Days off in lieu for bank holidays

RE: Days off in lieu for bank holidays

Martin Atkinson — Mon, 13 Nov 2017 12:54:11 GMT

[quote user="Edward Jones"]did you have/need documentation to prove that the client had prior knowledge of your OOH arrangements?[/quote]No, but she was advised verbally and this was recorded in her clinical notes.

RE: Days off in lieu for bank holidays

Neil Wheadon — Mon, 13 Nov 2017 11:56:17 GMT

[quote user="villagevet"]I am happy to leave patients in overnight with intermittent checks/medicating as their condition requires and inform owners of such, often ring or message the owner during checks also. The issue I have had in previous employment is where practice staff insist the patient stays as it needs 'special care' and/or 'needs hospitalising' as it is so unwell - leaving the owners to assume they will be constantly monitored and cared for and a distressing phone call the following morning if the patient has deteriorated[/quote]

The place I am in at the moment that uses an OOH centre has on the consent form that patients aren't monitored all night and have intermittent checks. (If they don't get transferred)

OK it's rare that an animal is kept in rather than using the OOH service, but in light of the recent VDS cases this seems very sensible

Neil

RE: Days off in lieu for bank holidays

Anthony Dennison — Mon, 13 Nov 2017 10:50:40 GMT

[quote user="Gillian Mostyn"]

No, but if you run a kennels or a cattery somebody has to be on site 24/7.

Supervision/responsibility
The cattery proprietor or a responsible person over the age of 18 years should always be present to exercise supervision and deal with any emergencies
whenever cats are boarded at the premises.
It is strongly recommended that the cattery
proprietor or a responsible person lives on site or a key-holder must live within a reasonable distance of the cattery. An emergency contact number must be
clearly displayed at the entrance to the cattery.

[/quote]

The branch practice I'm at used to be the on site accomodation for the RSPCA staff members to provide 24hours monitoring. They switched to a CCTV system and no longer needed people on site.

RE: Days off in lieu for bank holidays

Lindsey Edwards — Sat, 11 Nov 2017 11:26:26 GMT

I am happy to leave patients in overnight with intermittent checks/medicating as their condition requires and inform owners of such, often ring or message the owner during checks also. The issue I have had in previous employment is where practice staff insist the patient stays as it needs 'special care' and/or 'needs hospitalising' as it is so unwell - leaving the owners to assume they will be constantly monitored and cared for and a distressing phone call the following morning if the patient has deteriorated. Our nearest 24hour facility is 4 hours away and owners refuse to pay for a dedicated overnight shift for 1 patient so maybe we just adapt to deal with the resources we have available

RE: Days off in lieu for bank holidays

Michael Woodhouse — Fri, 10 Nov 2017 23:59:29 GMT

[quote user="Gillian Mostyn"]Michael...your comment is irrelevant. What you do with your own pets is up to you. I also leave my pets alone all day. That is different to what you do with other people's pets, which you are being paid to care for. [/quote]

I'm not convinced it's that different. We check in patients as often as the duty vet feels necessary (and can get back to the surgery). When that's explained to owners they understand. It's pretty rare something can't wait 4-6 hours between checks. We wouldn't leave something post surgery until awake and stable, but would check that sooner (or send home ASAP if a caeser). I've occasionally offered to send somewhere with 24 hour staff and no one has ever taken me up on it.

I'd be happy leaving my pet under such circumstances with either a vet, friend or kennels.

RE: Days off in lieu for bank holidays

Gillian Mostyn — Fri, 10 Nov 2017 23:44:39 GMT

I should make it clear I'm not passing judgement on anybody!

I am simply pointing out that there seem to be stricter rules governing the supervision of perfectly healthy pets than poorly ones. Worth considering really.

Michael...your comment is irrelevant. What you do with your own pets is up to you. I also leave my pets alone all day. That is different to what you do with other people's pets, which you are being paid to care for.

RE: Days off in lieu for bank holidays

Michael Woodhouse — Fri, 10 Nov 2017 23:17:10 GMT

My dogs spent 9 hours at home today by themselves and were fine...........

RE: Days off in lieu for bank holidays

Gillian Mostyn — Fri, 10 Nov 2017 22:30:55 GMT

Sorry, I didn't explain myself properly.

I am not aware that there is any guide that states that vet practices shouldn't be leaving animals without constant nearby supervision, and yet this rule is already in place for catteries and kennels. As in both situations owners are entrusting their pets' care to professionals, I guess it wouldn't be unreasonable to expect the same standards for both.

The proprietor or other key holder should be on-site or nearby....but if you look at the guide again, it clearly suggests that somebody is always on site when there are animals being boarded. I read this to say that the person nearby doesn't necessarily need to have access themselves (such as a neighbour) .... but there should be somebody there responsible for the pets. I can't see how a pet in a lock-up vet practice is being supervised at all..???

RE: Days off in lieu for bank holidays

Lindsey Edwards — Fri, 10 Nov 2017 21:37:13 GMT

[quote user="Gillian Mostyn"]or a key-holder must live within a reasonable distance of the cattery. An emergency contact number must be clearly displayed at the entrance to the cattery.[/quote]

Given that the above is only a recommendation, I don't see it as odd! It does not seem unreasonable or onerous to me that should there be a fire/flood etc that someone should have access and do not see how it precludes the owner from being away from the premises - not a weeks holiday without staff obviously able to go out for dinner? If you are self employed and have bookings - similar to any b&b/hospitality sector you would expect to have to provide staffing cover for your holidays!

RE: Days off in lieu for bank holidays

Gillian Mostyn — Fri, 10 Nov 2017 19:19:49 GMT

[quote user="Martin Atkinson"]its the same as a cat in cattery or a dog in kennels - do the kennel staff stay up all night?[/quote]

No, but if you run a kennels or a cattery somebody has to be on site 24/7.

One of my receptionists used to run a cattery, but sold it due to the lack of freedom. She even had to employ people to 'babysit' the cattery so she and her husband could go out together!

Seems odd that there are more stringent rules for the care of pets in boarding establishments than in vet practices...especially considering the organisations involved in writing their rules!

See

http://www.cieh.org/policy/model-licence-conditions-and-guidance-for-cat-boarding-establishments.html

RE: Days off in lieu for bank holidays

Edward Jones — Fri, 10 Nov 2017 12:46:47 GMT

[quote user="Martin Atkinson"]It was perfectly stable and she was advised that it would not be monitored. It died overnight and she complained to the RCVS[/quote]

Out of interest, did you have/need documentation to prove that the client had prior knowledge of your OOH arrangements?

RE: Days off in lieu for bank holidays

Martin Atkinson — Wed, 08 Nov 2017 18:46:25 GMT

[quote user="Chris Barker"]But tell me - what is the issue with leaving a stable animal in a cage overnight without 24/7 supervision? If the owners understand and agree, if a webcam is used, if staff return to check if judged necessary...just what is the problem?[/quote]None, its the same as a cat in cattery or a dog in kennels - do the kennel staff stay up all night?

We had a budgie in for minor surgery a while ago the owner couldn't collect and didn't want to pay for someone to return it for her or for it to be transferred to the OOH centre. It was perfectly stable and she was advised that it would not be monitored. It died overnight and she complained to the RCVS not so much on the basis that it wasn't attended but that we didn't leave a light on all night which its used to at home! RCVC just confirmed my present arrangements for OOH care were adequate and dismissed the complaint.

RE: Days off in lieu for bank holidays

Stephanie Wellings — Wed, 08 Nov 2017 18:08:20 GMT

[quote user="Chris Barker"]

[quote user="Robin Grimmer"]I have to say I don't think it's acceptable to keep an animal in overnight if there's no-one there[/quote]

That's an opinion I hear increasingly voiced but one with massive consequences. Financially for the owner - overnight supervision will always be expensive, perhaps increasingly so. And for the practice and the profession a massive staffing issue, with more and more professionals adamant that they will never again do OOH work.... How do you square the circle?

But tell me - what is the issue with leaving a stable animal in a cage overnight without 24/7 supervision? If the owners understand and agree, if a webcam is used, if staff return to check if judged necessary...just what is the problem?

[/quote]

If it is probably stable but might deteriorate then I think it will be better at home where the owner can watch it like a hawk and take to OOH at any time in the night if they are concerned.

When a human is sedated, they send you home straight after but say you have to have someone supervising you for the next 24 hours, so I think that’s an appropriate thing to ask of pet owners if necessary.

RE: Days off in lieu for bank holidays

Chris Barker — Wed, 08 Nov 2017 17:54:42 GMT

[quote user="Robin Grimmer"]I have to say I don't think it's acceptable to keep an animal in overnight if there's no-one there[/quote]

RE: Days off in lieu for bank holidays

Martin Atkinson — Wed, 08 Nov 2017 17:13:05 GMT

[quote user="Thomas Johnson"]We used to do this, but after an arson attack (someone used petrol to set light to the bins behind the practice) and our practice cat had to be euthanased because of smoke inhalation we've been very reluctant to keep anything in overnight.[/quote]This is something which is unforeseeable but I do occasionally use such scenarios to put clients off who want to bring animals in the night before or leave overnight, especially dogs, because they can't collect just for their convenience.

In reality this kind of risk is vanishingly small and could happen even if the practice is attended - health and safety protocols suggest you should get the hell out if there's a fire and not risk lives saving animals.

I see no problem at all keeping cats and small pets overnight if they are stable, I will often stay late or come back last thing to check they're OK, so long as the owners know this is the case.

RE: Days off in lieu for bank holidays

Robin Grimmer — Wed, 08 Nov 2017 16:09:18 GMT

[quote user="Thomas Johnson"]

[quote user="Robin Grimmer"]One of the practices I locum for doesn't keep any inpatients. Well, they won't keep dogs in period - because there's no-one on the premises for 12 hours. They will sometimes keep rabbits and cats in if stable eg routine post-op (although you could argue why keep them in at all if no-one there) or cat on iv fluids if stable - but the owners are always told there is no-one on the premises and they are always offered Vets Now if they want their pet monitored overnight.[/quote]

We used to do this, but after an arson attack (someone used petrol to set light to the bins behind the practice) and our practice cat had to be euthanased because of smoke inhalation we've been very reluctant to keep anything in overnight.

[/quote]

Jeepers - that's terrible.

I have to say I don't think it's acceptable to keep an animal in overnight if there's no-one there. Apart from maybe owner's convenience eg if they want to leave an animal in the evening for an op the next day if they are unable to bring it in the morning.

RE: Days off in lieu for bank holidays

Thomas Johnson — Wed, 08 Nov 2017 16:00:17 GMT

RE: Days off in lieu for bank holidays

Robin Grimmer — Wed, 08 Nov 2017 15:36:46 GMT

One of the practices I locum for doesn't keep any inpatients. Well, they won't keep dogs in period - because there's no-one on the premises for 12 hours. They will sometimes keep rabbits and cats in if stable eg routine post-op (although you could argue why keep them in at all if no-one there) or cat on iv fluids if stable - but the owners are always told there is no-one on the premises and they are always offered Vets Now if they want their pet monitored overnight.

It works pretty well - it's very rare that a patient is 'unsuitable for travel'. The only thing I don't like is yo-yoing of cases back and forth between OOH during the week eg blocked cats. Not a problem over the weekend/bank hol as they will stay at the OOH for the duration.

I think the model for OOH care in North America works better. The emergency centres are staffed 24/7 - so you can send over a patient at any time - not just after 7pm on weekdays and 12pm Saturdays. They will keep them as long as necessary so no yo-yoing of cases back and forth. It avoids that 'grey area' in the last hour or so of normal daytime practice where you say how much do we do and how much do we expect the OOH service to do? But of course, all of this comes at a cost - and would increase the cost of OOH as we know it.

RE: Days off in lieu for bank holidays

Anthony Dennison — Wed, 08 Nov 2017 14:11:33 GMT

[quote user="mariette asselbergs"]

It seems to me that the moral of the story is that practices without OOH overnight facilities should (and generally will) not operate on their patients in the afternoon. If they see an enterotomy or a pyo or a GDV coming they will generally send them on the the OOH practice anyway.

Mariette

[/quote]

We've recently started doing the OOH for another local IVC practice. This happens fairly frequently. Is a little annoying however if they don't even do initial work up in the afternoon and just divert the animal to us without any work up.

RE: Days off in lieu for bank holidays

Stephanie Wellings — Wed, 08 Nov 2017 11:42:26 GMT

I don’t think vets resent this as a concept. I can see it might be stressful at the time and sad if you got a bad outcome, but ultimately it’s one of the more rewarding bits of vetting. I think all vets might resent it if it happened often as a result of habitual understaffing/overbooking, or if the boss made no effort to give you any time off / money in return for an unplanned whole night shift.

In terms of bank holidays - if you are committed to be available to work in any capacity, I would expect a day off if that’s in your contract, and I wouldn’t be shy about telling your boss that. Unfortunately some bosses are short sighted and think getting one day of extra work out of someone is worth pissing off your most valuable asset, but I think most would be willing to have the discussion. As others have said, you might need to meet them halfway so it might turn into a day of on call rather than just inpatient checks so it depends on what is preferable to the OP (and I would probably discuss with other vets at your practice, as if it changes for you it’s likely to change for everyone, and they might not be thrilled!)

RE: Days off in lieu for bank holidays

Martin Atkinson — Wed, 08 Nov 2017 10:40:17 GMT

[quote user="Stephanie Fursland"]I think (even as an assistant) that the buck stops with the vet who is looking after the patient[/quote]I agree but I get the sense that there are growing number who resent this.

[quote user="Stephanie Fursland"]It’s a pretty rare situation though that the patient is so sick it can’t be moved even with a vet in the car.[/quote]Virtually never I'd say. We recently had a dog which was severely cyanotic and being kept alive with oxygen, I knew that our oxygen supply would not last all day/night to maintain this patient so we stripped the anesthetic machine down to just enough to be able to maintain a supply while the dog was transported in an animal ambulance with a nurse on-board. The owner had declined even to drive with said nurse in the back with the dog and the kit.

The irony was that when they arrived at the RVC and had to carry the dog in disconnected from the oxygen supply the staff wouldn't admit it immediately because they hadn't got the owner's consent even though they were aware it was on its way. My nurse had to kick ass to get them to realise the urgency of the situation.

RE: Days off in lieu for bank holidays

Stephanie Wellings — Wed, 08 Nov 2017 10:14:13 GMT

[quote user="Martin Atkinson"]

[quote user="Nicola M"]Personally I would operate then stay with the dog overnight until I deemed it suitable to transfer the dog if the weekend (or not transfer at all-If it was a weekday then I would stay with dog overnight then keep as inpatient as clinic would be fully staffed following day). [/quote]There is a question of where the buck stops here. I'm not clear if you are an assistant or the boss Nicola but as practice owner, under these circumstances I would be the one who stopped overnight I would not expect another member who was not contracted to work OOH to do so unless they volunteered and if I had a locum I would hope that he/she would take that responsibility on.

[/quote]

I think (even as an assistant) that the buck stops with the vet who is looking after the patient, although another member of the team/the boss might volunteer to take a shift, if nobody wants to, ultimately it’s my responsibility. It’s a pretty rare situation though that the patient is so sick it can’t be moved even with a vet in the car.

I agree it isn’t ideal for practices not to have hospitalisation on site overnight, but I think maybe we (and pet owners) have to accept the standards of care for animals are not the same as those for humans. Although we have to make arrangements for OOH care, these are to ensure animal welfare and not client convenience. Often OOH is further away from the clients home than they would like, or more expensive than clients would like to pay - that doesn’t mean it isn’t fit for purpose.

RE: Days off in lieu for bank holidays

Clive Ansell — Wed, 08 Nov 2017 09:46:21 GMT

[quote user="robloxley"]My reading of the VDS article was not that transfer was bad but that it needed to be flagged up at an earlier stage that it might need to happen and that it needed careful management.[/quote]

So just poor communication really then? It could have been that in thee hustle and bustle of dealing with an emergency, it got forgotten or side stepped?

I will often say with almost all non routine ops, or sick cases, that there is a possibility of having to arrange transfer to an OOH provider, if things don't go to plan - always sow the seeds early on in the discussion.

I had a case 2 weeks ago; very sick bitch with a pyometra on a Friday morning - admitted for IVFT to stabilise with surgery scheduled for early afternoon if all ok. Warned the owners that transfer for OOH care may later be needed, which they were fine with. The dog did much better than expected, so I was later happy to keep overnight within the practice on the basis of being unmanned with minimal supervision (Usually unmanned, but I was living in the practice flat during the locum) Again, discussed and agreed with the owner.

RE: Days off in lieu for bank holidays

Rob Loxley — Wed, 08 Nov 2017 09:22:29 GMT

[quote user="Martin Atkinson"]Is the primary care vet then going to face disciplinary action because he/she transfers the case and it dies or if he/she doesn't transfer it and it dies because they did not have specialist facilities? Devils and deep blue seas spring to mind.[/quote]

My reading of the VDS article was not that transfer was bad but that it needed to be flagged up at an earlier stage that it might need to happen and that it needed careful management. We recently had a collapsed dyspnoeic pug that we stabilised and transferred with vet and VN to the referral centre and owners met us there.

RE: Days off in lieu for bank holidays

Martin Atkinson — Wed, 08 Nov 2017 09:15:21 GMT

However, Clive has raised a pertinent observation versus Chris' rather 'college speak' stance. Although the primary practice may have to have facilities to hospitalise recumbent patients OOH a dedicated OOH facility will have more staff/be better equipped to cope with a case that requires specialist attention. Is the primary care vet then going to face disciplinary action because he/she transfers the case and it dies or if he/she doesn't transfer it and it dies because they did not have specialist facilities? Devils and deep blue seas spring to mind.