rvn's giving booster vaccines

Re: rvn's giving booster vaccines

Cat Henstridge — Mon, 07 Feb 2011 17:53:25 GMT

[quote user="Clive Ansell"]I have also worked for a (bad) low cost clinic that operated the "safari" system. I found it was all about cramming as many through as possible in the shortest possible time, there certainly was not enough time to take a history, carry out a full and thorough clinical examination, and then discuss any findings. Appointments were booked every 5 minutes, plus walk-ins and extras. I don't believe any of us can do a thorough job in less than 10 minutes, certainly not less than 5.[/quote]

This system worked well for me and in this clinic. There was no appointment system so clients understood if things were busy and they had to wait but I never felt under particular pressure (but I am quite laid back in general!) In particular they seemed pleased to speak to someone in detail about their pet and , because this effort had been made and things were explained properly to them, they were happy to buy diets and preventative medicine as advised.

I suppose any way of doing things will only work well if you have enough time and rescources.

[quote user="Clive Ansell"]I don't see the logic of a VN or ACA doing a healthy check, for the vet to then do it again ????[/quote]

Of course I would always do my own health check but it was beneficial for the nurses to do one, they got to practice and learn new skills and there is no better way of being able to identify abnormalities than looking at lots of normals!

Re: rvn's giving booster vaccines

Peter Ding — Mon, 07 Feb 2011 16:57:58 GMT

By their very nature any vaccination certificate with stickers on it, is not a Veterinary Certificate.

There is also inadequate animal identification unless the pet is chipped or tattooed etc. So Veterinary Certification rules do not apply.

No vet should technically sign a vaccination card if they think they are providing Veterinary Certification unless the animal is clearly uniquely identifiable and they should not use stickers or rely upon previous "sticker evidence".

Most vaccination cards break several rules of certification. Fulfilling those rules would require a certificate much more akin to a horse vaccination certificate,

A vet's signature is only required on a vaccination card because the owner expects it and it is traditional for us to sign them.

If a VN signs it and clearly indicates that fact it is up to the owner and anyone who relies on that vaccination card as whether they accept it as proof of vaccination.

I think the future has clearly been highlighted on this thread..........whether we like it or not.

Re: rvn's giving booster vaccines

Clive Ansell — Mon, 07 Feb 2011 16:56:36 GMT

[quote user="Cat Henstridge"]

I worked for a while in a (good) low cost clinic which ran a 'safari' system for routine boosters where 2 nurses ( or even just in-house trained ACAs) would call the animal in, do a health check, ask the owners if they had any concerns, discuss fleas/worms/diet ect, draw up the vaccine and then the vet, who worked between the two rooms, would come in, do a proper health check (which doesn't take long in a healthy animal), answer any questions, give the booster and sign the card.

The system worked well, people didn't have to wait long, had a chance to have a proper chat with the girls about the health care of their pet and got to see a vet as well. I saw more people go home with worm/flea treatment, vet diets ect from that clinic than I have anywhere else and it was simply because someone had the time to discuss things properly with them (and it was quite cheap!)

Maybe your friend the nurse should discuss this sort of option with her vet?

Cat

[/quote]

I have also worked for a (bad) low cost clinic that operated the "safari" system. I found it was all about cramming as many through as possible in the shortest possible time, there certainly was not enough time to take a history, carry out a full and thorough clinical examination, and then discuss any findings. Appointments were booked every 5 minutes, plus walk-ins and extras. I don't believe any of us can do a thorough job in less than 10 minutes, certainly not less than 5.

As a comparison; I had an private appointment with an NHS consultant dermatologist where a full history, exam and discussion took 40 minutes.

I don't see the logic of a VN or ACA doing a healthy check, for the vet to then do it again ????

Re: rvn's giving booster vaccines

Clive Ansell — Mon, 07 Feb 2011 16:26:21 GMT

[quote user="Hannah Wynne Richards"]

Clive How did you get around the problem that you can't sign unless you've done the vaccination-and the nurse can't sign ?

Wynne

[/quote]

The VN's used to sign the certificates if they gave the vaccines. The last time I worked there was 2007, and I was told their system had been discussed and accepted by the RCVS. I sometimes sign a vaccine certificate where the vaccine was given by a colleague, but the owner had forgotten it at the time, as long as it is logged in the medical notes. .

Re: rvn's giving booster vaccines

Cat Henstridge — Mon, 07 Feb 2011 15:17:14 GMT

Hi Malcolm,

In this situation the owner had been fully questioned by the nurses, who were good at their job, so any potential problems at usually been uncovered.

I am confident I can do a thorougher health check in a pet; eyes, ears, teeth, gums, chest, abdomen, legs, ect, ( I rarely do temperatures unless I am concerned, it only annoys the animal) in a couple of minutes and pick up on any issues but surely one of the most helpful pieces of information about a pet's health comes from the owners themselves?

Cat

Re: rvn's giving booster vaccines

Malcolm Ness — Mon, 07 Feb 2011 14:57:35 GMT

[quote user="Cat Henstridge"] would come in, do a proper health check (which doesn't take long in a healthy animal), [/quote]

...............but how does the vet know it is a healthy animal (and therefore needing only the health check that doesn't take long) until a full health check (which takes rather longer) has been done.????

Re: rvn's giving booster vaccines

Hannah Wynne Richards — Mon, 07 Feb 2011 09:51:54 GMT

Clive How did you get around the problem that you can't sign unless you've done the vaccination-and the nurse can't sign ?

Mark I would agree nurses are there to complement-not replace us My nurse knows far more than I do about diets, and also behaviour, as she is also a qualified behaviourist-so if advice is needed on 1 of those subjects-the owners and animal are booked in for a nurse consult It is a seperate and different profession

Wynne

Re: rvn's giving booster vaccines

Cat Henstridge — Mon, 07 Feb 2011 09:24:39 GMT

Maybe your friend the nurse should discuss this sort of option with her vet?

Cat

Re: rvn's giving booster vaccines

Vet2Vet — Sun, 06 Feb 2011 17:55:53 GMT

[quote user="Alan Tevendale"]

The last time my girlfriend went to the doctor the examination that she recieved totalled only a brief palpation of submandibular LNs - nothing else. This wasn't for vaccination either - she was unwell.

[/quote] I would say this is standard across the country , but our patients can't speak for themselves . Although , GPs don't do any better for infants or toddlers in my experience.

Re: rvn's giving booster vaccines

Alan Tevendale — Sun, 06 Feb 2011 14:58:58 GMT

Re: rvn's giving booster vaccines

Mark Hedberg — Sun, 06 Feb 2011 12:56:48 GMT

I've had a full physical. Not from a nurse. Not pleasant.

Re: rvn's giving booster vaccines

Michael Woodhouse — Sun, 06 Feb 2011 12:20:31 GMT

[quote user="robloxley"]Should one anecdote of poor practice be used to justify anything?[/quote]

No. Anyone EVER been to the nurse for a vaccine and had a full physical examination? I don't go to the doctor very often but I am sure I have never had one in my life.

Re: rvn's giving booster vaccines

Rob Loxley — Sun, 06 Feb 2011 10:48:46 GMT

[quote user="Michael Woodhouse"]As has been said before, when I last had a tetanus vaccine I was jabbed by a nurse and was in the room less than 3 minutes. Was never asked if I was well. Sat down, little small talk and all done.[/quote]

Should one anecdote of poor practice be used to justify anything?

Re: rvn's giving booster vaccines

Michael Woodhouse — Sat, 05 Feb 2011 23:06:37 GMT

The VMD have just 'taken' Leptavoid/Spirovac and Rotavec from vets to the trade. I have no doubt in my mind that pet vaccines will lose their POM-V status at some point in the [not too distant] future. The POM-VPS vaccines still state in their data sheets to only vaccinate healthy animals.

The VMD don't care how important vaccines are to your income. As has been said before, when I last had a tetanus vaccine I was jabbed by a nurse and was in the room less than 3 minutes. Was never asked if I was well. Sat down, little small talk and all done.

Re: rvn's giving booster vaccines

Mark Hedberg — Sat, 05 Feb 2011 16:11:56 GMT

[quote user="Kate Richardson"]

No offense taken. I am happy to discuss diet and dental care if needs be, but often the consultation gets taken up by discussions on other aspects of health care which I am more qualified to speak about than my nurses. By the nurses taking over on discussions on dental care and diet for example, which they are informed about by us vets, they are totally and 100% complementing my care. Of course I remain involved, I'm usually the one who points out the fact to them that their pet is overweight or needs to start teeth brushing, but I simply don't have the time to spend half an hour discussing diet, weight loss, routine home dental care and ways to manage these things, but the nurses do, and they enjoy it and the clients enjoy the fact that they get even more time to dicsuss 'their' pet with someone. I cant possibly know or remember everything in all its detail, so using individuals who 'specialise' for want of a better word is a good thing and is a good way of making the client feel that everyone at the practice cares about their pet, surely that's a good thing?

[/quote]

Fair do's, sound like a good system. It just sounded from your first post that clients were getting 'foisted off' on the nurses from certain points of view. (My words, not yours.) If the clients understand it is a complementary system it's a great way of doing things. It's just that some things that go without saying, aren't said at all.

It sounds like a good 'hook' for clients if well done. :)

Re: rvn's giving booster vaccines

Rob Loxley — Sat, 05 Feb 2011 15:39:24 GMT

[quote user="Clive Ansell"]It was a well organised practice and clients and patients were given the choice of seeing a vet or a VN (cheaper) for a booster vaccine providing certain criteria were met[/quote]

They are however pushing the boundaries of 'under your care' for POMs though if not seen by a vet for years, given the GTPC says animals should have been seen by a vet "recently enough or often enough for the veterinary surgeon to have personal knowledge of the condition of the animal or current health status of the herd or flock to make a diagnosis and prescribe"; the points on nurse vaccinations in the President's notes from the London Vet Show (http://www.rcvs.org.uk/Shared_ASP_Files/UploadedFiles/rcvs/3E8E0071-CC8F-43EC-B1ED-BA8D152801B1_lvs_presentation.pdf) as well as RCVS guidance note 11 and the Privy Council decision on the RCVS findings in the Macleod case appeal.

Re: rvn's giving booster vaccines

Kate Richardson — Sat, 05 Feb 2011 15:21:25 GMT

Re: rvn's giving booster vaccines

Mark Hedberg — Sat, 05 Feb 2011 14:24:53 GMT

[quote user="Kate Richardson"]

That's really interesting. I agree about nurses being better at discussing diet etc, too be honest it bores me, as I suspect it does many vets; I will discuss it, but no where near in as much detail as some of our nurses would, and I usually advise booking in to see the nurse in one of their clinics to discuss dental care, weight loss etc anyway. I think giving the clients the choice of a vet or nurse appointment for a vaccination is actually a really good idea. I'd rather be doing my job of treating sick animals to be honest and I trust my nurses to be strict about directing clients for vet attention when necessary. However its not my call as I'm not the boss!

[/quote]

That's interesting; but as vets isn't one of our prime aims effective communication? It may bore you, but it's what they want to hear, and if they don't feel you're involved in your case then they may just go elsewhere. And if clients can't ask us about their pet's health, exactly who are they supposed to ask?

No offense, but nurses are there to be a complement to your care, not take care of things you don't feel like doing.

Re: rvn's giving booster vaccines

Tanya Fielding — Sat, 05 Feb 2011 13:39:55 GMT

I am still not sure why a vet is needed to vaccinate a dog but my child was vaccinated by a nurse or health visitor. Once again animals seem to get better care and the NHS cuts costs. Has anyone seen a doctor for travel jabs or any vaccinations?

Re: rvn's giving booster vaccines

Kate Richardson — Sat, 05 Feb 2011 12:49:36 GMT

Re: rvn's giving booster vaccines

Clive Ansell — Sat, 05 Feb 2011 12:34:47 GMT

Kate - there were a few, but not very many, cases where people would book the cheaper VN appointment and when they arrived there were obvious clinical problems, or they would say "I don't want to see a vet, but can you look at his ear, eye, leg, pancreas etc" Always a firm no I'm afraid, any clinical problem at all. or if the VN was not happy, then an appointment with a vet was compulsory. They were strict with their criteria, and I think were successful at maintaining clinical standards while at the same time lowering costs.

I think this practice found a good way of reducing overheads to stay in business without going down the stack um high do um cheap option.

interestingly, some of the clients remarked they they preferred to see a VN for a booster vacc; they would spend more time discussing weight, diet, fleas etc etc, which many vets are not interested in and skip over. There VN appointments were 15 minutes.

Which is the better standard of clinical and client care; 5 minutes (or often less) in a filthy over booked low cost clinic seeing locum (not me I hasten to add) vet of the day, or 15 minutes with an experienced VN in a good well established practice offering a good standard with good vet back up as needed? .

Re: rvn's giving booster vaccines

Kate Richardson — Sat, 05 Feb 2011 11:31:58 GMT

Clive, that sounds very reasonable. I wouldn't personally have a problem especially with the guidelines/criteria they had.

Out of interest, were there many cases where the owners declared the animal was healthy, in order to book the cheaper option, but when the animal arrived it obviously wasn't or had signs of problems, say an elderly dog with signs of arthritis or had lost weight. If that did occur, how did the VNs deal with it, especially if the owners didn't perceive there was a problem and just wanted the vaccination done?

Re: rvn's giving booster vaccines

Clive Ansell — Sat, 05 Feb 2011 10:39:23 GMT

I once did a 3 - 4 month locum for a practice where VN's/RVN's routinely give booster vaccinations. It was well structured and worked very well, and was started initially for financial reasons as a response to the opening of a local low cost clinic affecting business. Because it worked so well they carried on with it. They had 4 good and experienced VN's who were very thorough.

It was a well organised practice and clients and patients were given the choice of seeing a vet or a VN (cheaper) for a booster vaccine providing certain criteria were met; Reception staff were well trained and would ask basic health questions (any problems? eating and drinking normally? any wt loss?) when booking appointments

1) patients must have been seen before at the practice by a vet, any new clients therefore must see a vet.

2) patients must be under 10 years of age.

3) patients must be otherwise healthy, if owners were worried about anything they would have to see a vet.

4) All puppies and kittens for first vaccines would be examined by a vet

5) VN's would get a basic history and perform basic health check (TPR etc) if anything was noted (pyrexia, bad ear, recent wt loss or pu/pd etc) a vet would have to be seen.

6) patients on on ongoing medications could see a VN if authorised by a vet, but would usually see a vet for a medication check.

7) a veterinary surgeon would have to be on the premises.

Re: rvn's giving booster vaccines

Hannah Wynne Richards — Sat, 05 Feb 2011 09:52:06 GMT

Don't push the boundaries of the Gto PC (or even more importantly-the law ) and risk being the test case

Wynne

Re: rvn's giving booster vaccines

Edward Jones — Sat, 05 Feb 2011 09:08:15 GMT

In direct response to the original issue and the question that I don't think we know the answer to yet is: Would the nurse be at risk from disciplinary action for administering a POM knowing that the animal had not been examined sufficiently to bring the animal 'under the care' of the veterinary surgeon?

In response to the question of whether a nurse could be trained (or already has sufficient training) to do a general health check, then I think almost certainly yes. But that would require a change to the Guide.