Not obeying the rules

RE: Not obeying the rules

grumpyoldman — Fri, 22 Mar 2019 15:55:56 GMT

Sounds like a bit of a grim situation all round so probably better to just get paid and do one.

RE: Not obeying the rules

Clive Ansell — Fri, 22 Mar 2019 12:53:56 GMT

[quote user="Neil Wheadon"]

[quote user="Gillian Mostyn"]I know CVS want practices to adhere to the rules. Don't know anything about the others.[/quote]

IVC and the Pets at Home group (I have worked in a lot of their practices) certainly comply in all the clinics I've worked in

[/quote]

I think, yes, they generally do.

I have recently worked in 3 practice for 2 different corporates where things were a little lax. In all 3 cases this was due to management at a local level. None of these branches have any permanent vets or RVN's, and a practice manager who covers a large area and many branches only rarely visits. Since pointing it out to them, they are now up to speed and are compliant.

As has already been said, one has to give a little leeway, but it is concerning when there are no permanent trained staff in a practice to ensure these rules are correctly followed.

RE: Not obeying the rules

Anthony Todd — Fri, 22 Mar 2019 11:58:20 GMT

I'll bet they all do!

Why would they break the law when it makes no difference to their profit as [pure!!] waste is built into the price?

Unless they want to make even more profit??.....

RE: Not obeying the rules

Neil Wheadon — Thu, 21 Mar 2019 23:23:16 GMT

[quote user="Gillian Mostyn"]I know CVS want practices to adhere to the rules. Don't know anything about the others.[/quote]

IVC and the Pets at Home group (I have worked in a lot of their practices) certainly comply in all the clinics I've worked in

Neil

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 17:46:54 GMT

[quote user="Neil Wheadon"]

[quote user="Clive Ansell"] I sometimes forget too if I am in a curry.[/quote]

I'm really not surprised

[/quote]

Typo. (must be from watching Spike Milligan and his Pakistani Daleks!)

RE: Not obeying the rules

Gillian Mostyn — Thu, 21 Mar 2019 17:40:24 GMT

[quote user="An On MRCVS"] a memo from management[/quote] who, specifically, though??

If it is one of the 'big corporate players', as you describe them, then I'd get in touch with their head office and check what their stance is.

I know CVS want practices to adhere to the rules. Don't know anything about the others.

RE: Not obeying the rules

Robert FalconerTaylor — Thu, 21 Mar 2019 17:32:51 GMT

[quote user="Clive Ansell"]

if one were to inject 1.0 ml of Synulox, the charge to the client would be the same presumably? It may be breaking the law regarding the use of medicines, but how would that be deceiving the client?

[/quote]

Trades description - like sell-by dates on foods. Clearly marked (and optionally discounted by retailer) so buyer has a choice to buy, or not. In this instance the client is being duped into paying full price for out of date goods. I would expect any lawyer could argue that one and win. Meantime, story's gone viral on social media etc.

RE: Not obeying the rules

Neil Wheadon — Thu, 21 Mar 2019 16:47:46 GMT

[quote user="Clive Ansell"] I sometimes forget too if I am in a curry.[/quote]

I'm really not surprised

Neil

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 16:23:48 GMT

[quote user="vs0u "]The odd bottle I'd probably turn a blind eye but being aware of the memo could put you in an awkward position.[/quote]

Me too.

All of my regular practices are on the ball with the rules and regulations, so if I come across the occasional open bottle that is not dated I just date it and carry on. I know it is a genuine error or an oversight. I sometimes forget too if I am in a curry.

What is worrying is when none of the injectables are dated, and staff seem oblivious to the requirements. More common than it ought to be.

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 16:11:05 GMT

[quote user="Bob Russell"]This is a tangent discussion of importance but the specifics here is a management that is telling staff in writing to break the law.[/quote]

I'm going to go out on a limb here, and say the more I think about this, the more I disbelieve it. Most management folk I have every come across are good at ducking and diving, avoiding the issue, passing the buck, and covering their own arses. I would be very surprised if they were stupid enough to instruct staff to break the law in writing. Sorry if that causes offence, but it is my opinion.

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 16:06:03 GMT

[quote user="Anthony Todd"]

Is there any actual evidence that broached bottles are contaminated, let alone cause harm?

May be just a broach time pulled out of the air and never supported with evidence, let alone documented harm.

[/quote]

that's as maybe, and I am inclined to agree, but it is not relevant.

The point is about rules being flouted and possibly the law being broken. We have to adhere to the rules whether we like them or not. Who wants to knowingly put their head on the RCVS chopping block - not me.

RE: Not obeying the rules

Anthony Todd — Thu, 21 Mar 2019 13:54:45 GMT

I'd be much happier breaking the law if I knew such action was not harmful!

[sounds as if there ain't any evidence to demonstrate harm??]

eg plenty for alcohol and driving and/or speeding; the law, therefore, has logic and sense.

I take the point regarding "instruction" though; not wise at all!

RE: Not obeying the rules

Bob Russell — Thu, 21 Mar 2019 13:46:14 GMT

This is a tangent discussion of importance but the specifics here is a management that is telling staff in writing to break the law.

The 28 days has been chosen arbitrarily. The pharmaceutical companies just show the product is OK at 28 days. They could easily choose to test up to 56 days or longer. It is just not good business to do so as product in the bin is still product sold.

RE: Not obeying the rules

Anthony Todd — Thu, 21 Mar 2019 13:41:14 GMT

Is there any actual evidence that broached bottles are contaminated, let alone cause harm?

May be just a broach time pulled out of the air and never supported with evidence, let alone documented harm.

The only reactions I can ever remember were from I/M depomedrone and then only rarely.

The forum should have loads of examples if it really was a problem??

I wonder how much profit there is from "expired" valuable therapeutics!

RE: Not obeying the rules

vs0u — Thu, 21 Mar 2019 13:02:07 GMT

The odd bottle I'd probably turn a blind eye but being aware of the memo could put you in an awkward position. Imagine the outcome if you ended up with an injection site abscess. As a locum you do need to be a bit pragmatic about occasional rule bending as otherwise you'd never work anywhere, but a corporate making a policy decision to break the law on this seems crazy!

Do they have permanent staff at the other branches? Are there other dodgy things? I think the memo needs to be brought up with someone senior, otherwise you have the choice of refusing to use any unlabelled stuff or getting out asap.

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 11:34:33 GMT

[quote user="Robert FalconerTaylor"]For the client is fraud isn't it?[/quote]

I can't see that it would be fraudulent?

if one were to inject 1.0 ml of Synulox, the charge to the client would be the same presumably? It may be breaking the law regarding the use of medicines, but how would that be deceiving the client?

RE: Not obeying the rules

Alison Clare Hickman — Thu, 21 Mar 2019 10:25:19 GMT

[quote user="Clive Ansell"]BoyCowPoo[/quote]

Stealing this. Hahahaha!

I worked at a practice BITD that gave me the day off for when there was an RCVS inspection because (and I quote) "You'll tell them the truth"

Boycowpoo happens...

RE: Not obeying the rules

bob lehner — Thu, 21 Mar 2019 10:16:31 GMT

[quote user="An On MRCVS"]Nothing gets thrown away at day 28, and a memo from management instructs staff to not date them and continue using them. Their approach to controlled drugs is the same[/quote]

Whether or not one agrees with the 28 day rule, it is a rule and should be adhered to. Not doing so contravenes the RCVS Code of Professional Conduct - ''All medicines should be stored in accordance with manufacturers’ recommendations whether in the practice or in a vehicle. If it is stipulated that a medicine be used within a specific time period, it must be labelled with the opening date, once broached.''

Both the RCVS and VMD should take a dim view of deliberate disregard of this - particularly if it appeared to be a management decision which was trying to force staff to contravene the RCVS Code of PC.

Most of the big corporates subscribe to PSS - which also includes reference to the 28 day rule - so there could be no excuse for claiming 'not to know the rules'.

Difficult position as a locum - but clearly you should not deliberately disregard the Code of PC. I would write a note to the Area Manager of the group stating that you are not happy and pointing out the error of their ways and the serious consequences which this might cause.

RE: Not obeying the rules

Clive Ansell — Thu, 21 Mar 2019 10:06:54 GMT

Yes, you could be held responsible as you are the MRCVS and therefore are accountable. Needs to be taken seriously.

Most of us may think it is BoyCowPoo, but it is an absolute legal and RCVS requirement to adhere to the rules regarding labeling, use of and disposal of all drugs, particularly so with controlled drugs.

Unfortunately, it is more common than you might think. I have worked in many practices where the rules are not followed, are blatantly flouted, and many lay staff and some RVN's and even veterinary surgeons seem ignorant of them. Where I work in such situations, I will label all injection bottles with a date; if clearly old I won't use them and order in new, if they look like they are fairly recently opened, and get used quickly (metacam, synulox etc) I will date them and carry on. Never never back date them. I would never throw bottles of drugs away, just wouldn't use them.

In many cases oral medications will reach therapeutic serum levels as quickly, or almost as quickly, as a s/c injection, so don't give it if not legally available. At a fairly recent CPD we were told that Onsior reaches serum levels more quickly after a tablet than after a s/c injection.

With Controlled drugs I adhere rigidly to the rules and will not use an unlabeled opened vial, or one which is out of date.

RE: Not obeying the rules

Bob Russell — Thu, 21 Mar 2019 09:42:58 GMT

Is it fraud? Is it only fraud if the product is substandard?

It certainly exposes the vet in charge to problems if a drug is ineffective.

The other side of the story is that these broach and dispose dates are arbitrary and potentially a product of greed rather than science. More important would be the number of broaches and the manner/hygiene of those broaches.

For years in the past we had bottles of say Tardak on the shelf. Used once in a blue moon but it remained effective and I cannot think of a single injection site abscess/reaction.

That said the rules, flawed or otherwise are what they are and it is not really your decision to make. It is not up to the management to decide which rules to follow and which ones not to.

I cannot sit here and swear we never have this issue. The VMD did find a bottle of vomend here that had been broached but not labelled!!

Controlled drugs are different, you do what you are supposed to and document in line with the legal requirements.

Our controlled drugs book did get into a it of a mess as we were using very small amounts often but when we did a detailed audit we were right to within a few drops.

I hate the volume and expense of the medicines being discarded and would prefer greater availability of single dose products.

RE: Not obeying the rules

Robert FalconerTaylor — Thu, 21 Mar 2019 06:09:10 GMT

For the client is fraud isn't it? Imagine the scandal for the corporate if THAT got into the Daily Mail - more vets ripping of clients stories - the press would love it! Perhaps apprach the powers that be along those lines. It would only take 1 whistle-blower...

RE: Not obeying the rules

Joyce Whitehead — Wed, 20 Mar 2019 21:08:38 GMT

I’m not sure the VMD would be impressed with the memo from management saying to ignore the broach dates! If this is in writing I’d be inclined to keep it. If you have a clinical director in another branch I think you need to speak to them and say you are not happy with this.

RE: Not obeying the rules

Sarah Keir — Wed, 20 Mar 2019 20:21:06 GMT

Contact the VMD and ask.

RE: Not obeying the rules

Neil Wheadon — Wed, 20 Mar 2019 18:38:11 GMT

The short answer is yes

Fundamentally you need to do what you think is the right thing to do

If you're there for 2 months, you won't know if anything had been opened yesterday, so that gives you a months grace.

When you say controlled drugs, I'm assuming they are recording their use?

At the very least photocopy the memo and keep it

If you are very uncomfortable then work a month, invoice weekly and leave after a month BUT give the practice notice of leaving, that's only fair, so they can find a replacement

Neil