for this. In my experience partners are the worst for this! A proper verbal handover is far better in my opinion, with the opportunity to ask any questions about the case/client.[/quote]

One note of caution on this. The very worse handovers I've done were with a vet who thought he was the greatest thing in creation. He/she would pick/pick/pick at everything that was done, ask excruciating questions and reduced several vets and nurses to tears.

Write everything down in the clinical notes and make time to do this. Consider yourself in the situation of 'How would I like this presented in the dead of night with no one else to ask' and 'always think of the next man' in things that you do.

Neil

Re: Continuity concerning hospitalised patients

Joyce Whitehead — Wed, 15 Oct 2014 18:28:37 GMT

We are a fairly small practice (4 vet) but have a system of oral handover between vets as much as possible, with a back up of a nursing handover folder as often the morning staff are different to evening. In this we'd make a note of any meds due (this is also in the hospitalisation forms obviously) but also minor details like which flavour of food is preferred, what bedding is best etc. We also have equine inpatients and follow a similar system for them. We have a large white board in the equine store room beside our stables, hospitalisation sheets and a nursing folder. This usually covers all bases. It also ensures that staff are aware if a horse may kick for instance.

Re: Continuity concerning hospitalised patients

Martin Atkinson — Wed, 15 Oct 2014 14:17:42 GMT

[quote user="Robin Grimmer"]Do you remember a few years ago a vet got hauled up over the coals for putting the acronym DMITO in the notes. [/quote]I thought it was actually ABTO (animal brighter than animal) but that may have been a different case. Anyway as I recall the dog was referred to a specialist and he/she showed the client the referral notes in which were scribed the offending acronym. The real issue here IMO was the specialist interpreting the acronym and telling the owner when the vet for all he knew meant something completely different like, 'actually bright terrific owner'. I wrote one one my Mr Angry letters to the Vet Times and suggested that I put Y- for such circumstances, as most people who it referred to would not have read Brave New World and known that the lowest in the pecking order were designated as Ypsilon minus!

Re: Continuity concerning hospitalised patients

ChrisBVSc — Wed, 15 Oct 2014 13:51:51 GMT

[quote user="Robin Grimmer"]

The trouble is Martin, some vets are not very good at writing things up properly

[/quote]

+1 for this. In my experience partners are the worst for this! A proper verbal handover is far better in my opinion, with the opportunity to ask any questions about the case/client.

Re: Continuity concerning hospitalised patients

Robin Grimmer — Wed, 15 Oct 2014 13:42:22 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]....for example if the owners are difficult ie things you couldn't really put in the notes.[/quote]There are ways without it being in black and white!

[/quote]

Do you remember a few years ago a vet got hauled up over the coals for putting the acronym DMITO in the notes. The owner saw it and asked what it stood for. And the owner's son was autistic or something I believe - oops!

Re: Continuity concerning hospitalised patients

Martin Atkinson — Wed, 15 Oct 2014 13:11:42 GMT

[quote user="Robin Grimmer"]....for example if the owners are difficult ie things you couldn't really put in the notes.[/quote]There are ways without it being in black and white!

Re: Continuity concerning hospitalised patients

Francisco Gomez — Wed, 15 Oct 2014 12:45:06 GMT

... and if I have the time, I tend to call the client and tell them who is going to be responsible for their pet and why. I.e. I won't be around tomorrow or my shift is different so my colleague A will be looking after Miffy until I can get her back. I do also try to reduce, as much as I can, too many vets looking after one patient, which isn't always possible.

Re: Continuity concerning hospitalised patients

Francisco Gomez — Wed, 15 Oct 2014 12:40:13 GMT

+1 for face to face handovers too.

I usually discuss cases with 4 + 1 main points:

- What's the condition we are investigating/treating. I.e why was the animal brought to the practice in the first place

- What is the current plan of action

- What is the likely prognosis

- Vet nurse: how is your feel of the patient currently: Easy to tablet, grumpy, having diarrhoea, etc.

+1 - How is the owner: This can't always be written in the clinical but it is helpful of how to managing the case. Always remember that a friendly client is more likely to result in a healthier pet.

- Had the owner been negligent leaving a condition to deteriorate? Is the owner very intensive and always on the phone when Miffy barks more than normal? Is the owner an 'internet researcher'?

Re: Continuity concerning hospitalised patients

Robin Grimmer — Wed, 15 Oct 2014 11:51:14 GMT

The trouble is Martin, some vets are not very good at writing things up properly and sometimes we all forget to mention things. Not such a problem in a small practice, but in a busy practice or OOH clinic where there is a high turnover of people in charge of a case a handover is vital to get a real feel for a case and the plan etc, for example if the owners are difficult ie things you couldn't really put in the notes.

Re: Continuity concerning hospitalised patients

Martin Atkinson — Wed, 15 Oct 2014 10:11:16 GMT

As a sole charge vet this isn't a concern for me but I'm finding it difficult to understand why the next vet can't just look at the patient's clinical notes as would happen if I was handing over to a locum. I tend to write fairly brief notes most of the time but when I know the locum is taking over I make them a more comprehensive. I assume each vet writes up relevant notes if they're not then that is the problem. Or am I missing the point?

Re: Continuity concerning hospitalised patients

Hannah Wynne Richards — Wed, 15 Oct 2014 09:10:20 GMT

It sounds as though Busybee is certainly a busy bee!

Wynne

Re: Continuity concerning hospitalised patients

Virginia Campbell — Wed, 15 Oct 2014 00:28:20 GMT

All vets and nurses at rounds in the morning 8.30-9am. The overnight nurse is on till 11am and usually leads rounds as she knows how each animal has been doing overnight. As well as a hospitalisation chart on every cage door, the nurses have a master "treatment sheet" showing which treatments each animal is to get at what times, which also has a "message for owner" section for each animal. The vet starting at the branch practice either calls in to make the day's plan for their inpatients at 8.30 on the way to the branch or phones up from the branch when it opens at 9. Some people don't start till 2 or 4pm so sometimes it gets a bit Chinese-whispery but if there are a lot of inpatients the incomers will do a "mini-rounds" on arrival with somebody who knows what's going on. If you're going to be off for the morning/day then you leave written instructions, write a brief plan on the record too and nominate another vet to take over the case

Things that help:

- having inpatient treatment nurses and theatre nurses. The treatment nurses should be able to tell the owner if Miffy has eaten or not etc and organise owner visits. Treatments at our place are done at 9am, 2pm and 7pm and the incoming treatment nurses for the afternoon/evening will talk to the morning ones

- the ops book has sections for "first charge" - vet's initials - and "second charge" - theatre nurse checks vet hasn't missed any charges and intials boxes for "discharge sheet done" and "O been phoned". so anyone glancing at the book can see who did it and therefore knows about it. There is one nominated discharge nurse for the afternoon/early evening who will collar the vets and nurses she needs to talk to before they leave. If its a non standard thing and you're not discharging it yourself, then write on discharge sheet and computer when you want to recheck it.

- internal teleos emails for the vet who's going to be in charge of your case if you don't overlap eg "Os really intense, will want dog home even though I have told them it needs to stay, ring them before they ring you, they know we're not going to recheck urea+crea till tomo"

- notes on record about estimates, "informed O of bill so far £250, stick to estimate please, ring O before going over estimate"

- lots of reference to who's taking over when talking to the owners "I'll not be here myself tomorrow but our senior nurse Nicola will be looking after Miffy overnight and will be here tomorrow. Eve, the vet who saw Miffy when she first came in, is on tomorrow and she's in later so I'll get her to look at Miffy this afternoon for comparison tomorrow. I'm back on Friday at 2pm and I'm on duty all weekend".

- pre-empt owners - ring them before they ring you if you can, so that you have the latest information on whether it ate its Dreamies and did a poo or not rather than having the receptionists leaving owners on hold while they do a lap of the practice trying to find out who knows

- have the initials of the vet in charge of the case on the hospitalisation sheet and on the teleos inpatient list beside the reason for hosp and the date it arrived - so "Miffy Andrews : pancreatitis? 14/10 GC". Always helps to have somebody to blame! If your initials are against it, its your responsibility to pass it on to another vet.

- remember to write on the record things like "explained to O that need to reXray chest to check pneumothorax resolved before will fix fracture, probably won't be fit to do till Thursday at the earliest" so if they do ring five times a day to see why it hasn't been operated on yet, they will receive a consistent message

Re: Continuity concerning hospitalised patients

Nicola Cole — Wed, 15 Oct 2014 00:26:57 GMT

+1 for face to face handovers. Otherwise you miss out on so much information, especially re: what has been discussed with owner.

Re: Continuity concerning hospitalised patients

Robin Grimmer — Wed, 15 Oct 2014 00:06:55 GMT

Having worked in various busy clinics and OOH clinics, I don't think there is anything better than a proper handover of cases between the vets/nurses involved with the case, ie talking face to face with them so you can discuss things fully, ask what the plan is and importantly what has been said to the owner.