Treatment of animals by non-VNs

Re: Treatment of animals by non-VNs

Noweia — Mon, 07 Feb 2011 18:39:51 GMT

[quote user="alex gough"]

The VN Standard guidance also sets out examples of medical procedures which should not be delegated by veterinary surgeons to a lay person such as:

Intramuscular injections
Intravenous injections
Introduction of an IV catheter
Passage of a urinary catheter

[/quote]

One would have hoped that guidance on what vets can't do would be in veterinary literature, not VN lit?

Re: Treatment of animals by non-VNs

Alex Gough — Mon, 07 Feb 2011 18:26:47 GMT

Owner's of animals are allowed to perform minor medical treatment to a greater extent to trained lay staff it seems from the rules. I dont think catheterising the dog counts if it is being done by the owner, but if someone did it for their elderly neighbour with parkinson's, then they would presumably be liable for prosecution. Of course that's nothing to do with the RCVS, they don't regulate lay staff.

Alex

Re: Treatment of animals by non-VNs

Peter Ding — Mon, 07 Feb 2011 18:22:33 GMT

[quote]...................................

The VN Standard guidance also sets out examples of medical procedures which should not be delegated by veterinary surgeons to a lay person such as:

· Intramuscular injections

· Intravenous injections

· Introduction of an IV catheter

· Passage of a urinary catheter

..................................

[/quote]

My bold.

If the RCVS uphold that stance then they should be prosecuting Liverpool Veterinary School!

The referral vets there initially trained a client of ours to catheterize his male labrador which had a complete inability to urinate voluntarily and empty his bladder . He had no innervation loss, rather some obscure non-responsive syndrome that failed to respond to all other forms of medical or surgical treatment.

The owner proceeded to empty the dogs bladder 3 times a day for over 7 years by catheterizing him (before other unrelated problems necessitated euthanasia). The dog occasionally developed cystitis but always responded to antibiotics. He tolerated the intervention incredibly well, raising a leg whilst in lateral recumbency to assist! The owner used Milton "sterilization" and boiling water to reduce infection risk but re-used catheters regularly. Lubrication was key. We re-sterilized the catheters whenever he requested it and provided new ones every few months.

After a few months we withdrew the medical treatment because it made no difference, with Liverpool's blessing.

The Royal College's stance is nonsensical unless they insert the word "normally"!

There will always be exceptional circumstances where hard rules should not apply. A modicum of common sense is all that is required.

We provide that.

I think that lay person probably catheterized his dog more times than many vets or nurses do in a whole lifetime!

I admired his dedication, but he said it only took a few minutes each day and was far better than any other option available. The dog had a pretty normal life. He could also tell if his dog was beginning to get a UTI just by the smell of his urine! Our occasional cultures demonstrated that fact.

Re: Treatment of animals by non-VNs

Alex Gough — Mon, 07 Feb 2011 16:23:59 GMT

I was quite impressed with the letter, and also pleased that it seems the rigid interpretation taken by some on this forum isn't the one the RCVS takes.

Alex

Re: Treatment of animals by non-VNs

Bob Russell — Mon, 07 Feb 2011 16:00:41 GMT

I suppose you can argue that the worst thing you are likely to hit s/c is a blood vessel. I/m lots more choice of things to hit! No reason why people cannot be trained to give i/m injections safely and effectively without a VN qualification.

I won't be losing any sleep over it, I am happier with reasonably well defined boundaries!

Re: Treatment of animals by non-VNs

Mark Holmes — Mon, 07 Feb 2011 15:49:44 GMT

Can anyone tell me what the logic is in defining im injections being different to SC injections? Yes - some caution needs to be given wrt to nerves but once you have said "inject here" to somebody, its not a difficult instruction to follow and doesn't need 3 years of study to acheive.

Re: Treatment of animals by non-VNs

Bob Russell — Mon, 07 Feb 2011 15:41:06 GMT

Restarted my breathing! This is actually a pretty good letter so perhaps quite a lot of thought has gone into what can and cannot be done by lay-staff. Quite rightly most of the responsibility is passed onto the treating veterinary surgeon!

Not so sure about the 'well-documented' process! Do I write s/c injection given by X because VN Y was in the loo? This is perhaps documentation gone too far!

Re: Treatment of animals by non-VNs

Alex Gough — Mon, 07 Feb 2011 12:16:18 GMT

I now have the reply from the RCVS. I think it is quite helpful. What do you make of it, and does it change anyone's position?

Alex

Good Afternoon Mr Gough

Thank you for your email. You have asked for advice in relation to lay staff not yet enrolled as student veterinary nurses and the definition of "medical treatment". You are correct in that because your two new staff members are not yet enrolled, they do not meet the definition of "student veterinary nurse" in paragraph 7 of Schedule 3 to the Veterinary Surgeons Act 1966 ('the Act'). Therefore they cannot undertake "any medical treatment or any minor surgery (not involving entry into a body cavity)" and are correctly treated as lay staff.

You are also correct in that "any medical treatment or any minor surgery (not involving entry into a body cavity)" is neither defined in the Act, nor is there a definitive list of medical treatments or minor surgical procedures that can be delegated to non-veterinary surgeons under Schedule 3 to the Act. However the RCVS does provide guidance on Schedule 3 for veterinary nurses and student veterinary nurses on the RCVS website www.rcvs.org.uk which can be accessed by following this link and is also published annually in Section 4 of the List and Register of Veterinary Nurses. This guidance provides in particular:

Veterinary nurses should only carry out medical treatment or minor surgery after considering in each individual case whether they are competent to do so, taking into account their training and experience, the nature of the treatment or procedure and the condition of the patient. The directing veterinary surgeon should take the same matters into account in deciding whether the nurse is qualified to carry out the treatment.

However there is no specific legal dispensation for a veterinary surgeon to delegate anything falling within the definition of 'veterinary surgery' to a lay person employed by a veterinary practice. Therefore the definition of "any medical treatment or any minor surgery (not involving entry into a body cavity)" is not strictly relevant to any decision to delegate a particular task to a member of lay staff in a veterinary practice.

The RCVS provided a restatement of the guidance on Schedule 3 and gave further advice on what unqualified practice staff can do in the August 2010 issue of the VN Standard Newsletter (attached). The relevant advice is on pages 4 and 5. Turning to your specific queries on subcutaneous injections, removing a catheter and administering a tablet directly by mouth (or into food), any delegation to unqualified practice staff would need to be justified and is a matter of professional judgment in any individual case following a risk assessment. The RCVS recognises that in certain circumstances it may not be in the public interest to take regulatory action where:

the delegation to a lay member of practice staff is reasonable
it does not put the animal at risk; and
does not amount to more than minor medical treatment of the sort which an owner could undertake

Paragraph 1 of Schedule 3 provides the exemption that 'minor medical treatment' may be given to an animal by its owner and the RCVS considers that the administration of uncomplicated subcutaneous injections (for example, the treatment of diabetes) falls within this category as well as administering a tablet into the mouth or food. Whether a veterinary surgeon could delegate the removal of a catheter would be a matter for their professional judgment once they have taken account of the circumstances of the individual case and completed a risk assessment.

The RCVS has indicated in the Practice Standards Scheme Manual that lay staff could provide nursing care of in-patients although preferably this should be provided by a veterinary nurse or student veterinary nurse. Similarly the RCVS Advice Note on the maintenance and monitoring of anaesthesia (attached) provides that although the most suitable person to monitor and maintain anaesthesia is a veterinary nurse or, under supervision, a student veterinary nurse, lay staff could assist with these tasks.

The VN Standard guidance also sets out examples of medical procedures which should not be delegated by veterinary surgeons to a lay person such as:

Intramuscular injections
Intravenous injections
Introduction of an IV catheter
Passage of a urinary catheter

You will appreciate that it would be almost impossible to list all the procedures that might be permissible, because the delegation of veterinary procedures, even minor medical treatment, will involve consideration of all the circumstances, not just the procedure itself. The guidance therefore also provides three key factors to be considered when delegating:

The nature of the procedure (or treatment)., i.e. its level of complexity
The individual animal concerned, i.e. species, condition, likelihood of owner's wishes
The qualification of the person being delegated to, i.e. Listed of enrolled student veterinary nurse (or in the case of a minor treatment, a lay person), specific training, experience, confidence, willingness to accept delegation and the availability of someone more qualified to step in if needed

Should a delegation decision become the subject of litigation, or a professional conduct complaint, a court (or an RCVS investigation) would consider the 'reasonableness' of the veterinary surgeon's actions. A clearly reasoned decision, taken having followed a logical and well-documented process, should therefore be behind every delegation of a veterinary surgeon to a non-veterinary surgeon.

I hope you have found this information helpful and if you have any further questions, please do not hesitate to contact me.

Sincerely

Carrie

Re: Treatment of animals by non-VNs

Kate Richardson — Fri, 04 Feb 2011 13:05:58 GMT

[quote user="Bob Russell"]

Jane - if Panorama was unbiased and gave the whole story I am sure the DC would have a field day. However most if not all of us believe it to be an unrepresentative programme. Many practices would have things happen within their walls that would be embarrassing/ or open to misinterpretation if filmed especially if the camera was there for a year!

If the general processes in the practice were acceptable to the PSS then there is a major defence there. The trainee nurse/animal care assistant etc etc situation has been clarified (to some extent) by the President of the RCVS since the programme.

If you feel you are being made a scapegoat let us know! With thousands of members I am sure the opinions expressed here are seen by the powers that be even if they don't admit to it!

Hopefully the PIC will come to a sensible and fair conclusion based on facts not media hysteria!

[/quote]

hear hear

Re: Treatment of animals by non-VNs

Bob Russell — Fri, 04 Feb 2011 11:22:12 GMT

If you feel you are being made a scapegoat let us know! With thousands of members I am sure the opinions expressed here are seen by the powers that be even if they don't admit to it!

Hopefully the PIC will come to a sensible and fair conclusion based on facts not media hysteria!

Re: Treatment of animals by non-VNs

Martin Atkinson — Fri, 04 Feb 2011 10:02:28 GMT

With regard to Jane's situation, we all know that television aims to sensationalise everything, and I don't for one moment condone any form of gross incompetance or unprofessional behaviour, but considering that the undercover nurse was there for so long the amount of 'wrong doing' she uncovered was pretty small and a lot of it was to be honest 'there but for the grace of God go I' stuff. For example we've all had difficult moments trying to place an IV cannula but if as Jane says the same person who was struggling to perform this task has successfully completed it several times before, Panorama would choose not to show that because it didn't fit with the remit of their programme. On the general theme of this thread and particularly for Wynn's attention, I've already stated that I don't presently employ any qualified VNs and that I was previously a training practice that had success in turning out competant qualified nurses. I don't presently employ a VN because I couldn't get one to fill my vacancy so what do I do - shut up shop because there's no-one to help me out other than perfectly competant nursing assistants I've been training for several years or do I multi-task and perform every minor task myself to the detriment of others that require my full professional committment? We don't live in an ideal world, a bit of common sense and give and take is needed not dogma.

Re: Treatment of animals by non-VNs

Heather Toft — Fri, 04 Feb 2011 02:30:18 GMT

[quote user="Jane Dunnett"]

And again! Jeez you're a hard bunch

[/quote]

Wasn't me!!

I don't know you, but from your posts on here I think it would be a terrible loss to the profession if you were made the latest scapegoat for the corperates. Sounds like you didn't intentionally direct some-one who wasn't a SVN to perform a task they shouldn't have been doing. Hopefully the PIC willl take this into account.

Re: Treatment of animals by non-VNs

jd2008 — Fri, 04 Feb 2011 02:07:34 GMT

And again! Jeez you're a hard bunch

By the way, I chose not to post anonymously (despite Bob's invitation/suggestion) because:

1) It's not my style

2) I believe in owning up and facing up to one's mistakes and accepting the consequences.

3) I'm genuinely appreciative of the opinion of my peers - positive or negative.

4) I don't believe one can ever be truly anonymous on the internet.

Fire away!

Jane

Re: Treatment of animals by non-VNs

jd2008 — Fri, 04 Feb 2011 00:02:51 GMT

Oi! who gave the fact I've go a PIC investigation ongoing and am potentially about to lose my career 5 stars?

Re: Treatment of animals by non-VNs

jd2008 — Thu, 03 Feb 2011 23:18:53 GMT

[quote user="Bob Russell"]

Anyone facing such action out there? Perhaps post under anon and see what reaction you get. All the talking in the world will change very little after the event.

It is possible to change the rules but much easier to change opinions before the rules get changed.

I genuinely feel the VMD are now respecting the views of vets more rather than riding roughshod over us as seemed to be the case not long ago. A good example being the extended 'POM' category.

I accept that the petition I started regarding cascade has not changed the world but I do think the presence of over 350 signatures including some 'big' names may have given some food for thought! We are not a profession of rebels but with improvements in 'real-time' communication between groups of vet (such as this forum) it is much easier to get opinions heard.

Perhaps the DC need to feel that they are a little more accountable to the profession as a whole.

[/quote]

Cast your mind back to the Panorama programme last year.

Following that I have been accused of allowing an assistant nurse who was not currently enrolled at college to attempt to place an iv catheter in a dog (if anyone remembers it was the red setter about to undergo a tie-back) Extending from this the accusation is that the dog was caused unnecessary suffering.

I probably shouldn't give any further details at this stage save to say that the nurse assistant in question was under my supervision but I was not "standing over her" at the time and she had placed iv catheters successfully and under my direct supervision on many occasions previously. We had many,many trainee nurses rotating through the group at Medivet and I was not aware that this nurse assistant had missed the college enrolment date. My error. I have admitted my error and apologised in my reply to the PIC. Wynne has aready made her views on the matter clear to me in a private message via this site.

Bob - you asked in the Albring thread whether the RCVS has any impact on one's ability to register in another country. They do. I emigrated to Australia just a few weeks after Panorama aired. At that point I had a spotless record and was able to register with the Vet Board of Victoria havng received my certificate of good standing from the RCVS.

When I applied to re-register with the board in December I declared the PIC investigation currently underway.

The Victorian vet board have written to the RCVS on 2 occasions now requesting further information but the RCVS have not deigned to reply.

If they do not reply in the very near future I will not be able to renew my registration and will hence be unable to work.

Re: Treatment of animals by non-VNs

Bob Russell — Thu, 03 Feb 2011 15:40:17 GMT

Years ago many practices were training practices. It was straight forward and not much of a burden. The pass rate was very low (I seem to remember between 45-50%) and this seemed to upset the powers that be. The system was given a major overhaul which removed many practices because of the bureaucracy and associated costs.

What was ignored was the fact that quite a number of student nurses remained in their practices and continued to perform their existing duties albeit without the VN (or RANA as it was when I was qualifying) title.

We would consider ourselves far too small to give a fully 'rounded' education because of our case load. With some cooperation from other practices, however, we possibly could.

There are a lot of small practices out there that are able to spend time and put a lot of effort into training. It is a good exercise in learning for all involved.

Re: Treatment of animals by non-VNs

Gillian Mostyn — Thu, 03 Feb 2011 15:18:43 GMT

There is also a big discrepancy because we have 'ideal' and then we have 'realistic'. In an ideal world the training system should be so straight forward and common that a non-VN working in a practice would be unknown. However, as it is at present, where many (most?) practices choose not to undertake VN training, there are just not enough VNs to fill the vacancies. IMO the new training system does seem more straightforward, so hopefully things will improve. However, while there are vets out there, as has already been said in this forum, who don't worry about whether their assistants are qualified or not and therefore don't encourage formal training, then the problem of unqualified staff being as good as qualified staff is not going to go away. Wouldn't it be nice if every VN was qualified and then this problem wouldn't exist?

[quote user="Hannah Wynne Richards"]Perfectly simple if they're not enrolled with RCVS, then only allow them todo kennel maid/man duties.I can't understand why it's only those who wish to challenge the rules pretend they don't understand them[/quote]

Wynne - you obviously believe all nurses should be qualified and wouldn't employ someone for a nursing role unless they were. Thus you only have 2 tiers in your practice - kennel maid or veterinary nurse. Am I correct?

If so, that makes life very easy for you as the rules for VNs are more clear - it is non-qualified vns where the rules get really hazy.

I assume you are a training practice then? Because to decide to only employ VNs, but not take any part in actually helping to train them.....

Re: Treatment of animals by non-VNs

Hannah Wynne Richards — Thu, 03 Feb 2011 13:56:46 GMT

There's also a lot of veterinary surgeons-probably most of us who signed the petition for "veterinary nurse " to be a protected title who would sign a petition for Scedule 3 procedures to be strictly limited to VNs and (enrolled with RCVS )SVNs-let alone all the VNs who have taken the trouble to qualify

Wynne

Re: Treatment of animals by non-VNs

Bob Russell — Thu, 03 Feb 2011 13:28:36 GMT

Anyone facing such action out there? Perhaps post under anon and see what reaction you get. All the talking in the world will change very little after the event.

It is possible to change the rules but much easier to change opinions before the rules get changed.

I genuinely feel the VMD are now respecting the views of vets more rather than riding roughshod over us as seemed to be the case not long ago. A good example being the extended 'POM' category.

Perhaps the DC need to feel that they are a little more accountable to the profession as a whole.

Re: Treatment of animals by non-VNs

Mark Holmes — Thu, 03 Feb 2011 12:54:05 GMT

[quote user="Martin Atkinson"]

[quote user="Mark Holmes"]

I wonder if something like this is very straight forward. If a reasonable body of veterinary surgeons defined what they considered to be acceptable and were prepared to stand together, I cannot see the RCVS being prepared to act against a body of 30-40 members. Would they suspend/strike off that many at once? I suspect they would suffer from testicular hypoplasia.

[/quote]

When some poor soul is dragged up before the RCVS it is not until the procedures are complete that the rest of the profession gets to hear about it which is a bit late. Furthermore, the evidence is against the individual not equally and severally, they are not going to prosecute en-masse 30-40 members as there is no direct evidence against them. Plus, when the time comes would this same 30-40 put up their hands and be counted, and if they did what action could they take? Picket Belgravia House, go on strike? Sounds like a cue for the vets union to be aired again.

[/quote]

I just wondered, if an individual is investigated by the RCVS and were to turn to the profession at large and say "what do you think" and a body of the profession contacted DC saying "if you discipline him you really should us" what the outcome would be?

Re: Treatment of animals by non-VNs

Martin Atkinson — Thu, 03 Feb 2011 12:46:05 GMT

[quote user="Mark Holmes"]

[/quote]

Re: Treatment of animals by non-VNs

Mark Holmes — Thu, 03 Feb 2011 12:03:15 GMT

Re: Treatment of animals by non-VNs

Martin Atkinson — Thu, 03 Feb 2011 11:15:12 GMT

[quote user="Bob Russell"]

I have seen poorly trained RVN's and well trained and experienced 'nursing assistants', I know which I would trust most to know their limitations. I have also thank goodness known and employed a number of first class qualified VN's that I would trust totally!

[/quote]

Absolutely, many of the nursing assistants I have trained have been far more competant than some trained VNs. Indeed I've had one who became president of the BVNA and said that the skills she learned with me as a school leaver still stand her in good stead. However where I would leave a VN alone to make some decisions I would not leave a non-qualified assistant to do so however competant I thought she/he was.

Re: Treatment of animals by non-VNs

Bob Russell — Thu, 03 Feb 2011 11:06:46 GMT

I have just started to hold my breath! We shall see if the RCVS can give a sensible answer before I suffocate!

My staff work pretty well to the guidance given in the talk by the President of the RCVS and I will use it in my defence should the matter arise!

Re: Treatment of animals by non-VNs

Alex Gough — Thu, 03 Feb 2011 11:00:30 GMT

I've sent this email to the RCVS. Will let you know what they say;

Dear sir, I wonder if you could provide some guidance. An issue has arisen in our practice where we have two new student VNs. However, as they can't enrol on their courses till September, I understand they must be treated as lay staff rather than SVNs, and so cannot perform medical treatment. The issue arises because it seems from a debate on a veterinary forum that it is unclear what consitutes medical treatment, and the advice on the RCVS website is also unclear, in that it states medical treatment is not defined in the Veterinary Surgeons Act, and it would be up to the courts to decide.

I had considered that acts such as placing iv catheters, taking blood samples and administering iv injections were restricted to vets, vet students, VNs and SVNs, but I am unclear whether the same should also apply to situations such as giving a subcutaneous injection, removing a catheter, administering a tablet directly by mouth, or even administering a tablet into food.

Would you be able to clarify the situation?

Thank you in advance