OOHs medication

RE: OOHs medication

Martin Atkinson — Thu, 12 Nov 2015 10:29:01 GMT

[quote user="Michael Woodhouse"]It would seem so long as I prescribe the medication that I can direct others to administer it, providing that I am satisfied the person administering the medicine is competent to do so.[/quote]Hallelujah, someone has hit the nail on the head at last.

This doesn't of course address the question of whether a lay person should be left unsupervised in charge of a patient but as I've stated many times before, I am satisfied that my unqualified nurses that I have trained are the equal of many qualified nurses and I would trust them to supervise a patient even more than some vets I've met. A few letters after your name does not automatically make you competent or give you common sense. I'm certain there would be many situations where a RVN or vet left in charge would feel inadequate and seek the advise of a more senior vet, its all a question of proportion.

RE: OOHs medication

Anthony Dennison — Thu, 12 Nov 2015 09:55:40 GMT

We have a night ACA on at our 24 hour centre, who keeps an eye on any inpatients and does general care of those needing minimal input - oral meds for example are given by them if the patient is comfortable and stable. Any injections are given by a vet (or RVN if we're lucky to have one covering holiday).

Any unwell animals are monitored by the vet; if a stable animal becomes unwell and the ACA is concerned they call the vet in. Works well with us.

Of course, you do occasionally get the terrible people who put a dog down for methadone at 2am and 6am when they're not on call...

RE: OOHs medication

Thomas Johnson — Thu, 12 Nov 2015 09:01:26 GMT

[quote user="Michael Woodhouse"]

You are all being silly about this. To clarify we don't use lay staff to inject animals, but I believe it is perfectly legal and within the guidance of the code.

[/quote]

I think it could be interpreted that there is a conflict within the code, the section Michael highlights suggests that the veterinary surgeon needs to be satisfied that the person is competent to give the medication, with no mention of that person needing any qualifications, whereas the section Gillian linked to includes amongst its definitions of veterinary surgery that can only be carried out by a veterinary surgeon the medical or surgical treatment of animals, with specific exemptions, and none of the exemptions include lay staff.

RE: OOHs medication

Dagmar Steele — Thu, 12 Nov 2015 07:02:33 GMT

[quote user="Malcolm Ness"]

If it were my dog and it were sick enough to need hospitalisation, I think I would prefer that it were injected by a trained, though admittedly neither qualified or registered, lay nursing assistant working under the direction of a diligent and caring veterinary surgeon than transferred to another place at 6pm, then back at 8am, then back at 6pm and back yet again at 8am.

Better still to have a hospital facility staffed by qualified, registered VNs with vets there as well. Geography and demographics prevent that being a reality in some cases - veterinary egos in others.

[/quote]

Wonder who red-starred you for that... Anyway, this is exactly why I refer patients that need hospitalization to a place where they can stay for the entire duration of the hospitalization and are looked after by qualified staff, vet on site. If people don't want to be referred it's their choice. I don't hospitalize anything I cannot look after properly. Period.

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 23:11:11 GMT

[quote user="Malcolm Ness"]If it were my dog and it were sick enough to need hospitalisation, I think I would prefer that it were injected by a trained, though admittedly neither qualified or registered, lay nursing assistant working under the direction of a diligent and caring veterinary surgeon [/quote]

Nobody is saying a lay person couldn't provide some care, just that, as you say, a vet should be directly supervising. The OP asked whether it was appropriate for lay staff to be on their own OOH.

[quote user="Malcolm Ness"]Better still to have a hospital facility staffed by qualified, registered VNs with vets there as well. Geography and demographics prevent that being a reality in some cases - veterinary egos in others.[/quote]

You don't mention practice finances. We simply couldn't afford the number of staff required to run the clinic 24hrs a day.

RE: OOHs medication

Michael Woodhouse — Wed, 11 Nov 2015 22:50:22 GMT

From the code:

4.23 A veterinary surgeon or SQP who prescribes POM-VPS veterinary medicinal product, or
supplies a NFA-VPS veterinary medicinal product, and a veterinary surgeon who prescribes a
POM-V veterinary medicinal product must:
a. before s/he does so, be satisfied that the person who will use the product is competent
to use it safely and intends to use it for a use for which it is authorised;
b. when s/he does so, advise on the safe administration of the veterinary medicinal
product;
c. when s/he does so, advise as necessary on any warnings or contra-indications on the
label or package leaflet; and
Code of Professional Conduct for Veterinary Surgeons
Downloaded: 11/11/2015 - 22:28 page 37
d. not prescribe (or in the case of a NFA-VPS product, supply) more than the minimum
quantity required for the treatment.
4.24 The Veterinary Medicines Regulations do not define 'minimum amount' and the RCVS
considers this must be a matter for the professional judgment of the veterinary surgeon in the
individual case.
4.25 Veterinary medicinal products must be supplied in appropriate containers and with
appropriate labelling.
Administration
4.26 A medicine prescribed in accordance with the Cascade may be administered by the
prescribing veterinary surgeon or by a person acting under their direction. Responsibility for the
prescription and use of the medicine remains with the prescribing veterinary surgeon.

It would seem so long as I prescribe the medication that I can direct others to administer it, providing that I am satisfied the person administering the medicine is competent to do so.

At no point in the VSA 1966 or the code of professional conduct can I find reference to a lay person not undertaking an injection. Can a lay member of staff feed an in patient? Can they put a tablet in the food if I tell them to? Who has to put the food in the bowl? If I have to put the tablet in the bowl can the lay staff put the bowl in with the dog?

You are all being silly about this. To clarify we don't use lay staff to inject animals, but I believe it is perfectly legal and within the guidance of the code.

RE: OOHs medication

Rob Loxley — Wed, 11 Nov 2015 22:43:10 GMT

[quote user="Michael Woodhouse"]Can you show me where in the act?[/quote]

“veterinary surgery” means the art and science of veterinary surgery and medicine and, without prejudice to the generality of the foregoing, shall be taken to include— (a) the diagnosis of diseases in, and injuries to, animals including tests performed on animals for diagnostic purposes; (b) the giving of advice based upon such diagnosis; (c) the medical or surgical treatment of animals

I'm not sure you can argue that giving an injection is not the medical treatment of an animal?

RE: OOHs medication

Malcolm Ness — Wed, 11 Nov 2015 22:28:46 GMT

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 19:11:42 GMT

[quote user="Utlendigur"]I don't recall using it to justify poor vet care - I was merely contradicting a point you made[/quote]

Noted. . Still not sure why incidents of totally inadequate care contradicts my point though....that people aren't (usually) ignored all night in hospitals.

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 19:01:06 GMT

Www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/treatment-of-animals-by-unqualified-persons/

Can't be bothered to read the whole act Michael, but happy to go with the RCVS interpretation.

RE: OOHs medication

Utlendigur — Wed, 11 Nov 2015 18:55:04 GMT

[quote user="Gillian Mostyn"]There may be isolated cases in NHS hospitals of inadequate overnight care. Hardly something we should use to justify us providing something similar.[/quote]

I don't recall using it to justify poor vet care - I was merely contradicting a point you made

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 18:45:31 GMT

OK. I give up. I assumed that hospitalised patients were, by definition, poorly. And that any animal requiring an insulin injection would be getting more clinical attention than just a jab.

There may be isolated cases in NHS hospitals of inadequate overnight care. Hardly something we should use to justify us providing something similar.

However, if you can be honest about, and justify, the level of care you have offered a pet, both to the owner, your peers and your own conscience, then you wouldn't ever have anything to worry about!

RE: OOHs medication

Michael Woodhouse — Wed, 11 Nov 2015 18:41:22 GMT

[quote user="Hannah Wynne Richards"]Micheal Giving an injection, including a sub cut one is legally classified as an act of veterinary surgery.[/quote]

Can you show me where in the act? I have attached a PDF for your convenience.

RE: OOHs medication

Hannah Wynne Richards — Wed, 11 Nov 2015 18:32:58 GMT

Micheal Giving an injection, including a sub cut one is legally classified as an act of veterinary surgery. It is a criminal offence for anybody not on the RCVS register of veterinary surgeons, a veterinary student in the clinical years of the university course, a VN, or a student VN, enrolled with Royal College to do this. There are also legally allowed exemptions for owners to inject their own animals, so owners injecting diabetics is fine, and in the case of farm animals, that owner exemption extends to bona fide employees of the owner. That's it.

If you are allowing lay employees to administer these injections, then you are breaking the law, exactly as those who allowed RANAs to give injections were.

Wynne

RE: OOHs medication

Martin Atkinson — Wed, 11 Nov 2015 18:28:59 GMT

[quote user="Gillian Mostyn"] I really don't think most owners would want an unqualified and completely unsupervised person administering medicine to their pets.[/quote]Yet they do it themselves at home even though they are unqualified and completely unsupervised? Bit of a dichotomy of views there I'd say. But the unqualified staff are still more experienced than any owner and probably very competent. Otherwise I would not be employing the nurses I do.

[quote user="Gillian Mostyn"]But neither will they be completely ignored until morning if they did have a problem.[/quote]Sadly there have been a number of high profile cases in the media where it has very much been the case and have suffered the consequences.

RE: OOHs medication

Michael Woodhouse — Wed, 11 Nov 2015 18:28:43 GMT

[quote user="Gillian Mostyn"]Michael...

Why do you give pet vaccinations? Any monkey could do it.[/quote]

Because it has to be prescribed to an animal under my care. An inpatient is already under my care.

A herd of cows is under my care. Therefore they can have vaccine and crack on themselves.

The VMD don't believe that a sheep even needs to be under the care of a vet to buy a lot of vaccines.

The easiest part of any vaccine consult is giving the bloody vaccine!

RE: OOHs medication

Utlendigur — Wed, 11 Nov 2015 18:28:22 GMT

[quote user="Gillian Mostyn"]

[quote user="Michael Woodhouse"]Many people in a human hospital will get no examination over night.[/quote]

But neither will they be completely ignored until morning if they did have a problem.

[/quote]

This poor girl was

http://www.bbc.co.uk/news/uk-england-northamptonshire-26681550

From what I have seen in hospitals when my elderly parents were frequent patients, I have become a lot more cynical of the NHS. Even if the monitoring is there, basic skills like pain assessment and noticing deterioration are severely lacking.

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 18:16:11 GMT

Michael...

Why do you give pet vaccinations? Any monkey could do it.

RE: OOHs medication

Francisco Gomez — Wed, 11 Nov 2015 17:43:45 GMT

I'd put the asterisks round the word monkey instead nah! People are paying you money for this, you might want to think about using qualified people...

RE: OOHs medication

Michael Woodhouse — Wed, 11 Nov 2015 17:12:50 GMT

[quote user="Gillian Mostyn"]You really think so? Don't you think there is a difference? I really don't think most owners would want an unqualified andcompletely unsupervised person administering medicine to their pets.[/quote]

How many practices use student nurses on OOH rotas? They are giving medications and they are (for all intents and purposes) lay people. What's to say my in house trained 'nurse' can't give an injection with greater skill than a SVN or even some VNs?

If I didn't believe I could safely train a lay person to give injections without my supervision I'd have to put all the diabetic animals to sleep. It is up to the employer to ensure the person given any task is up to it. Who will get the blame when student nurse gives 2.5ml of insulin and not 25 IU?

As I said- we don't do this BUT it is a stupid system where that can happen. I don't believe administering a prescribed medication requires training remotely close to VN skill. If the vet dealing with a case is not on over night or a weekend, they draw up the drugs in labelled syringes here. Any monkey *could* give them.

RE: OOHs medication

Gillian Mostyn — Wed, 11 Nov 2015 15:39:25 GMT

[quote user="Michael Woodhouse"]It does seem a strange world where the lay member of staff can inject her own diabetic dog at home, but not give a hospitalised dog it's insulin when she was giving it some food.[/quote]

You really think so? Don't you think there is a difference? I really don't think most owners would want an unqualified andcompletely unsupervised person administering medicine to their pets.

[quote user="Michael Woodhouse"]Many people in a human hospital will get no examination over night.[/quote]

But neither will they be completely ignored until morning if they did have a problem.

In my practice, OOH medication and checks would only be carried out byvets, occasionally a VN. We wouldn't keep an animal hospitalused unless it were stable and no changes are anticipated. Owners are warned that there is minimal supervision.

RE: OOHs medication

Michael Woodhouse — Wed, 11 Nov 2015 14:31:21 GMT

It does seem a strange world where the lay member of staff can inject her own diabetic dog at home, but not give a hospitalised dog it's insulin when she was giving it some food.

We don't use lay staff to do that (on a weekend the vet on duty attends as often as they believe is required and looks after the patients and administers treatments). I still believe there is a significant number of animals that require hospitalisation for various reasons without 24 hour person in attendance. Many people in a human hospital will get no examination over night.

RE: OOHs medication

Braden Collins — Tue, 10 Nov 2015 13:44:19 GMT

I think if you've got patients in hospital they need to be checked by suitably qualified staff. I think to leave an unwell or injured animal for up to 14 hours without being checked by qualified staff is pretty hard to justify, and to place decisions as to when there is a sufficient concerns into the hands of lay staff could be pretty dangerous.

RE: OOHs medication

Nicola Lawlor — Tue, 10 Nov 2015 11:59:45 GMT

We send most of our inpatients to a 24hr centre so that there are qualified staff to deal with their needs. On the rare occasion a patient stays in our clinic instead they are checked by a member of staff as needed and there is a vet who is available to come in for any meds, drip issues etc as needed. We will not hospitalise with us if there is not suitable cover from vets to attend.

RE: OOHs medication

Martin Atkinson — Tue, 10 Nov 2015 11:14:30 GMT

On the very rare occasions I keep something in overnight that requires attention I stay in the flat above the surgery or take them home in a transportable cage or the ICU unit. Being sole charge this is my decision so there are no arguments. If you do your own OOH and/or you regularly keep patients in overnight and you don't have RVNs capable of the tasks necessary I'm afraid the vet on call has a responsibility to attend as required. I can't see how you can do it any other way.