Safety at Work - Drugs

Re: Safety at Work - Drugs

Bob Russell — Fri, 24 Sep 2010 11:10:54 GMT

Funnily enough my uncle was a vet and tried to put me off - obviously with no success!!! Is this a common thing??

Re: Safety at Work - Drugs

Edward Jones — Fri, 24 Sep 2010 10:30:24 GMT

Touché.

In a previous life I was pretty cavalier about my own H&S - I probably would have gone ahead and bought the phenol, then hid it away in the back of a cupboard. Easier to get away with (from the boss and from H&S point of view) in a small branch. I wouldn't any more.

There's not much more pathetic than not taking responsibility for your own mistakes. Your phenol issue is pretty serious, in my view. The mirtazapine issue, less so - simply because safety data sheets aren't required for the vast majority of prescription medicines (human or animal).

What special precautions do people take with formalin - any necessary? (well obviously precautions are necessary, but from a COSHH/RA point of view, I mean).

Re: Safety at Work - Drugs

J G Wray — Thu, 23 Sep 2010 22:29:15 GMT

[quote user="i am ed"]I'm a bit frustrated by this thread. The original issue seems to be either a training problem or a disciplinary problem.[/quote]

Sorry about your frustration. I was originally and subsequently interested to hear whether others thought that my intelligent professional co-workers should be prepared to acknowledge an accident had taken place for which they were, in part, responsible or whether they are part of a more general trend amongst vets to have a "cavalier" approach, in which contemplating and avoiding hazard has little relevance if there is a clinical imperative.

The vet involved acknowledged they knew about the requirement for a COSHH assessment, but expressed no remorse or culpability and disciplinary action was vetoed by my partner. So, I was left with enquiring whether the "attitude" was commonplace or exceptional.

[quote user="i am ed"]

[quote user="Jonathan Wray"]I sense that younger vets and vets who do referrals where unlicensed or non-mainstream product is advised are more likely to risk these products.[/quote]

To join in with the mud slinging for a moment: I sense that some older bosses are entirely resistant to consider having new products on the shelves. A statement equally unsubstantiated, of course .

[/quote]

I'm not sure it was mud slinging, and made no claim other than I "sensed" this and expressed an opinion. It's an opinion based upon twenty seven years of observation, whatever that's worth.

[quote user="i am ed"]Anyway, what works in a small practise with regards to COSHH will not scale up into a larger practise. [/quote]

That's a tad glib. I can see it working perfectly well if the smallest working unit of practice in the larger group - an autonomous branch perhaps - has vets/nurses willing to take on the "cavalier" and require a full assessment of the new product. But, how many want to take on this responsibilty voluntarily?

[quote user="i am ed"]Seems to me it's one of those things where "It's only a problem if there's a problem"[/quote]

Hmmm, time for an anecdote, since this looks like a swingeing condemnation of a culture of safe practice.

My uncle was a vet, who failed to put me off. He contracted Brucellosis. As he suffered recurrent bouts he also had bouts of depression, a dangerous thing for a vet and hell for his family and colleagues as well as him. He had the same cynical view of the theoretical problem before the illness, but doesn't hold it now.

[quote user="i am ed"]and a problem is exponentially more more likely in a large practise than in a small one.[/quote]

Eh? Ah, opinion, something you sense.

[quote user="i am ed"]GW: In hindsight, if you had been approached with a request for Mirtazapin, would you have ultimately said yes (if there was clinical justification)? What about the phenol - could you have worked out the problems inherent with it?[/quote]

In hindsight, the council of perfection, well, for Mirtazapine I think I would have said yes, but after consideration of all the elements that meant its use is justified - and the practice has a protocol to justify it's use which is broader than just the clinical. As for phenol, as we both know, the justification on clinical grounds is thin and it's gotbugger all else going for it, so I would have asked my colleague to go back and consider alternatives, a nice way of saying "No".

JGW

Re: Safety at Work - Drugs

Edward Jones — Wed, 22 Sep 2010 16:37:44 GMT

I'm a bit frustrated by this thread. The original issue seems to be either a training problem or a disciplinary problem. Then the thread is nothing more than a dare for anyone to disagree that there is a problem for a good mud slinging match.

[quote user="Jonathan Wray"]I sense that younger vets and vets who do referrals where unlicensed or non-mainstream product is advised are more likely to risk these products.[/quote]

To join in with the mud slinging for a moment: I sense that some older bosses are entirely resistant to consider having new products on the shelves. A statement equally unsubstantiated, of course . I'm not sure phenol is necessarily 'non-mainstream', it's use in treatment of corneal ulcers is fairly common I think (although I'm not sure if it's 'best practise').

Anyway, what works in a small practise with regards to COSHH will not scale up into a larger practise. That doesn't mean what happens in the smaller practise is necessarily inappropriate, however. Seems to me it's one of those things where "It's only a problem if there's a problem", and a problem is exponentially more more likely in a large practise than in a small one.

JGW: In hindsight, if you had been approached with a request for Mirtazapin, would you have ultimately said yes (if there was clinical justification)? What about the phenol - could you have worked out the problems inherent with it?

Re: Safety at Work - Drugs

Malcolm Ness — Wed, 22 Sep 2010 14:07:49 GMT

[quote user="Michael Woodhouse"]He will conduct a risk assessment and consult the data sheet. We will contact the company and request further information. Are you pregnant/immunosuppressed/left wing/member of the AA? We will also conduct an extensive literature search to make sure the evidence is good that this is the best treatment for your dog.[/quote]

Do I detect here a note of what the Americans will continue to call irony until they discover the meaning of sarcasm?

Unless you have considered most of the information you list (which, as a professional about to bring judgement to bear, you should have to hand and not need to trawl the literature for) then you are not really using "clinical judgement" bridled or otherwise, but rather just taking a bit of a guess.

Some months ago, a locum threw their toys out of the pram when my wife (a dermatologist) stopped the order of ??Tacrolimus - a substance so noxious that FDA have massively restricted its distribution. The locum in question had ignored the practice protocol about giving steroids to derm cases without a diagnosis, ignored the practice protocol about consulting the in-house dermatologist about cases that weren't getting better and then threw a hissy fit when his "professional clinical judgement" was being "interfered" with over the ointment order. ("I have had a lot of sucess with it "in this type of case""). The patient and owner, a young mother with 2 year old twins and possibly pregnant again (read the Tacro. warnings!!) was finally seen and subjected to some proper dermatology - skin scrapes supported a diagnosis of demodecosis which resolved spontaneously once the "Professionally clinical judger's" cortico-steroids were withdrawn.

Re: Safety at Work - Drugs

Anthony Todd — Tue, 21 Sep 2010 16:01:24 GMT

[quote user="Michael Woodhouse"]I was told, very simply, that I could order whatever I wanted - so long as I sold it. The practice didn't want stuff on the shelf going out of date and I can fully sympathise with that. Certain things have been ordered and the whole pot sold to the client - even if we didn't dispense it all [with the client being aware]. [/quote]

Sorry,I was in the advanced stage of phenolic expiratory apoplexy

Re: Safety at Work - Drugs

Bob Russell — Tue, 21 Sep 2010 09:50:50 GMT

Our PMS will not allow things to be ordered without them being set up with mark up etc so unless someone phones or faxes an order there is some degree of control there. Only certain members of staff can set up new products.

If you are running a practice the buck stops with you. The choice of medication on the shelf is yours (you are buying it) however this does not necessarily limit the choices for other staff just the requirement to keep you informed.

Phenol is classified as a hazardous substance, should be used in a fume cupboard and there are very strict controls on disposal. It is toxic by inhalation, ingestion and skin contact. There is a skull and crossbones on the bottle for a reason. It should never be used in practice without a proper risk assessment - not because of bureaucracy but because it is dangerous!

Re: Safety at Work - Drugs

J G Wray — Tue, 21 Sep 2010 07:41:50 GMT

[quote user="Michael Woodhouse"]I'm still fairly sure that the practice has a responsibility even if it is something I have done as an individual. [/quote]

Quite so, jointly liable. However, that does not mean that the practice would be enthusiastic about supporting your liability. I am not at all clear how sympathetic I would be if one member of staff's actions were in any way responsible for another's injury or illness where the justification were as thin as you have proposed and established practice had been contravened.

[quote user="Michael Woodhouse"]My main issue is the time for the process in the middle of a consulting spell on a busy day - it's just not going to happen![/quote]

H&S does not become irrelevant when professional pressures are high. I can see there being a case for this being exactly the time when professionalism should be at its highest and that includes embracing best practice rather than expediency, based upon a perceived "clinical" requirement.

[quote user="Michael Woodhouse"]You'd be surprised how 'good' I am when it comes to conforming to the cascade. I know of plenty of practices dishing out human amoxycillin like smarties. [/quote]

Care to name names?

[quote user="Michael Woodhouse"]My point is that the patient in front of you sometimes means that you have to 'get on with things'. Even the VMD accept is is ok to get an owner to give the dog an aspirin and bring it in in the morning![/quote]

I'm getting confused here. In one breath your are describing how, when it is busy, you have to "get on with things" H&S judgements and procedures can become cumbersome and detrimental to a clinical situation and now you've illustrated your point with the reverse, viz stalling on treatment.

[quote user="Michael Woodhouse"]Gosh - sometimes it's nice to be a small practice with <5 staff so we don't have to jump through as many H&S hoops. It's all very nice having an 'intranet' but the data sheet is available. We don't stock chemo drugs because of the risks and the waste [don't even start on waste....][/quote]

The intranet is a convenience for a two site practice, an effort to get uniform practice, which has apparenlty failed, in my view, because of the lack of professionalism by professional staff.

The data sheet does not contain the COSHH information

If you don't stock chemo drugs "because of the risks" any authority would be clear that you have accepted there are risks with some drugs/substances and therefore understand the issues.

Waste regulations exist, not for veterinary practices, but to protect the public and the environment.

[quote user="Michael Woodhouse"]Ah but it is. From the HSE website "Take care of your own health and safety and that of people who may be affected by what you do". You just have a duty of care to ensure you have done all that is 'reasonable' to protect your employees.[/quote]

All true, but as part of the definition of what is reasonable, COSHH regulations have formalised matters and provided a benchmark, which is generally accepted. Exceptions based upon expediency are increasingly rare.

[quote user="Michael Woodhouse"]I spend a lot of time on farms - a bottle of phenol doesn't come close to a lot of what we do outside.Health and safety can go too far.[/quote]

There are cavaliers.

JGW

Re: Safety at Work - Drugs

Michael Woodhouse — Mon, 20 Sep 2010 23:29:41 GMT

[quote user="Jonathan Wray"] If you are ordering product that you have not used before and a member of staff, as here, is injured, who would be responsible and accountable? I only see you.[/quote]

So you are saying that my employer doing a risk assessment is taking the liability off of me as an individual and shifting it on to himself? That seems a jolly decent thing of him to do - suddenly I am liking the sound of all this.

I'm still fairly sure that the practice has a responsibility even if it is something I have done as an individual.

[quote user="Jonathan Wray"]

[quote user="Michael Woodhouse"]So you see a dog with an unusual but treatable condition. There's either something new, some human generic or something not usually stocked that would treat it. You say to the owner:

"I can fix your dog, BUT I have to talk to the boss. He will conduct a risk assessment and consult the data sheet. We will contact the company and request further information. Are you pregnant/immunosuppressed/left wing/member of the AA? We will also conduct an extensive literature search to make sure the evidence is good that this is the best treatment for your dog. There will be a meeting of the partners and we will have a decision for you in 2-4 weeks. Then, and only then, can I order you the medicine. You dog will either be better or dead".

[/quote]

Ah, hyperbole. Has it ever ocurred to you that you could do all this?

[/quote]

I'm sure I could - technically. A number of other posters have clearly stated that any novel drugs ordered have to go through 'the boss' for consideration. You must all have simple practices where people are easily contactable or people are happy waiting for their drugs.

Do the bosses not have half days, or the assistants? One or the other out on farm calls. Can sometimes go a little while without time to discuss the pro's and con's of a particular therapy. I'm not saying it never happens - because it does. But usually when a new product is been considered for stock. Here I fell my input is taken into consideration, and we stock things that if I wasn't there we wouldn't have.

My main issue is the time for the process in the middle of a consulting spell on a busy day - it's just not going to happen!

[quote user="Jonathan Wray"]

[quote user="Michael Woodhouse"]Take the product in question - assume the phenol is for treating an ulcer. Do I have to go for all the rigmarole or order the phenol and book the dog in for tomorrow and cure it?[/quote]?

I detect a reluctance to conform with regulation when it, irritatingly, gets in the way of a clinical issue. This may not be a defence.

[/quote]

You'd be surprised how 'good' I am when it comes to conforming to the cascade. I know of plenty of practices dishing out human amoxycillin like smarties. My point is that the patient in front of you sometimes means that you have to 'get on with things'. Even the VMD accept is is ok to get an owner to give the dog an aspirin and bring it in in the morning!

[quote user="Jonathan Wray"]

[quote user="Michael Woodhouse"]What if the injured person [let's make her a pregnant nurse] had broken some corticosteroid and splashed into her eyes, what if it was Estrumate?[/quote]

I don't know if the injured person is pregnant. She doesn't have to tell me until she is sure and then we will review her health as per. If she had one of the accidents you noted, anyone in the practice could go onto our intranet, available at all workstations, and check what the RA and SOP for this is and act accordingly. If these do not exist in your practrice then, if you ordered the drug and hadn't assessed the risk of storage and use, I guess your name would be in the frame to explain the overwhelming expediency of what you perceive as clinical need to an authority or a family member, over taking the time to do a RA and develop a SOP.

[/quote]

Gosh - sometimes it's nice to be a small practice with <5 staff so we don't have to jump through as many H&S hoops. It's all very nice having an 'intranet' but the data sheet is available. We don't stock chemo drugs because of the risks and the waste [don't even start on waste....]

[quote user="Jonathan Wray"]

[quote user="Michael Woodhouse"]I know we all have to be mindful of health and safety, but we have to take some responsibility on our own shoulders as professionals.[/quote]

Fine words. I take it you mean that my staff member should have been more careful when knocking the phenol off the shelf. I'm pretty sure that's not how these things work.

[/quote]

Ah but it is. From the HSE website "Take care of your own health and safety and that of people who may be affected by what you do". You just have a duty of care to ensure you have done all that is 'reasonable' to protect your employees.

I spend a lot of time on farms - a bottle of phenol doesn't come close to a lot of what we do outside.Health and safety can go too far.

Arlo - I hope there's not a word limit on these posts.......

Re: Safety at Work - Drugs

J G Wray — Mon, 20 Sep 2010 22:53:17 GMT

[quote user="robloxley"]

[quote user="Jonathan Wray"]I have that responsibility in our practice and I have told staff, time and again, that if they want new product, to put the request to me first.[/quote]

So why don't they - have you asked them that question? IMHO people 'work around' protocols either because the reason for the protocol hasn't been explained, or because the protocol just doesn't work in practice.

[/quote]

What a very good question. I have asked them now that the accident has happened and am waiting for the answer. Up to this point I thought, I assumed, nay I was certain, that the vets, who I treat as well trained intelligent grown-ups, as fellow professionals, had listened when I explained the reasons, but evidently not. I am clearly a fool.

It will be interesting to see if any colleague steps forward and asks to share the burden of responsibility for doing this task, or whether they'll just carry on as before, slightly chastened.

JGW

Re: Safety at Work - Drugs

Michael Woodhouse — Mon, 20 Sep 2010 22:47:21 GMT

[quote user="Anthony Todd"]

[quote user="Michael Woodhouse"]]I would never work somewhere that restricted clinical decision making in such a draconian way. I aspire to practice ownership and I see no reason to dictate on paper what is best* in the very fluid interaction of vet-pet-owner. [/quote]

You will, sunshine, trust me, you will. After the first wasted £100 tub of something exotic , you will.

[/quote]

I did say in my earlier post:

Re: Safety at Work - Drugs

J G Wray — Mon, 20 Sep 2010 22:44:00 GMT

[quote user="Michael Woodhouse"]I am aware of that and the COSHH regs. What I can't understand is the issue we have here. Most of our drugs are more than capable of causing harm in one way or another. We have drugs that could cause abortion, antibiotics that could induce an allergic reaction. You may all be in big practices with large amounts of every drug you could want or need. Maybe been a small mixed practice that is not a luxury we have. Frequently I order things in because we have either run out, or because it's not normal stock. Some of these things I have not used before. [/quote]

You seem to be unclear of what a COSHH Risk Assessment is for. It is there to formalise an examination of the characteristics of the substance and possible hazards that might be consequent upon its storage and use and then devise safe working practice, sometimes in the form of SOP. If you are ordering product that you have not used before and a member of staff, as here, is injured, who would be responsible and accountable? I only see you.

[quote user="Michael Woodhouse"]

So you see a dog with an unusual but treatable condition. There's either something new, some human generic or something not usually stocked that would treat it. You say to the owner:

[/quote]

Ah, hyperbole. Has it ever ocurred to you that you could do all this? Have you ever considered learning the detail of the exercise?

I detect a reluctance to conform with regulation when it, irritatingly, gets in the way of a clinical issue. This may not be a defence.

[quote user="Michael Woodhouse"]What if the injured person [let's make her a pregnant nurse] had broken some corticosteroid and splashed into her eyes, what if it was Estrumate?[/quote]

[quote user="Michael Woodhouse"]I know we all have to be mindful of health and safety, but we have to take some responsibility on our own shoulders as professionals.[/quote]

Fine words. I take it you mean that my staff member should have been more careful when knocking the phenol off the shelf. I'm pretty sure that's not how these things work.

JGW

Re: Safety at Work - Drugs

Anthony Todd — Mon, 20 Sep 2010 22:37:27 GMT

[quote user="Jonathan Wray"]Phenol[/quote]

Funny how things crop up. AFAIK it comes in 500ml bottles only when annual usage [apart from spillage] is at most 0.5ml among 7 vets

We now have 4 bottles ,at last count, because the others have "expired", yeah "expired" There is an expiry date, would you believe......and the vets "won't use expired drugs".........

We have clinical freedom BUT vets particularly locums often order stuff based on nothing but a whim, often we have supplies at base, often we have the equivalent, often the client doesn't want it 'cos it's too expensive [usually] and always we are left with a large pot of a weird drug that won't get used in a million years..... so run it past me first please.

[quote user="Jonathan Wray"]]I would never work somewhere that restricted clinical decision making in such a draconian way. I aspire to practice ownership and I see no reason to dictate on paper what is best* in the very fluid interaction of vet-pet-owner. [/quote]

You will, sunshine, trust me, you will. After the first wasted £100 tub of something exotic , you will.

Re: Safety at Work - Drugs

Rob Loxley — Mon, 20 Sep 2010 19:28:45 GMT

We order electronically from the practice management system and only a few people have access rights to add drugs, giving good control over 'random' things being introduced. Any new drugs added to the drugs list by those authorised are also flagged up in a system email to the boss.

[quote user="Jonathan Wray"]I have that responsibility in our practice and I have told staff, time and again, that if they want new product, to put the request to me first.[/quote]

Re: Safety at Work - Drugs

Michael Woodhouse — Mon, 20 Sep 2010 17:31:18 GMT

[quote user="Robert Whiteford"]Good for cauterizing corneal ulcers too[/quote]

We have a little in the back of the cupboard for that job - never used it.

[quote user="Jonathan Wray"]Expecting to have unbridled clinical freedom, even as a fully qualified and paid up MRCVS is naive, because your professional responsibilities and accountability extends beyond your patient in front of you. [/quote]

I am aware of that and the COSHH regs. What I can't understand is the issue we have here. Most of our drugs are more than capable of causing harm in one way or another. We have drugs that could cause abortion, antibiotics that could induce an allergic reaction. You may all be in big practices with large amounts of every drug you could want or need. Maybe been a small mixed practice that is not a luxury we have. Frequently I order things in because we have either run out, or because it's not normal stock. Some of these things I have not used before.

So you see a dog with an unusual but treatable condition. There's either something new, some human generic or something not usually stocked that would treat it. You say to the owner:

Take the product in question - assume the phenol is for treating an ulcer. Do I have to go for all the rigmarole or order the phenol and book the dog in for tomorrow and cure it? What if the injured person [let's make her a pregnant nurse] had broken some corticosteroid and splashed into her eyes, what if it was Estrumate?

I know we all have to be mindful of health and safety, but we have to take some responsibility on our own shoulders as professionals.

Re: Safety at Work - Drugs

Robert Whiteford — Mon, 20 Sep 2010 17:08:25 GMT

[quote user="Jonathan Wray"]Phenol[/quote]

Mmmm...phenol...I love it...great smell and good for removing fingerprints (i mean from your fingers!). Also as a dash extra in iodine to make Navel Iodine. Worked well on a couple of farms that had developed bad joint-ill problems in calves. Good for cauterizing corneal ulcers too. Always used with extreme care and not splashed into your own eyes. . . .

Re: Safety at Work - Drugs

Edward Jones — Mon, 20 Sep 2010 17:05:06 GMT

It is possible to keep and use all these things safely and legally, isn't it?

Phenol needs an RA. All medications need COSHH but not necessarily an RA (as far as I know!).

It's silly for an assistant to get medications in without consulting, although in many working atmospheres I've found you're often better off asking for forgiveness instead of permission. Putting up barriers without the staff understanding the reasons will inevitably lead to things happening behind your back.

Re: Safety at Work - Drugs

Michael Woodhouse — Mon, 20 Sep 2010 17:03:27 GMT

[quote user="Gillian Mostyn"]

One of my assistants ordered that in once. I wasn't impressed. But then I also wasn't chuffed when she ordered potassium permanganate - I expected everything to end up pink.......

[/quote]

Things do! :D

Re: Safety at Work - Drugs

Gillian Mostyn — Mon, 20 Sep 2010 16:56:35 GMT

One of my assistants ordered that in once. I wasn't impressed. But then I also wasn't chuffed when she ordered potassium permanganate - I expected everything to end up pink.......

Re: Safety at Work - Drugs

Bob Russell — Mon, 20 Sep 2010 15:41:34 GMT

No we don't thank goodness

Re: Safety at Work - Drugs

Bob Russell — Mon, 20 Sep 2010 15:20:54 GMT

I have a feeling we have a bottle of that at the back of the cupboard. Not nice stuff.

Re: Safety at Work - Drugs

J G Wray — Mon, 20 Sep 2010 15:04:24 GMT

[quote user="Michael Woodhouse"]I think it's a real shame when a Vet's clinical judgement is taken away by a practice handbook or protocol saying I must use drug X in situation Y. If you are employing veterinary surgeons then they should have the clinical freedom to use the treatment they deem most appropriate in the situation.[/quote]

Hmm I can see why you were awarded five stars - who did award you five stars, by the way - speak up?

[quote user="Michael Woodhouse"]I would never work somewhere that restricted clinical decision making in such a draconian way. I aspire to practice ownership and I see no reason to dictate on paper what is best* in the very fluid interaction of vet-pet-owner. [/quote]

Then you are not aware of the significance of COSHH regulations.

I see the use of drugs/substances as a matter of professional judgement, or to put it another way, the remit of a professional. I do not see the use of a drug/substance as being only based on clinical judgement. If you see yourself as a clinician with limited professional responsibilities then I can see how you might sustain your point of view. If you have a broader aspiration to being all the things a profession confers, then responsibility and accountability also have their place.

One of those areas of responsibility and accountability is devising and maintaining a safe working environment for yourself and your colleagues. It's not v sexy. It's bureaucratic. It's restrictive. It gets overlaid with economic considerations and regulation. It might even influence your clinical judgement. Expecting to have unbridled clinical freedom, even as a fully qualified and paid up MRCVS is naive, because your professional responsibilities and accountability extends beyond your patient in front of you.

[quote user="Michael Woodhouse"]What was this evil substance that was spilt?[/quote]

Phenol

JGW

Re: Safety at Work - Drugs

Bob Russell — Mon, 20 Sep 2010 14:14:12 GMT

The issue here is not what drugs are to be prescribed but simply making sure that the required H&S assessment is carried out. If the person in charge of COSHH is unaware that a new drug is on the shelf no assessment can be made.

The legislation is rather over the top for a practice with medically qualified staff but it is there and should be followed as closely as possible to avoid legal problems.

We have chosen not to stock some medication purely because of the H&S issues (eg Griseofulviin) and others are restricted access (eg sedatives, some painkillers).

A practice handbook sets down the rules for new drug assessment not whether that drug is used. This is not IMHO draconian but purely a sensible way of making sure medicines are treated with responsibility.

Re: Safety at Work - Drugs

Michael Woodhouse — Mon, 20 Sep 2010 13:36:59 GMT

I think it's a real shame when a Vet's clinical judgement is taken away by a practice handbook or protocol saying I must use drug X in situation Y. If you are employing veterinary surgeons then they should have the clinical freedom to use the treatment they deem most appropriate in the situation.

There are obvious legal issues here, cascade etc. Obviously would be stupid ordering a different make of a certain drug (maybe you get a better discount from one company over another) but if there is a clinical justification for using something not on the shelf what's the harm?

I was told, very simply, that I could order whatever I wanted - so long as I sold it. The practice didn't want stuff on the shelf going out of date and I can fully sympathise with that. Certain things have been ordered and the whole pot sold to the client - even if we didn't dispense it all [with the client being aware].

I would never work somewhere that restricted clinical decision making in such a draconian way. I aspire to practice ownership and I see no reason to dictate on paper what is best* in the very fluid interaction of vet-pet-owner.

What was this evil substance that was spilt?

Re: Safety at Work - Drugs

Bob Russell — Mon, 20 Sep 2010 13:07:24 GMT

Random inspections of drugs orders and the threat of disciplinary action if a written protocol (ideally in a staff handbook) is not followed, will usually bring people to heel! This only works if you genuinely do these inspections.

I find, however, that if those in charge of the ordering know clearly why these rules are in place they 'self-police'.

I am a sole vet but it is amazing what medicines haver appeared on the shelf on the few occasions I have had a locum in. I have never had issues with the choice of medication but was rather pi**ed off to find boxes of program injection on the shelf after going on holiday for two weeks. I have never been that impressed with the product and definitely not impressed by the price of the two boxes ordered!!!