My experience of OOH

RE: My experience of OOH

Rob Loxley — Mon, 23 Oct 2017 19:34:05 GMT

[quote user="Bob Russell"]Tiny fraction of the suggested dose, given i/v[/quote]

I've certainly found if you give the standard dose iv it works very well, and have on occasion had to give cerenia... S/c seems to work well but can cause post vomiting drowsiness. Never tried the conjunctival route but the ability to wash it out appeals.

[quote user="Bob Russell"]Still have to discard the rest of the vial so no cheaper to the client[/quote]

Ah, but new smaller vial sizes are coming

RE: My experience of OOH

Bob Russell — Mon, 23 Oct 2017 14:38:30 GMT

Tiny fraction of the suggested dose, given i/v. Always seems to work. Never gone any way near the recommended dose. If the tiny dose fails, can always give more but not so far in 30 odd years.

Still have to discard the rest of the vial so no cheaper to the client. Hate the idea that a patient is going to have its insides turned out just for a bit of chocolate!

RE: My experience of OOH

Martin Atkinson — Mon, 23 Oct 2017 14:11:11 GMT

[quote user="Thomas Johnson"]I've just checked the BSAVA formulary[/quote]I checked that as well and I'm sceptical - I fail to see how somewhere with a low blood supply i.e. SQ can be better that somewhere with a higher blood supply i.e. IM. Unless there is some weird pharmacology going on involving degradation by mygolobin.

RE: My experience of OOH

Thomas Johnson — Mon, 23 Oct 2017 10:45:27 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Dennison"]On the subject of apomorphine, I know we've had this debate before, but do people give it i/v or larger amounts s/c?[/quote]Halfway house so IM.

[/quote]

My understanding is (and I've just checked the BSAVA formulary) that apomorphine is less effective when given i/m compared to s/c, though i/v is most effective. I normally give it s/c, though have on occasion given it transconjunctival as well.

RE: My experience of OOH

mariette asselbergs — Sat, 21 Oct 2017 00:29:42 GMT

[quote user="Joyce Whitehead"]

We use it S/C, and only quite small doses seem to work fine unless the stomach is pretty empty. And we freeze the remainder in small aliquot and then only charge for what we use. Works fine after.

[/quote]

We do exactly the same, we open an ampul and freeze 0.2 and 0.1 ml doses. Works perfectly.

Mariette

RE: My experience of OOH

Evelyn Barbour-Hill — Fri, 20 Oct 2017 23:39:01 GMT

It does give me a mild warm glow when someone says "Thank you for seeing us so promptly" even when it's been at a comfortable time like 10 a.m.! Makes you wonder what sort of service they'd been expecting.

[quote user="Arlo Guthrie"]

For example (and these are just a few rough thoughts going through my head, you might think they're rubbish)

"We hope you've been satisfied with the Out of Hours Emergency Service we provide, and thought you might be interested to know a few more facts and figures about the service:

[/quote]

No, I really don't like that sort of stuff.

RE: My experience of OOH

David Mills — Fri, 20 Oct 2017 23:34:01 GMT

Transconjunctival, dropped in. Same dose as iv. Flush out with saline once you're done.

RE: My experience of OOH

Julian Earl — Fri, 20 Oct 2017 18:07:54 GMT

: I think that there is no doubt that we as vets boost our reputation (or otherwise!) by the standard of care that we give at the most difficult times. i.e, being cheerful, kind and helpful out of hours, plus, of course at the worst of times, this being at a euthanasia. Nowhere does one boost one's reputation as much as when performing a euthanasia kindly, patiently and efficiently. Getting it wrong can have the opposite effect of course. All new graduates should be told this!

RE: My experience of OOH

Anthony Dennison — Fri, 20 Oct 2017 17:56:00 GMT

[quote user="Eilidh Corr"]

I was once typing up notes after a client had left, about 11.30pm, in my pyjamas with a practice fleece thrown on top, when a man and his dog walked in.

"Hello. Could I please have some ear cleaner?" he said casually, as if it was the most normal request imaginable.

[/quote]

We regularly have people ringing at 2am ordering flea treatment or food.

RE: My experience of OOH

Martin Atkinson — Fri, 20 Oct 2017 17:17:01 GMT

[quote user="Gillian Mostyn"]Nah...just happily married husbands! [/quote]That could only come from a woman!

RE: My experience of OOH

Gillian Mostyn — Fri, 20 Oct 2017 16:35:49 GMT

[quote user="Martin Atkinson"]What are you: mice or men?[/quote]

Nah...just happily married husbands!

RE: My experience of OOH

Martin Atkinson — Fri, 20 Oct 2017 16:27:41 GMT

[quote user="Mark Hedberg"]

[quote user="Evelyn Barbour-Hill"]

I wouldn't dream of arguing.

[/quote]

Yes, my Mrs H is also She Who Must Be Obeyed :)

[/quote]What are you: mice or men?

RE: My experience of OOH

Mark Hedberg — Fri, 20 Oct 2017 16:15:44 GMT

[quote user="Evelyn Barbour-Hill"]

I wouldn't dream of arguing.

[/quote]

Yes, my Mrs H is also She Who Must Be Obeyed :)

RE: My experience of OOH

Eilidh Corr — Fri, 20 Oct 2017 14:05:17 GMT

[quote user="Clare Tapsfield-Wright"]we did not want to appear open for routine work during the night[/quote]

I was once typing up notes after a client had left, about 11.30pm, in my pyjamas with a practice fleece thrown on top, when a man and his dog walked in.

"Hello. Could I please have some ear cleaner?" he said casually, as if it was the most normal request imaginable.

When I told him that we were shut, and the system was down, and no he couldn't have his ear cleaner, he looked completely mystified. He honestly thought we were open all hours. Probably the same sort of person who goes to A&E at 4am about a cough he's had for a fortnight

RE: My experience of OOH

Joyce Whitehead — Fri, 20 Oct 2017 13:53:00 GMT

We use it S/C, and only quite small doses seem to work fine unless the stomach is pretty empty. And we freeze the remainder in small aliquot and then only charge for what we use. Works fine after.

RE: My experience of OOH

Martin Atkinson — Fri, 20 Oct 2017 12:00:29 GMT

[quote user="Anthony Dennison"]On the subject of apomorphine, I know we've had this debate before, but do people give it i/v or larger amounts s/c?[/quote]Halfway house so IM.

RE: My experience of OOH

Anthony Dennison — Fri, 20 Oct 2017 11:55:32 GMT

[quote user="Bob Russell"]Actually apomorphine is a pretty pricey drug to stock and use so take that off the bill and you did even better![/quote]

I was going to say, you got a pretty good deal Arlo! We probably would have charged similar price without the flea treatment.

On the subject of apomorphine, I know we've had this debate before, but do people give it i/v or larger amounts s/c?

RE: My experience of OOH

Bob Russell — Fri, 20 Oct 2017 11:30:42 GMT

Actually apomorphine is a pretty pricey drug to stock and use so take that off the bill and you did even better!

We charge about £50 for a vial (takes into account that it does not always get used so some vials get discarded at use by date. I try tiny doses and it seems to work really well but the rest of the opened vial has to be discarded anyway.

Some toxicity calculators on-line will make 200g milk chocolate a severe risk where others consider it mild for an average sized dog. New tangent?

RE: My experience of OOH

Gillian Mostyn — Fri, 20 Oct 2017 11:08:31 GMT

In my first job I lived at the practice, so the lights were on at one end of the building. Cue knocking at the door at all hours, despite opening times and emergency numbers on clear display.....

RE: My experience of OOH

Martin Atkinson — Fri, 20 Oct 2017 10:11:44 GMT

[quote user="Clare Tapsfield-Wright"]Otherwise you get someone wanting their dogs nails clipped at three am hammering on the door or phoning you because the lights are on. [/quote]I can recall just such a situation when I lived above the practice, someone was hammering on the door because the outside lights/signs were illuminated. Just as they gave up the lights went off on the timer so they must have thought someone was in to have switched the lights off and they came back for another bout of hammering. The emergency telephone number is clearly displayed but they never called. The timer is set to go off shortly after out normal closing time now.

RE: My experience of OOH

Clare Tapsfield-Wright — Fri, 20 Oct 2017 10:01:48 GMT

The reason we used to dim the lights Arlo is because we did not want to appear open for routine work during the night. It is different if you are running a full night service but not if you are just seeing emergencies and the vet and nurse are asleep except when called in advance. Otherwise you get someone wanting their dogs nails clipped at three am hammering on the door or phoning you because the lights are on.

RE: My experience of OOH

Arlo Guthrie — Fri, 20 Oct 2017 09:47:37 GMT

[quote user="Evelyn Barbour-Hill"]We try not to be dimly lit, although my wife insists on only switching on half the waiting room light when it's OOH.[/quote]

Buy LED lights; you can light the place up all night like Wembley Arena, and probably still save electricity over half-lighting with normal halogens!

[quote user="mariette asselbergs"]Working in OOH I often feel that we provide an amazing service in the middle of the night for very reasonable money. [/quote]

Yes, I just wonder whether enough is done to explain to and/or remind clients how much work goes into providing the service.

When I came to pay the bill, I was handed a till receipt.

As I left the practice, I was wondering if there was a missed opportunity to staple the receipt to a small flyer which tells me a little more about what goes into it all.

For example (and these are just a few rough thoughts going through my head, you might think they're rubbish)

"We hope you've been satisfied with the Out of Hours Emergency Service we provide, and thought you might be interested to know a few more facts and figures about the service:

1. Our out of hours service is staffed by one veterinary surgeon and one veterinary nurse, all night, every night.

2. On a typical night, we take about xx calls from clients with a concern about their pet.

3. The average wait time before a veterinary surgeon is able to call back is 10 minutes.

4. On a typical night, about xx animals need to come to the practice to be seen by a veterinary surgeon. There is normally no waiting on arrival at the practice.

6. Last year we helped xx clients with advice or treatment outside normal working hours.

7. The most common reasons for needing our help were: xxx, xxx, xxxx.

8. The most severe problems we are called on to help with are ...

RE: My experience of OOH

mariette asselbergs — Thu, 19 Oct 2017 23:13:25 GMT

Thank you for your description of OOH as it should be Arlo!

Working in OOH I often feel that we provide an amazing service in the middle of the night for very reasonable money. Two professionals (vet and RVN), no consult lasts less than 30 minutes, often considerably longer (chocolate dogs delaying puking, euthanasias, "worried well" animals, etc.). Blood results and xray/ultrasound results within minutes. Surgery possible same night if necessary.

Then at least half the phone calls involve mainly advice, which our nurses give with endless patience and professionalism at any time of the night for no money.

And then the world is divided in two kinds of people. When I was a large animal vet and was called for a calving which succeeded without a caesarean section, about half the farmers were happy with a live calf, healthy cow and smaller bill, but the other half of the farmers would be annoyed, grumpy, frustrated and say: after all I could have done that myself and saved me a night vet bill. Both type of people had genuine emotions about the outcome, I could understand both of them, but I know who I prefer as fellow human beings!

Mariette

RE: My experience of OOH

Evelyn Barbour-Hill — Thu, 19 Oct 2017 14:58:22 GMT

[quote user="Arlo Guthrie"]Two people manning a dimly lit practice overnight ... I guess there are going to be moments when it's fun, [/quote]

It is, it is.

We try not to be dimly lit, although my wife insists on only switching on half the waiting room light when it's OOH. I wouldn't dream of arguing.

RE: My experience of OOH

Martin Atkinson — Thu, 19 Oct 2017 11:31:23 GMT

[quote user="Arlo Guthrie"] I am paying more towards the NHS than I am for veterinary care[/quote]Sadly this is true. My AXA PPP premium at the age of 66 was £1755 p.a for full cover, I hazard a guess that they take little less out of my taxes for the NHS than that and I hardly ever bother them.