Practice Manual - Oak Barn Vets · Orthopaedic emergencies are not suitable however. (Emergencies to NFR or Anderson Abercrombie). Mark also specialises in perianal surgery (fistulas,

Practice

Manual

SEPT 2018

Oak Barn Vets Practice Manual

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Use of Practice Manual

This manual is intended as a point of reference for all Oak Barn Veterinary Centre LLP employees. All veterinary

surgeons should be familiar with its entire contents, but the information is also intended for everybody to be able to

use. The Partners welcome any suggestions for further inclusions.

Please take the time to read it thoroughly, to ensure that you are familiar with practice policy on the different areas

included here. We wish to give our clients continuity and consistency of information.

Mission Statement

Through traditional service and understanding we aim to provide the ultimate Veterinary experience. With the most

modern facilities, in a caring environment, we offer to look after client’s pets as if they were our own.

Vision Statement

Traditional Values, Modern Practice.

Page

Use of the OBVC Practice Manual 1

Practice Location and Information 2

OBVC Services 3

OBVC Benefits 6

Vaccination Protocol 9

Pet Travel Scheme (PETS) 12

Protocols 13

OBV Day Procedure 19

Roles and Responsibilities for nurses 20

Reception Roles and Responsibilities 23

Consultations 25

Pricing Tips 25

Surgical Charges 27

Hospitalisation and OOH

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Contents

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Practice Location and Information.

Oak Barn Vets, Tilehouse Barn, East Shalford Lane,

Guildford, Surrey, GU4 8AE.

Telephone 01483 455355

Fax 01483 326518

www.oakbarnvets.com email [email protected]

Opening Hours 8am – 7pm Weekdays and 9am – 12 noon Saturdays.

15 minute Veterinary Consultations by appointment only.

Emergencies at any time throughout the day.

House visits available too.

Nurse Consultations by appointment.

The Seahorse Pub

http://www.oakbarnvets.com/

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OBVC Services

We are an exclusively Small Animal veterinary practice, looking after dogs, cats, rabbits/guinea pigs and small pets

including chickens! We provide preventative healthcare and advice, full medical, surgical and dental facilities with

fully separate hospitalisation and intensive care therapy, and full dispensing capabilities.

We are well equipped to diagnose almost all conditions with the most up to date digital x-ray (including dental x-ray

facilities), ultrasound and excellent in house laboratory facilities. We offer laparoscopy (keyhole) surgery and

endoscopy procedures, this gives our patients the benefit of minimally invasive surgical procedures (like neutering)

with reduced discomfort and shortened recovery times.

In addition, we have the benefit of visiting veterinary specialists and can deal with most problems in house, resulting

in less stress for the patient concerned.

Many procedures (i.e. in house blood testing) can be performed whilst the owner waits in our large waiting room.

There is separate seating to allow dogs and cats/small pets the space they need to decrease any anxiety and blankets

are provided to cover over any pets in baskets that might get scared.

We are lucky enough to have ample free parking and a large waiting room. Clients can enjoy free refreshments whilst

they wait for their pet, they can browse the retail area or read a magazine and children are welcome. From our

patients point of view they can wait with their owner, thus reducing their stress.

NEW CLIENTS New clients are accepted wholeheartedly. Any prospective client ringing for information should be informed of all

our services, not just the cost of the vaccination – for example. Every effort should be made to engage the client and

register them at the time of the call. It is especially important to register their email and mobile numbers (please check

spellings) as we send most practice communications (ie booster reminders/newsletters) via email/SMS.

For new clients with animals previously registered elsewhere, it is essential to take the previous practice details and

request a clinical history from this practice BEFORE (whenever possible) the client is seen. This is part of the RCVS

professional conduct so must be followed. New clients are sent a Welcome Pack, including practice information and a

price list – if the client has an email address this is emailed to them straight away or given to the client at the time of

their first appointment.

TELEPHONE ADVICE Any client that phones for advice should be made an appointment. The RCVS dictates that telephone advice renders

the pet under our care and if there are complications (i.e. diarrhoea advice of starving/bland food but the pet dies

because it has Parvo) we are held responsible. If the client declines an appointment this must be recorded on their

records.

PAYMENT All clients are expected to pay at the time of consultation, unless any previous agreement has been arranged (see

below). Under no circumstances should retail items be sold without advance payment. We do not allow credit, even

though some clients seem to expect it. We do not accept cheques, unless a client has settled an account by post.

All members of staff should be familiar with how to take payment, use the PDQ machine and pay off outstanding

balances. Clients should be informed of all costs as procedures are being performed (e.g. primary vaccinations,

injections or blood tests such as; Convenia, Thyroid profiles, and any medical or surgical work-ups). Estimates should

be created if necessary.

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Estimates are easily generated on the Jupiter system and can be saved and printed on the clients records. On the Add

Treatment page, book the imaginary treatment and then the second top left – Save as Estimate. New clients expected

to have invoices over £500 (e.g. OOH RTA) are requested to pay £500 initially, and subsequently as required to avoid

large bills at the end of treatment.

PUPPY PLAY LUNCH Puppy play lunches are held at noon every other Saturday lunchtime after morning surgery. These are intended to

allow puppies to learn how to socialise with other pups their own age. It is not to teach them how to sit etc. During

these sessions we can advise regarding puppy health, proactive general care and tips for their pup growing up to be

happy and healthy.

INSURANCE All insured clients are still expected to pay for treatment as it is performed, and then claim back from the

insurers.

Insurance forms should be filled out & signed by the client – INCLUDING:

Condition to be claimed for

Dates of treatment

Signature where ever appropriate – some forms require a second signature on the back of the

form – please check while the client is still present!

The form is then placed in the insurance tray in the office for completion and sent directly to the insurance

company. A copy of which is scanned and kept on the animals records.

We try not to do direct claims wherever possible. However, if the claim is over £500 it would be considered.

The claim form must be with us at the time of the procedure. Depending on the procedure often we will

arrange for a pre-authorisation from the company concerned. This involves considerable paperwork and

time and as such there is a charge for this (under Direct Claim). Please ensure clients are informed of this

charge as often their insurance companies will not cover it.

Instruction on completing an Insurance Form from Jupiter

Into Animals History

Tick in the insurance column boxes related to claim

Right click mouse, click insurance then Print and then file – Print = this will print an itemized invoice for the

claim

Exit

Right click Insurance then Save

An Insurance claim number will be allocated to that claim, it will appear in the clinical history ‘Ins No’

To make adjustments to the claim e.g. select/de-select items or re-print

Click Insurance then Select range – insert Insurance Number and adjust as necessary. Re-saving will allocate a

different Ins. No.

Write in the Clinical Notes :-

Insurance Claim Number, Name of Insurance Co, Policy Number, Condition for claim, Dates of claim and the

Amount(s) e.g. Insurance Claim 7, Petplan Policy number 123456789, Hyperthyroidism, 01/01/10 -01/02/10 £100.01

Make the clinical notes in Red by adding a * at the beginning of the notes

Complete the Insurance form by signing and attaching the printed invoice and return to Karen who will finish

completing by adding the practice stamp, scan and post – this process should be completed within 5 working

days of the form arriving at Oak Barn Vets.

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CONDOLENCE CARDS We encourage vets to write and send a condolence card to every client who loses a pet. It is the one thing that we can

do to make a real difference at this very sad time. These cards are located in the second drawer in Andrew’s desk in

the office. Please make a note in the animal’s clinical records when this has been done.

QUALIFIED STAFF

We are lucky enough to have the ability to invite specialists from other hospitals to come to Oak Barn and perform

procedures beyond the scope of a normal practitioner. These include –

Mark Pertwee – Certificate Holder in Orthopaedics and Soft Tissue Surgery. Will perform fracture repair,

stifle and joint surgery and investigations including TPLO. Orthopaedic emergencies are not suitable

however. (Emergencies to NFR or Anderson Abercrombie). Mark also specialises in perianal surgery (fistulas,

anal gland resection etc.) and other soft tissue surgeries.

Kate Alvis – Ophthalmic Surgeon. Kate is a Certificate holder and can perform most specialist eye surgeries

and assessments in house.

Rachel Perry – Perry Dental Vet. Dental specialist who will perform restorative treatments in juvenile pets

and white fillings, maxofacial surgery etc.

Elise Robertson – The Feline Vet - Feline medicine specialist but also has a keen interest in scoping and can

perform a variety of endoscopic procedures including oesophagoscopy, gastroduodenoscopy, rigid

anterograde rhinoscopy, flexible retrograde rhinoscopy, flexible bronchoscopy, otoendoscopy, cystoscopy,

vaginoscopy, and colonoscopy in small animals in house.

Andrew Ketteridge – Laparoscopic/keyhole surgery – referral Lap Spays

SECOND OPINIONS This is a formal procedure, different to a client switching vets permanently for whatever reason. Second opinion

clients are referred back to the original vet after the consultation unless the client subsequently decides they would

like to have the treatment with us. In order for the Vet to be able to offer a second opinion, a full clinical history

MUST have been received prior to the consultation. The Veterinary surgeon MUST then return clinical notes to the

original practice, if agreed by the client.

It is important when booking a Second opinion appointment to find out if the client wants this, or is looking to switch

practices.

REFERRALS We refer clients to specialists if we are unable to offer a certain treatment ourselves. This is a formal procedure which

is arranged by the Vet not the client. A referral letter should be written to partnership the clinical history, and any

diagnostic information such as x-rays which are e-mailed to the referral centre, prior to their appointment. There is a

charge for the work involved in arranging a referral ‘Referral Fee’.

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OBVC Benefits

Oak Barn Veterinary Centre offers:-

Enjoyable and unrushed 15-minutes consultations – 30 minutes for Puppies and Kittens. Most other vets only

give you between 5 and 10 minutes of their time. We endeavour to see the client the same day and in case of

an emergency, then and there.

We are a tier 2 accredited RCVS practice standard centre. This is a scheme where the practice is rated by a

strict examination by the Royal College of Veterinary Surgeons. Tier 2 is the highest standard a General

Practice can achieve. Above this are Hospitals and Specialised centres. It indicates that we provide the best

facilities to enable us to look after pets as best as possible.

We have a practice team of highly skilled & experienced, dedicated & professional staff who care greatly

about the client’s pets’ health and well-being

We all undergo regular on-going training, in compliance with the Royal college of Veterinary Surgeons

(RCVS) guidelines.

We have Vets who specialise or have special interests in many fields, including diagnostic imaging;

orthopaedic surgery, ear nose and throat surgery, and ophthalmology. Our clients can be assured that if their

pet does fall ill or becomes injured that we can offer them the best chance of a speedy recovery.

We employ fully qualified registered Veterinary Nurses who undergo a rigorous training program to qualify.

We are also a registered Training Practice for Student VN’s who undergo three years of training before

gaining their diploma.

We offer regular nurse clinics including: nutrition and weight management; puppy and kitten development;

diabetes management; rabbit husbandry, and dentistry & oral healthcare

We provide a dedicated specialised out of hours service. This is located in Guildford 4 miles away, through

Vets Now. Much as clients may feel slightly nervous about seeing a new face in the unlikely event of an

emergency out of hours, this has the advantage that they are not waking up their vet who has already worked

a long day and would not be able to provide the best level of care, in the middle of the night. They can be

confident that the Vets and Nurses they see have been trained especially for emergencies and are up

throughout the night to take care of their pet. This allows the day staff to be equally able to give 100% during

routine hours.

We charge all our services according to a structured and often time-related, price plan and – unlike most vets

- do not offer lost leaders to try and entice our clients to join our practice

We are proud of our facilities and equipment, including:

Separate Dog and Cat wards, hugely reducing stress

In house laboratory for rapid sample analysis, but also courier access to an external laboratory for more

complex tests, we have daily collections available with next day results.

The most advanced digital X-ray, Hospital standard Ultrasound, ECG, blood pressure monitoring &

ophthalmic equipment.

We send out regular reminder and information updates by mail, email and SMS and also send a quarterly

newsletter. We also have a facebook, Google+, Linked in, pInterest, instagram and twitter page.

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We have an excellent web site full of free information for clients. They are welcome to add their pets

photos by emailing the practice (these will be included on the waiting room TV as well)

Existing and New clients will often price shop when looking for a new practice, but this obviously doesn’t always

provide a complete picture of the services and skills that we offer at Oak Barn Veterinary Centre and that we are so

proud to offer. If ever questioned with regards to prices, it is important to explain fully the service that the client will

receive from OBVC. It is also the best opportunity to take client details, or make a booking, rather than expect them to

call us back. Clients are important to us. We are always more than happy to give a free pre-operative estimate at a

complimentary consultation for something more complicated (ie a dental procedure). Price lists and practice

information are always available for posting or email.

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VACCINATION PROTOCOLS

Vaccinations are an important part of our work load. The vaccination appointment is not just an injection, but a full

health check and opportunity to discuss potential ailments, therefore the client should be informed of this service.

Vets should be familiar and aim to discuss all the points below at the first vaccine, and touch on all parts again at the

second vaccine as there is a lot of information which often isn’t absorbed all in one go. A complimentary puppy,

kitten or rabbit pack should also be given at the time of the appointment which includes supplementary information

on these details.

PRIMARY VACCINATIONS:

Our primary vaccination for puppies and kittens consists of the following, in accordance with manufacturers’

recommendations and best policy practice recommended by the World Small Animal Veterinary Association.

DOGS:

Two appointments:

1st: 30minutes, at least 6 weeks old, followed after 4 weeks by:

2nd: 15minutes, must be at least 10 weeks old

We use Nobivac vaccinations (DHP / L4 / KC)

For at risk puppies who are late starting their vaccines or need to socialise as quickly as possible we can fast track

their vaccinations by giving the DHP component of the vaccination just two weeks apart (with walks allowed a week

after the second). HOWEVER these pups are not fully protected against leptospirosis and must not be allowed to

swim or play in areas frequented by rats until after their second L4 vaccine which is given 4 weeks after the first. The

owners must be made aware of this and if confusion is likely to be created then stick to the 4 week interval between

just two injections.

CATS:

Two appointments:

1st: 30minutes, at least 9 weeks old, followed after 3-4 weeks by:

2nd: 15minutes,

We use Nobivac Tricat Trio / DuCat + FeLV vaccinations.

RABBITS: One appointment. At least 5 weeks old. We use a combination Rabbit vaccine that protects against

Myxomatosis and RHD1 in one. This has the added benefit of lasting a year, is cheaper than the older alternative and

much less stress is involved having only one visit (compared to 3 before).

There is now also a RHD2 vaccine – we are recommending all rabbits receive this vaccine due to local outbreaks of

this fatal disease in East Horsley. It needs to be given two weeks apart from the combo Myxi/RHD1 vaccine and lasts

for a year.

FERRETS: Please refer to the veterinary surgeon.

Each vaccination is chargeable as an individual item, although we encourage the take up of the following (this has the

advantage to the client that they only pay for what they need)

Vaccination, as above. We are able to give Kennel Cough Vaccinations at the same time as the second

vaccination and strongly recommend this to all clients. Please discuss KC vacs at both vaccinations.

Microchipping – with the option of a Biotherm temperature microchip

A Flea (+ lungworm in dogs) treatment (Advocate) – we sell individual pipettes for rapidly growing animals

and recommend a monthly weight and worm session until pets are six months of age. This has the advantage

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that the puppy becomes accustomed to visits to the Vets without fear and gives the client peace of mind that

they are growing normally (it also means they do not waste money buying products the puppy will quickly

grow out of).

For pets who prefer not to use spot on applications we also offer monthly Milbemycin worming and

BravectoTM tablets given quarterly to offer maximum parasite protection depending on the lifestyle of the

pet.

Dietary advice including a puppy/kitten/rabbit pack with food samples, toys and information

Worming advice including Lungworm- this is very common in this area.

Insurance advice and 4 weeks free insurance with PET PLAN, without commitment (IVC – see below)

Neutering, Dental, Training advice.

Free monthly nurse health checks

Puppy Play Lunches to help socialise the pups, held every two weeks at Saturday lunchtime.

Our nurse puppy and kitten checks, at no extra charge, include

Monthly weight checks and dietary advice

Advocate application or tableting as needed – clients can purchase just what they need as their pup is

growing thus saving money and cutting out waste as the pup grows.

Worming checks and administration if needed.

Dental checks and advice about Teething and teeth cleaning

Ear cleaning and plucking

Flea/Parasite advice

Training advice

ANNUAL VACCINATIONS (INCLUDING RABBITS AT ANY AGE)

Comprehensive Vaccine Service designed to provide the best preventative healthcare for life of your Dogs, Cats &

Rabbits:

A full “head-to-tail” clinical examination

Vaccination given & health certificate completed

Dietary advice

Flea advice

Worming advice

Dental advice

Body condition advice with weight check

Insurance advice

Microchipping advice.

WHAT WE VACCINATE AGAINST:

DOGS:

We use Nobivac vaccinations, comprising of the following:

FULL: Distemper; Parvovirus; Infectious Hepatitis (Adenovirus Type 2); Leptospirosis (- 4 strains). +/- KC

vaccination. The Leptospirosis (= Weill’s disease) is the safest and most up to date vaccination worldwide. It

protects against 4 strains of Leptospirosis compared to the old L2 vaccine which only covers two. With many

dogs going abroad now L3 and L4 are becoming a problem in the UK. We can offer L2 or L4 vaccine

depending on clients preferences and the lifestyle of the dog.

INTERMEDIATE: Leptospirosis (L4) +/- KC vaccination

We do not vaccinate against all diseases every year to avoid over vaccinating. Dogs will receive an intermediate

vaccination for 2 years then a full vaccine every third year.

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Kennel Cough (some may refer to as Infectious Bronchitis)

We recommend that all dogs but especially puppies have this vaccination, and can be given as part of the primary

vaccine course at 12 weeks of age. Kennel Cough/Infectious bronchitis is a highly contagious respiratory disease

which can cause a nasty cough for several weeks. Puppies are particularly at risk as they tend to do a lot of socializing

at a young age. Whilst they are coughing they are contagious and cannot go out for walks – this can last for an

extended period (ie 4-6 weeks)

This vaccine is licenced for use at the same time as other Nobivac vaccines and lasts for 12 months. It is important to

warn owners that the vaccine is modified yearly to give pets the best protection but if there is a mutation in the

Bordatella bacteria responsible then dogs may still contract a mild strain of the disease despite being vaccinated.

However they will recover quickly (within a couple of days) and most do not feel ill at all. Protection is achieved

within 72hours of intranasal administration – only 0.4mls (one vial) required in one nostril.

It is worthwhile remembering this is a LIVE vaccine and dogs may shed Bordatella for 48hrs after inoculation. It

should not be given to immunocompromised animals (ie on Chemotherapy) or if they are on antibiotics.

Other canine vaccines that we offer depending on the pets lifestyle include a Lymes Vaccination and Leishmaniasis

vaccination – best discussed with the veterinary surgeon if these are needed.

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CATS:

We use Nobivac Tricat Trio, DuCat and Nobivac FeLV

Core vaccinations include Feline Herpes and Calici virus – responsible for ‘Cat Flu’ and Feline infectious enteritis. We

also recommend Feline Leukaemia vaccination for any cat that will be going outside. FIE is only required every third

year, starting from year 2, as below:

RABBITS:

In Guildford we are unfortunately surrounded by a large population of wild rabbits who carry Myxomatosis. Pet

rabbits do not need to come into contact with them as the disease is carried by the rabbit flea which can easily live on

cats, birds and other wildlife. They do not need to be in contact with other rabbits to contract this life threatening

disease.

We use a combo Nobivac Myxo RHD1 vaccine. It lasts 12 months and is injected subcutaneously (no intradermal

required). Rabbits must be over 5 weeks age and are given yearly boosters. Not only does this protect against

myxomatosis but also against a viral form of haemorrhagic diarrhoea which is fatal in rabbits.

There is now also a RHD2 vaccine – we are recommending all rabbits receive this vaccine due to local outbreaks of

this fatal disease in East Horsley. It needs to be given two weeks apart from the combo Myxi/RHD1 vaccine and lasts

for a year.

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6 – 8 WEEKS

+4 WEEKS

YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5

NOBIVAC DHP

NOBIVAC LEPTO 4

NOBIVAC KC

OAK BARN DOG VACCINATION PROTOCOL

Recommendation

This protocol should be read in conjunction with the relevant product data sheets.

Nobivac DHP is a live attenuated vaccine containing canine distemper virus, canine adenovirus 2 and canine parvovirus, Legal Category POM-V Nobivac L4 is an inactivated, bacterial vaccine containing the following inactivated Leptospira strains: L. interrogans serogroup Canicola serovar Portland-vere (strain Ca-12-000), L. interrogans serogroup Icterohaemorrhagiae serovar Copenhageni (strain lc-02-001), L interrogans serogroup Australis serovar Bratislava (strain As-05-073), L kirschneri serogroup Grippotyphosa serovar Dadas (strain Gr-01-005). Legal Category POM-V Nobivac KC is a live attenuated vaccine containing bordetella bronchiseptica and canine parainfluenza virus. Legal Category POM-V

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PET TRAVEL SCHEME (PETS) AND

RABIES VACCINATION

Clients wishing to travel abroad with their pet can do so if they have a valid pet passport – to participating countries

(most EU members and those listed on the APHA animal health website.). Travel to countries not part of PETS should

be referred to a Vet and APHA. The scheme can be started from 12 weeks of age, but usually after the animal has

completed its primary vaccination course. A client wishing to have a pet passport should make an appointment with

a vet.

At Oak Barn Vets we have a vast experience in exporting pets but each country is different and it would be sensible

for an owner to come and speak to one of the vets well in advance of any travel plans they have. This is not only to

arrange the correct paperwork and vaccinations but to discuss parasite control depending on their destination.

The basic requirements for PETS has been simplified from 1st Jan 2012:

A microchip, to be inserted before the vaccination.

Rabies vaccination Nobivac Rabies: This is a 3 year licenced vaccine given SC or IM. The animal cannot travel for 21

days from the date of vaccination. The pet must be over 12 weeks of age to qualify for the PETS Scheme. A Blood

sample is no longer required for pets returning to the UK from January 2012

A Passport to be issued and stamped by an LVI

The animal has to fulfil re-entry requirements – i.e. visiting a vet between 5 days and 24hrs BEFORE they are due

to return to the UK for tapeworm treatment.

Vets – it is essential the microchip is scanned before any rabies vaccination and checked with computer records.

This needs to be recorded on the animal’s record (Microchip checked).

The process now takes only approximately 1 month to set up due to lack of serology testing. However

clients need to consider tick/parasite control before they depart for their holidays too.

Nobivac Rabies is licensed for 3 years. It can be given with other Nobivac vaccines, although we ideally recommend a

2 week interval especially in juvenile animals.

Clients must be told that they must not overrun the vaccination valid until date in the passport, otherwise it will

become invalid. They are also responsible for their own rabies vaccination, and should not rely on our reminder

service, although we do send out reminders.

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PROTOCOLS

PARASITE CONTROL.

At the Barn we offer a free bespoke parasite control system tailored to each individual pets needs. Many

clients are confused about types of parasites (fleas/ticks/roundworm/tapeworm/lungworm etc) and what

they need to do to protect their pets and their family. We have an option for them to subscribe to a

monthly direct debit in which all their parasite control costs are spread over a 12 month period – clients

who use this service are entitled to visit the practice for a free nurse clinic on a quarterly basis to have their

pet treated accordingly.

WORMING (INCLUDING LUNGWORM IN DOGS):

It is essential to discuss worming at puppy and kitten checks, but also annual vaccinations. Worms can not only cause

direct intestinal issues, but lung worm can cause potentially fatal disease and some worms can cause human health

issues.

Puppies and Kittens:

Panacur Paste at first and second vaccination – 3 day course each time: to treat intestinal worms and giardia.

Even if puppies have been wormed at their breeders they may well have reinfected themselves whilst

suckling from their mothers.

Advocate at first vaccination (unless <1kg) or <7 weeks Dogs, <9 weeks Cats and then monthly thereafter –

can be sold individually for rapidly growing animals. For puppies we recommend free monthly weight

checks until six months of age to enable accurate dosing, save money and allow the pup to become

accustomed to coming to the Vets without always needing an injection. (Advocate puppy composite charge

on Voyager.). This has the benefit of continually protecting against roundworms (human health issues) and

lungworm.

Bravecto – For puppies and kittens. Need to be 12 weeks old and given for their current weight size – can be

repeated in 8 weeks rather than 12 weeks for very rapidly growing large breed pups. Ideal for puppies who

pick up ticks, clients who have young children/don’t like spot ons. Currently if the client purchases the first

Bravecto treatment the second is free of charge at six months of age. Again we offer free monthly puppy

checks to help socialise the pup at the vets.

Tapeworm (Prazitel) from 6 months onwards every three months, or every six months if using Advocate

monthly. If using Bravecto quarterly for tick and flea protection then use Milquantel for tape/round and

lungworm protection monthly).

Profender (topical wormer) is an alternative tapeworm treatment for cats that can’t be given tablets. Bravecto

Plus is now available for cats as a single combo worming/external parasite spot on, used on a quarterly basis. If using

Profender, you must leave a week’s interval if a topical flea application such as Advocate/Frontline has been

given. It is very important that multicat households should not allow other cats to groom each other when

spot ons have been used.

Adults:

Advocate&Prazitel or Bravecto&Milbemycin as standard. This can be altered on a case by case basis. For

example owner preference, prone to ticks, allergic to spot ons etc. We offer free nurse clinics for

application/tableting for all our parasite control.

If collars are tolerated a cost effective solution for prevention of fleas/ticks is the Serresto Collar. These pets

will still need appropriate worming treatment though. The collars last for 8 months and are safe to swim in.

They can be used in combination with Advocate. They are tick repellents as well as killing ticks and fleas.

If advocate is used every month then Tapeworming is only required every six months. In this case a

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Tapeworm Six Month Reminder needs to be booked on the card to activate a six rather than three month

reminder.

If Bravecto is used then worming control needs to be given using milbemycin either monthly for at risk

lungworm dogs, quarterly for hunting cats and most dogs or 6 monthly for retirees/low risk/indoor pets.

Depending on the patient we can create a bespoke parasite prevention program for each pet.

Clients should be made aware that no product offers 100% protection for lungworm in dogs or Ticks in dogs and cats.

FLEA TREATMENT:

Advocate is used for all cats and dogs as the first line product as this is also used for lungworm prevention.

Alternative treatments include Advantix for dogs, Advantage for Dogs, Cats and rabbits (non POM), and Effipro

(frontline) (non-POM) which are available if requested. An alternative spot on is available for Dogs with dermodex –

discuss with the Vet (Promeris Duo or Bravecto).

Bravecto – an oral tablet for dogs that prevents fleas and kills ticks in dogs and spot on cats. This lasts for three

months and can be used in conjunction with monthly milbemax for lungworm protection. Bravecto also comes in a

combo wormer for cats called Bravecto Plus. A Bravecto spot on for dogs is also available for dogs who are not easy

to tablet.

Program– This is an injection that we can use in cats, one injection gives 6 months protection. However this does not

kill fleas but only prevents the breeding life cycle so is not good for flea allergies.

Rabbits - Rabbits may be dispensed Advantage Spot On for fleas. Rabbits do not suffer from the normal roundworm

burdens but they can suffer from a protozoal parasite called E. cuniculi. We recommend Panacur Rabbit to prevent

this 2-4 times a year depending on the risks.

The majority of these products listed are Prescription Only Medicines or POM’s for short. By law the patient must be

registered under our care and must have been examined by a vet within the preceding 12 months. However

Advantage Spot On can be sold over the counter to non-registered pets quite legally – it contains a different chemical to

frontline so often works well if clients have been struggling with flea control. It is always a good idea to recommend

a client treats the environment for fleas too as the bulk of the lifecycle of the flea lives off the pet – Acclaim

Household Spray protects for 12 months and also can be sold over the counter.

For pets that need a POM parasite product we offer free of charge examinations with a Vet (under Free Flea Check) to

legally cover our requirements.

With all spot ons please ensure the client is aware that the pet should not be able to lick the product off (watch for

multi pet households) and to take care with leather/delicate upholstery until the product is dry.

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ENVIRONMENTAL CONTROL OF FLEAS

A large proportion of the flea life cycle is within the home environment rather than on the animal, so treating this is

essential if owners have an infestation. We recommend Indorex to be used if they have allergic pets or a current

infestation. Routine use of advocate though will treat the house too rendering household sprays a thing of the past if

there is not an infestation or allergic pet.

TICKS

Some pets are especially prone to attracting ticks in the summer months. When the tick bites to feed the pet is at risk

of contracting various tick bite diseases (ie Lyme’s Disease). Effipro and Frontline only kill the tick after it has bitten –

thus not protecting the pet.

For dogs we can use either

Seresto Collars - These collars have the advantage that advocate can be used at the same time giving

continual lungworm protection without confusion over when to apply topicals. The collars are safe to swim

in and last for 8 months (ie the Tick Season). They also work out cheaper than using additional topicals and

are most importantly Tick Repellents as well as killing the ticks.

Advantix – FOR DOGS ONLY CAN BE FATALLY TOXIC TO CATS. Advantix is a topical spot on that we

only recommend in certain cases if the dog is travelling abroad as it protects against biting flies too. It cannot

be applied at the same time as advocate – 2 week gap required. Again it is a tick repellent in addition to

killing them. A pipette needs to be applied monthly for tick protection and it must be applied at least a week

prior to travelling abroad.

Bravecto – this is a tablet for dogs or a spot on for cats, that will kill ticks after they have bitten for up to three

months. Research shows that although the tick needs to bite to be killed by the product the parasite is dead

before it has time to transmit disease such as Lymes Disease. However for pets travelling abroad we would

recommend further tick repellence products such as Advantix for dogs only, Serresto or Scalibor collars

depending on where they are travelling to.

Frontline/Effipro – we do not recommend their use as they only kill ticks after they have bitten.

In cats the choices are

Bravecto – this is a three monthly spot on that kills ticks and fleas continuously. Research has shown that the

ticks are dead before they have time to transmit diseases.

Seresto Collars – these are safe to use in cats and are designed to snap or stretch if caught on a tree etc. They

repel ticks as well as killing them and again last 8 months.

Frontline/Effipro – again not recommended as only kills ticks once they have bitten. However for cats that

will not tolerate collars this is your only other choice at present.

DISPENSING OF FLEA / WORMING TREATMENT

New staff must have dispensing training. Some flea and worm products are POM-V. A POM product can be

dispensed if the animal has been seen within a year, GSL products (i.e. Advantage, Effipro) can be dispensed without

the pet being seen or even registered at the practice. Animal weight should be up to date.

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WEIGHING ANIMALS:

Every visit should see the pet being weight checked. Dog scales are in reception, cat/small pet scales are in

the Consult room.

Weigh each animal during every examination and save in pet details.

Body Condition Score all animals (1-5 as below)

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DIETARY ADVICE

We recommend the Hill Vet Essentials or Science plan, and prescription ranges. These foods offer the best in animal

nutrition, combining closed formulas (identical ingredients with every batch) and traceable ingredients and only

grade A standard meat. Hills may be perceived as an expensive option, but if broken down into cost per day of

feeding, it is comparable to many supermarket brands.

Puppies and Kittens should be encouraged to try the free sample in the packs provided. Hills have the advantage of

100% money back guarantee in the unlikely event the pet will not eat it. If this occurs the owner needs to return the

item to us and they are immediately credited the amount on their records. Hills are then contacted directly to credit

us normally with replacement stock FOC.

However for pets who do not like Hills we have access to several other different makes and can shop around and

arrange next day delivery where needed. We can order individual alternative diets if requested by the owner, and

frequently stock a range of Renal diets. We have the advantage of next day delivery on any foods so long as the

Wholesaler has them in stock.

DENTAL CARE AND HYGIENE

Options to discuss, in order of effectiveness include

Teeth cleaning with a brush and Petdent toothpaste, daily.

Hills t/d, vet essentials range – good for cats

Microfibre tooth cleaner – impregnated with silver, antibacterial.

Oral wipes – Hexarinse and cotton wool, daily

Dental Kongs and Chews (ie Stag Bars, Veggie Dent, Chewdles)

Plaque off – a seaweed based algae that inhibits tartar production and is added to food.

Recommending G/A Dental descale +/- extraction & polishing if required. We offer a reduced set price for half an

hours anaesthetic time and just a descale and polish. This is to encourage clients to act before extractions are required.

We are more than happy to give a free dental check-up with the vet to give an estimate of treatment potentially

required. It is often difficult to be 100% accurate with dental procedures as often it is not always clear if an extraction

is required until the teeth have been cleaned under anaesthetic.

We offer free Dental Nurse Clinic examinations where we can advise and teach clients how to brush their pets teeth.

Any pet who undergoes a dental procedure should routinely then be checked every 3-6 months thereafter.

NEUTERING We recommend all cats; dogs and rabbits should be neutered for the following reasons:

Responsible ownership to prevent unwanted pregnancies

To prevent medical conditions, such as mammary cancer; uterine infections (pyometra); testicular cancer and

prostatic problems. Spaying before a first season removes the risk of mammary tumours.

To avoid behavioural problems such as straying and aggression

To reduce fighting between litter mates (especially rabbits)

We have the advantage of offering Key Hole surgery to dogs and cats for neutering giving the advantage of very

quick recovery times (usually 48hrs) and no sutures!

Advised Ages: All Dogs, Cats at 6 months (for Giant Breed Dogs we recommend waiting to neuter until they are

skeletally mature) Rabbits over 16 weeks – preferably heavier than 2kg. Other animals – refer to vet. For older

animals Bitches should be spayed 3 months after any season (i.e. mid cycle). Cats/Rabbits – cycles do not matter. If

owners are considering using laparoscopy to spay their bitches via keyhole surgery then the timing of the operation is not so

important.

SEPT 2018


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Male dogs with behavioural problems (ie aggression) may not improve with castration. There is an implant available

that can temporarily castrate a dog for six months. After six months his fertility will return to normal. This is

advisable to see if castration will help. If the implant does not improve his behaviour then castrating him will not

help.

All animals are to be booked in with a Vet for a pre-neuter check within a month of the planned operation date, and

advise all animals have at least 1 advocate treatment prior to surgery to remove the risk of bleeding due to lungworm.

If the pet has not been examined by a vet within a week of the surgery then a pre op appointment and check over

should be scheduled on that day.

MICROCHIPPING – this is compulsory in all dogs since 2016. We recommend all pets are Microchipped. There are two types of microchip

Biotherm Microchip, includes a thermometer, read by scanning

Tracer – a basic microchip

It is best in an ideal world not to microchip a pet at the same time as a vaccination. The use of emla cream, sterilising

the area with surgical spirit and having a nurse assist holding the pet is vital. The owner if they wish to be present

should be encouraged to offer lots of treats as the chip is placed.

REPEAT PRESCRIPTIONS AND FOOD ORDERS We ask that our clients give 24 hours’ notice of their requirements. As a small practice it is difficult to keep all types of

food and medication in stock. We are lucky enough to have next day delivery from our supplier at no extra cost to the

client. So long as the client informs us before 6.30pm, an item (which is in stock at the wholesaler) will be with us by

11.30am the next day.

Repeat medication prescriptions can only be fulfilled if the animal is currently under our veterinary care, which

according to the Royal College of Veterinary Surgeons means that the animal has been examined and re-assessed

within the preceding 3-6 months by a vet regarding the problem for which the drug is being prescribed. For flea and

worming POM preparations the animal needs to have been seen within the preceding 12 months by a vet.

We recommend 3 monthly prescription checks on all meds, unless otherwise agreed. There is a separate 3 monthly

check fee on computer. For POM-V flea products and wormers we offer a free of charge check-up.

Repeat Prescription/Food Order Protocol

Any medication requests should be directed to the Veterinary surgeon who should assess the patients records

and if agreeable the item should be booked and a label produced.

Any food order should equally be booked on the clients record and a label produced.

The label is then given to reception so they can order it from the Wholesaler and on arrival attach the label to

the item.

The client should be informed that their prescription is ready for collection once it arrives.

OFF LICENCE CONSENT

It is important that all vets adhere to the VMD / RCVS Cascade when prescribing drugs, and it is the responsibility of

the individual vet to adhere to this. When prescribing off licence drugs, informed and written consent must be

obtained.

The VDS has provided forms for this purpose and they can be found under Consent form in the pets record. For

exotics including small pets a lifelong form can be used. For dogs, cats and to some extent rabbits a single consent

form per product should be used. Items requiring off licence consent are indicated as such on the medications list in

Voyager when a label is produced.

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On collection of any medication the staff member dispensing should

discuss the labelled instructions on the product and confirm that the

owner is happy to give it and understands what they are doing.

It is essential to check the product and the label correspond to the

computer records – often fridge items are forgotten!!!

INSURANCE We recommend pet insurance per se but only display and give advice on Petplan policies due to FSA regulations –

you must become familiar with their policies and give no advice whatsoever with respect to any other pet insurance,

otherwise you will be breaking the law. Simply inform a client that they should contact the particular company for

further information.

Petplan offer * Cover for life Rather than excluding conditions after 1 year)

* Are the most consistent at settling claims

* Tend to offer higher policy limits

PETPLAN IVC (IMMEDIATE VETERINARY COVER)

A Petplan cover note should be offered to all clients at their first vaccination, or to any animal uninsured under a year.

It provides instant protection for 4 weeks, without any commitment financially.

For older animals we have vouchers available for internet/telephone set up with Pet Plan.

Pet Plan also have a breakdown of types of policy – found in reception – which is helpful for allowing clients to

recognise what they are getting with a particular type of policy. (ie difference between a lifelong policy and a set limit

policy)

All staff should perform Petplan online training – discuss with Karen/Louise.

SEPT 2018


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OAK BARN VETERINARY CENTRE

DAY PROCEDURE

Enter via office, alarm off.

Check items have been collected from Idexx box (envelope would still be sticking out of the door).

Retrieve Key for downstairs from desk.

Lights and Fans on in main barn.

Unlock toilet door. Take till/float and keys out to reception.

Check reception phone for any answerphone messages.

Unlock front & NVS doors and switch lights on in display cupboards.

Replace water in dog bowl outside, weigh scales turned on.

Start-up computers x2 reception & consulting rooms.

Check Consult room is stocked up and tidy ready for consulting.

Check @hello @prescription @registration. Inform Vet/nurse of any arrivals especially histories/lab

reports/referral info etc. Especially important to check if any Vets Now emails and inform duty nurse.

Any post? Frank and ensure postman takes today.

Ops/Procedures from previous day to have a call back to check on progress – VN to do but check done if they

are busy.

Open up kennels, lights on, unlock back door.

NVS order - deliver to kennels door, check off on delivery sheet, and ensure food bags are clean and not

damaged. Pre-ordered medication/food will have a label to attach to product (pot on front desk). Phone

client to advise has arrived and ready for collection. Any damaged/missing stock/returns need to be relayed

to NVS the SAME day and let Louise/Karen know.

After morning consults hoover and use rotawash to clean reception and consult rooms. Once a week

reception and consulting room shelves etc. should be wiped thoroughly. Ensure all stock in reception is

priced correctly, clean and in date.

Check afternoon consults see if anything needs to be got ready.

RECEPTION - check reminders (monthly), missed appointments (day before), banking, fridge temps &

debtors weekly, weigh dogs and welcome clients as they arrive, record dogs weight on records.,

NURSES – stock, call backs from ops previous day and messages.

Hand over with any patients for the evening if finishing early shift.

Make sure consult rooms are ready for evening consults.

Check the following morning consults see if anything needs to be got ready.

End of consults sweep and mop in front of desk and consulting rooms.

Empty bins including consult and kennels – especially isolation which often gets forgotten. Switch of cabinet

lights.

Dog bowl emptied and brought inside, turn dog scales off.

Send NVS order before 8pm. Nurse in charge of medical stock, Reception covers all retail stock found in

reception.

Lock front door & NVS door – ENSURE CONSULT ROOM AND KENNEL DOORS ARE LOCKED TOO!

Cash up put till/float in the toilet, daily takings in appropriate envelope with detailed cash sheet in safe and

any keys in DD cupboard.

Check answer machine is on.

Double check all windows are locked and that autoclave machine and tumble dryer are turned off.

Lock toilet door and check theatre door. Make sure all heating lights and fans are turned off. Key back in

desk. Please ensure all internal doors are shut so they do not inadvertently set the alarm off.

Dishwasher is put on

Take Idexx Lab supplies outside to Lock Box.

Shut Office internal door and put toilet key in draw.

Lights and computers off alarm on and exit via office. Large glass of wine…..

SEPT 2018


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ROLES AND RESPONSIBILITIES FOR NURSES

Assist on reception 8:00 –9.00 if on the early shift – if already admitting animals please carry a walkie phone.

Set up for the day.

Make follow up calls from ops the previous day and any other follow up calls marked in the diary – liaise with reception

regarding any Vets Now emails.

Check in-patients. Clean out kennels and take dogs out to the garden, whenever possible – minimum every two hours.

If possible perform a TPR and check the animal’s weight. If the animal is fractious then wait for the vet to help. Ideally

patients should have a TPR twice daily – first morning check and repeat 3-4pm.

Remove catheter bandage, flush intravenous catheter, checking patency and is comfortable, hep flush.

Write up activities and observations on the hospital sheet. Administer any medications as directed by the vet. If needing

assistance await help.

Update all notes on computer including animals weight

Monitor IVFT. Medicate and feed in-patients, according to the vet’s instructions

If possible, help calculate pre-meds for day patients, give as appropriate

Bring any complications to the vet’s attention as soon as possible

Prepare kennels with warm, dry bedding and heat pads for patients that are undergoing surgery

Monitor animals on recovery from surgery (TPR, colour, CRT, op site) Report any complications immediately to the vet,

including information about pain scoring

Complete the laundry for the day (Wash bedding and towels). Drapes should be soaked if bloody in cold water then

washed.

Clean the kits and other surgery equipment when op’s finished

Wipe down the surfaces in kennels

Admit patients for day surgery- normally this is done by a vet but if it is busy -

Confirm owner and animals details, check contact phone number for the day (mobiles/home and email address)

Weigh patient and update records on computer, check animal has been starved overnight and perform TPR wherever

possible

Check owner is clear about procedure and has been given estimate. Go through consent form: anaesthetic risks, pre-op

bloods, IVFT, microchip and ask owner to indicate payment method- circle method, sign and date the form.

Book a discharge appointment which will be confirmed when the vet calls following surgery

Transfer the animal to a kennel on a lead or in a basket.

DO NOT CARRY CATS LOOSE IN ARMS THROUGH THE HOSPITAL AREA. Use one of the practice baskets if

you are worried about the owners’ carrier security.

Set up theatre

Ensure oxygen cylinders are connected, turned on and the reserve is full. Is the correct anaesthetic circuit on the machines

as required

Ensure scavenging is attached

Prepare ET tubes, laryngoscope, drapes, kits, gowns, gloves and any other surgical equipment required for the procedures

of the day

Place a grey vet bed on the theatre table and a heating mat underneath.

Check clippers are clean

Assess the ops for the day – discuss order of events with the Vet and arrange kits as required in the trays in the trolley

table in theatre.

Prepare Patient

Liaise with the vet as to the order of the procedures with regards taking blood samples and giving pre-meds. Preclip legs

(small and neat) and apply emla and small dressing prior to IV cannula placement.

Collect blood samples as required and place i/v cannulas.

Ideally where possible run bloods – all animals having a general anaesthetic will undergo a mandatory PABS

Calculate pre-meds and check with vet dose rates & when to give

Assist vet with induction and maintenance of anaesthesia during procedure

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Recovery of Patient

Once the animal has had its ET tube removed transport back to kennels (seek help if the animal is heavy or awkward to

carry)

TPR the animal and record results on anaesthetic form.

Monitor closely including assessment of IVFT rates, complications that may occur, post op analgesia etc.

Do not leave the patient alone until they are able to lift their head and have an active swallow reflex. More patients are

lost in recovery than at any other time.

Cleaning

Clean and tidy away all equipment used (use Trigene 1:200 dilution)

Place rubbish in appropriate bins

Place drapes and kits for washing

Clean down table and all surfaces, including windows, doors and walls in theatre with Trigene

Clean down Prep, Dental and X-Ray

Empty bins

Check and refill Isoflurane vaporizers

Restock shelves as required

Hoover and mop floors

Ward Round

Attend ward round at 2.30pm for up-dates on in-patients to be discharged by evening Staff.

Inform evening staff of any changes to discharge times

Double check times for post-op checks and animals medications to go home with

Discharging patients

This should always be done in the Consulting Room or Dental – never in reception. If possible do without the animal

present so the owner has your full attention and can arrange payment and booking of post op appointments without an

excited pet to see them!

Talk owner through the post-op form, any medications, specific problems they might see or need to look out for and when

to next bring their pet in for post-op checks. Book appointments as required.

Only allow the owner to see the patient first if they are being particularly noisy causing the owners concern.

Allow the owner to ask any questions, confirm they have paid – if not direct them to reception to pay whilst you collect

the animal from kennels

Aim to do ops discharges before the end of the shift. If this is not possible due to clients’ needs, hand over to another staff

member with full details of the discharge.

NURSE CONSULTS

Nurse consults in Acorn,

Perform banking duties after last client has left and paid

Print off daily cash sheet in full

Do banking on credit card machine

Put both together in to plastic envelope and place in safe.

Check message is correct and answer machine is working at 7:00pm

Prepare hospital sheets for the following day

Saturday

Reception duties as weekdays, including post op phone calls.

Check washing and autoclaving is up to date – set Ethylene oxide autoclave if needed and you have undergone the

appropriate training – this runs all weekend as the cycle takes 24 hours and is noisy!

Empty all bins – REMEMBER ISOLATION!! Check fridges for anything smelly.

Set dishwasher

Ensure answer machine is on at 12 Noon.

SEPT 2018


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RECEPTION ROLES AND RESPONSIBILITIES

REMINDERS The majority of these now are done automatically by iRecall – these include vaccinations, not just annual

boosters but rabies, kennel cough, lymes disease etc.

This automated system works on emails and mobile phone details which is why it is vital to record these

details correctly. If you are registering a new client and it is very busy get these two details first and a post

code – The Post Office Website on line can easily get you the rest of their address!

For the few clients who do not have email we will still send out written reminders.

For weight checks, medication check, heart, thyroid etc checks these need to be done by hand on a monthly

basis. There are pre written invitations within reception email to message these clients directly.

MISSED APPOINTMENTS

From the day before call owners and rebook, leave a message if not in. This is important as they may think

they have another appointment on a different day!

BANKING

Weekly – normally on a Monday. Ensure we have enough change!

Check cash against day sheets in safe

Fill out banking book; check LK has no hidden cheques! Bank Lloyds TSB in Cranleigh (GU6 8BD – 15 miles round trip) or Guildford (GU1 3AG – go via Warwick’s

Bench Road - 5 miles round trip) of Godalming.

POST Use franking machine in office. Ensure date is correct on envelopes. This post can only go on that day

indicated.

Post man (Paul) will take with him.

If already missed post man then take to any post office who will accept. DO NOT POST INTO REGULAR

POST BOX.

DEBTORS

Do weekly (Mondays)

Generate list and print. Discuss with LK.

Cross off staff, hospital and anyone who has food/medication waiting to be collected.

Generate appropriate accounts and post to anyone who has an account over £10.00.

File sheet and record actions in debtor’s folder.

Chase insurance claims.

CALL BACKS Liaise with VN who may have already done them.

Advise owners of any medications/foods ready for collection.

Messages in the diary.

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HISTORY As needed, give practice sending either our email [email protected] or our fax number 01483 326518.

Both will return via the email address.

Save to desktop, upload to correct animal’s record.

Put on vaccination reminders etc.

Delete from desktop.

History saving protocol

Saving to computer

FOR PDF FILES ONLY

1. Click on the email

2. Right click on the attachment

3. Choose “save all attachments”

4. Click ok

5. Select save to desktop

6. Save

7. Go to the desktop and make sure you can open and read the file you have just saved

Putting on to Jupiter

1. Open Jupiter

2. Select client record

3. Go into the pet

4. Go to Document Management

5. Click Attach Existing

6. Select Document from File on the left hand side

7. Using the drop down menu select History.

8. In description write the vet practice name ie “Pet Doctors Shalford”

9. Click Next

10. Using the drop down locate and click Desktop

11. Find the file and double click, if there is more than one file for the pet hold down ctrl and select the files you need with

your mouse.

12. Click Next

13. Finish and close

14. Double click the history to make sure it works

15. Save

16. Open history and find last date of vaccination, flea treatment and wormers and follow the steps to setting reminders.

Setting reminders

1. Go to reception screen and find the client

2. Click once on the pet

3. In the pet menu click details

4. Go to reminders

5. Enter date of last vaccination or flea treatment or wormer

6. Choose which reminder

7. Save

8. Repeat for each reminder needed. Vaccination is the MOST IMPORTANT!

mailto:[email protected]

SEPT 2018


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LAB REPORTS Will return via email. Follow same protocol for Histories to upload onto clients records

NEED TO SAVE IN HTML FORMAT.

Place note on diary on Voyager.

Lab reports protocol

Saving to computer

8. Click on the email

9. Go to file

10. Choose “save as”

11. Select save to desktop

12. Save as file type HTML

13. Go to the desktop and make sure you can open and read the file you have just saved, two files will appear

you need the html one not the folder!

14. If it will not open start again, make sure you have saved it as an HTML

Putting on to Jupiter

17. Open Jupiter

18. Select client record

19. Go into the pet

20. Go to Document Management

21. Click Attach Existing

22. Select Document from File on the left hand side

23. Using the drop down menu select Lab Report

24. In description write the access number(on email from the lab), type of test and date it was

collected/sampled i.e. “1121941505 FNA 12.12.11”

25. Click Next

26. Using the drop down locate and click Desktop

27. Find the file and double click, if there is more than one file for the pet hold down cntrl and select the files

you need with your mouse.

28. Click Next

29. Finish and close

30. Double click the lab results to make sure it works

31. Save

32. Place a reminder on the diary in the actions column for the vet. Also tell the vet verbally if you can. As a

failsafe, message them through Jupiter to let them know the results are back.

ASHES Call owners on return but do not leave a message. Keep trying until you have spoken to them personally. Please

ensure ashes are always handed out to clients in an OBV bag – not just the box. Clients must always have settled their

accounts before ashes can be given out unless discussed in advance with LK.

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FRIDGE/PHARMACY THERMOMETERS For practice standards we have to monitor the temperature that are drugs are kept at – there are digital USB

thermometers in the vaccine fridge in consult, upstairs in the drug fridge in the lab area and in the cupboard where

the POM’s are kept in consults too.

Fridge Thermometer Protocol

15. Go and find a thermometer (they are grey USB sticks; 1 in the fridge upstairs, 1 in the vaccine chiller unit in

the consult room and 1 in the left hand top cupboard in the consult room

16. Plug 1 into the computer at a time (remember which is which, I find it easier to go and get them one at a

time)

17. Open the Easylog USB icon on reception 1 desktop. (it looks like a toy block)

18. Select “Stop the USB data logger and download data” (red button)

19. Click Yes

20. Check it has come from the right location (ie pharmacy) and Click OK

21. Save file as today’s date and name (ie 29.06.12Pharmacy), click save

22. A chart should appear. Check the temperature has stayed between the two dotted lines, if it hasn’t find out

why and adjust the fridge/room temperature as necessary.

23. Click close or X

24. Go back to easylog and click the Green button, “Start and set up the data logger”

25. Check logger name. This is where you can adjust the length of time it reads for; I have them set to 11 days,

although I check and save them weekly, this means if you have an emergency or bank holiday it is not the

end of the world if they are not checked until the following day or so.

26. Click next

27. Check the high and low threshold and alarm boxes are checked. Click next

28. You should now have a start time box, with it ticking away. Click on the minutes and increase it by two or

three minutes, this means you won’t then have a spike on your next week’s graft where it’s measured the

temperature of the computer!

29. Click next

30. Unplug the USB, pop the cap back on and take it back to where it came from straight away.

31. Exit Easylog.

All loggers should have a constant flashing green light, if it flashes red they are either running out of battery, the temperature is above or below limits set or it is full of data and not measuring until you follow the instructions above. Data loggers are bought through MSD animal health. All data must be saved for Practice Standards.

QUIRKS Reception 2 computer opens the till – do not shut down till you have finished the end of day banking!

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CONSULTATIONS

CONSULTATIONS

Our consultations are 15 minutes and include a full head to tail examinations on every consultation

30 minute consultations are booked for all puppy and kitten 1st vaccination appointments and all new clients

and clients with new pets

All consultations are charged at full price for new conditions, then a second consultation and third

consultation for on-going conditions that need regular examinations.

‘Minimum Check Up’ can be applied for rechecks where the complaint has resolved but a check-up was

warranted (e.g. resolving wet-eczema/ear infection etc.)

3 Monthly check up fee is applied for on-going medication checks or 6 monthly check up fee depending on

the condition.

HOUSE VISITS We do house calls or visits but they need to be planned with vet availability

Any call should be pre-arranged as far as possible (unless emergency)

Please discuss with the vet the best time to do the call before booking, and inform the client of the costs

involved.

PRICING TIPS FOR VOYAGER

Common Charges

Consultation (rabbit, g/pig, bird), second consultation, third and subsequent etc.

Minimum check-up fee –final check for on-going condition

Pre-op check- no charge (included in op price or for providing an estimate)

Post-op check-no charge (two included in the price of all ops)

Nurse Consultation – chargeable item unless for weight check, puppy monthly check or special offer (i.e. Diabetes

month)

Vaccinations – species specific then charge for appropriate vaccine given (i.e. First/second/booster)

Kennel Cough Vaccination – reduced price if done at time of booster.

Microchip Tracer or Bio thermo (takes temperature)

Petplan IVC – all puppies/kittens/rabbits under 1 year of age.

Cartrophen Course – charges as a composite for whole course of four injections. No further costs for repeat

appointments/injections.

Nail Clip (all species)

Express anal glands – if the ONLY thing you do – otherwise is charged as an additional item (i.e. Vaccination and

Express anal glands)

Euthanasia (+/- House visit – priced on mile radius. Takes into account journey/time/consultation)

Species specific for euthanasia and size (in 15kg increments) – composite item so must record euthatal used.

Cremation also species and size specific. Individual cremation prices for ashes returned in a smart scattering

cardboard box that is biodegradable and can be buried. Otherwise Wooden Casket and plaque supplement on top -

other requests can be met but will have to check with Surrey Pet Crematorium with regards to costs. Owners can be

present at the time of burial/cremation at SPC and there are lots of other options regarding pendants/paw print

jewellery that can be discussed if the client is interested.

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Hospitalisation

Hospital Day Case - dog/cat/rabbit for outpatient procedures (NOT including castrate/spay)

Hospitalisation-dog/cat/rabbit for overnight per 24 hours composite item with various options included.

Examine in hospital by vet fee-weekday/weekend/BH

Fluids

Intravenous fluid charge – is a composite so please charge for equipment used.

Drip maintenance fee per day (starting from 2nd day of IVFT) +/- additional bags/giving sets etc.

Labs

We do not put a mark-up on Idexx/Cytopath prices – the price you read in the book is BEFORE vat. All tests going off

will have a Diagnostics fee charged first (with blood taking/courier charges as appropriate).

Blood taking fee – always priced unless in house bloods for preans

In house – then name of sample i.e. In House preans or In house snap test FELV/FIV etc.

External labs Cy for Cytopath, Id for Idexx etc. codes should match those in lab books supplied.

Idexx does all our routine Lab work – we have an automatic collection in the evening EXCEPT SATURDAYS. Night

time collection from our Drop Box always occurs. Key for the box in top drawer office desk. Results next day.

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SURGICAL CHARGES

NB: PLEASE REMEMBER TO GIVE AN ACCURATE ESTIMATE AT ALL TIMES FOR ALL

PROCEDURES, on admission at the latest.

CHARGING PRINCIPLES

Separate computer training will be given, but below are examples of correct charging procedures.

If in any doubt, as how to charge or estimate, please consult the partners.

To ensure a fair price most procedures are charged on time and the amount of materials used, thus smaller pets with

short treatments will cost less than giant breed dogs requiring large amounts of treatment. It is the duty of the

anaesthetic monitoring nurse to note how long the GA and procedural time is at the start and end of the procedure.

Nurses should also note on the monitoring chart the time at which events take place (e.g.: First incision, iso off etc.).

GENERAL ANAESTHETICS By weight for the first half an hour, including premed, induction, isoflo and oxygen. NSAIDS and additional

meds are charged extra

Extra anaesthetic time as 10 min increments for maintenance thereafter.

Sedation is charged as a separate fee as a composite item to price for amount of drug used.

Charged every time a G/A is given, apart from neutering

It is practice policy that any pet expecting to have a lengthy anaesthetic – ie over 30mins should have

supportive intravenous fluids and PABS regardless of their age.

NEUTERING This is charged as a complete fee for premed, NSAIDS injection, GA and surgery, including consumables

Extras including bloods samples, fluids, buster collars are chargeable

If additional procedures performed under same GA, these are chargeable accordingly – additional anaesthetic

time (per 10 minutes) plus procedure and materials (E.g. deciduous tooth removal/umbilical hernia repair)

We do not charge blood drawing fee for routine neutering

All neutering’s are to have subcut sutures placed using the intradermal technique.

SURGERY All surgery is chargeable in 10-minute blocks

Surgery time is priced per 10 minute block. Except for surgical biopsies/lance and flush abscess etc.

Theatre Consumables are priced on a scale system depending on amount of gloves/drapes/general mess

created.

All disposable items should be noted on the patients charge and charged for accordingly.

Theatre assistants – vets or nurses – to be charged for per hour with a minimum of half hour (if required,

rather than there for learning)

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NON-SURGICAL PROCEDURAL TIME Again in 10 minute blocks. This is used when performing medical procedures – such as unblocking a urethral

obstruction. Some medical procedures are itemised on the system.

CONSUMABLES AND DRUGS All priced accordingly – item description will indicate if pricing for individual tablets or per packet.

RADIOGRAPHS All x-rays are charged per interpretation, not per plate.

First x-ray is more expensive to cover the set up costs

Dental x-rays are charged in the same fashion, under Dental

DENTISTRY All dentals should be charted with the nurse before commencing work – please take before and after photos

for discharge sheets.

For a simple routine descale and polish there is a set fee depending on the size of the pet. This includes half

an hour of general anaesthesia time.

If dental x-rays or extractions are required this is charged for separately and ADDITIONAL ANAESTHESIA

TIME MUST ALSO BE PRICED.

Where ever possible estimates must be given for dental work – however it must be stressed to the client that it

is a rough guide as often conscious full examination of the mouth is difficult and dental calculus can hide

problems only then discovered once the procedure is underway.

Dental disposables are charged for all dental work – this covers the cost of prophy paste, polishing heads,

burrs and a dental pack which all clients are send home with

DISCHARGE APPOINTMENTS Any animal that has been in for the day and had a procedure performed must go home with a post-op

discharge form. Composites for these can be found in the consent form section. You will find certain parts (ie

dates for rechecks) need to be added manually and the medication chart will need completing. Please

annotate accordingly, print and give to client at discharge

If x-rays, dentals have been performed there are separate discharge sheets for these. On which copies of

images/dental charts can be cut and pasted for the client to have at home.

All patients are to have a see out appointment either with a VN or Vet – this is to discuss medication, show

the client x-rays etc. and discuss any concerns they might have.

Regardless of their procedure all clients are to be phoned the next day for a progress report to see if they are

managing with medications or have any concerns.

Routinely if an animal has had surgery it is to have a 2 day and 10 day post-operative check. For neutering’s

the first 48hrs involve STRICT rest and then if healing well at the 2 day check-up they can then proceed to

lead only exercise until the 10 day check.

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1. Turn on PACS PC in dental if not already on. Dell Machine, password Visbion.

2. Make sure Voyager is open Locum and password. Utilities at top. Open HL7 Image and leave it open!!

3. Visbion also needs to be open. Administrator and Visbion to get in. Leave it open.

4. Switch orange switch outside x-ray on.

5. PC in x-ray is always on (located inside table – do not switch off!). Moving mouse will activate screen.

6. Ctl/ALT/DELETE to open. nxuser1 and nxuser1.

7. This opens work list – click new exam.

8. Fill in clients details. IT IS VITAL THAT YOU PUT THE CORRECT ANIMAL NUMBER INTO ANIMAL ID!

Then click OK

9. Then add images that you want to take (ie Whole body/abdomen and then view lateral etc.). You can set this

up to have all your images that you intend to take.

10. The DR will send the image taken to whichever image has the highlighted green bar on the Image Overview

section (RHS screen).

11. Turn NOVA HF on by pressing the button that has the green light in it (large circle with a dot in the middle).

It will take a few seconds to charge up.

12. Settings are on the wall.

13. Once happy with settings and collimation. Close door and then take picture as usual!

14. Image will appear as if by (expensive) magic on the screen – you can edit here.

15. On edit function add the KV and MAS settings – VN will normally do but this is vital for RCVS PSS

16. Once you are happy and have taken all the images you wish on click close and send. This will forward your

images to the client’s records on Voyager.

17. For Owners please copy a JPEG image and attach to the patients discharge notes. These can also be annotated.

Oak Barn Simple (!) Guide to X-raying. Hopefully this makes sense – if not and you don’t know what you are doing – DON’T USE IT!!! Please ask and

someone will hopefully be able to help.

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1. Turn on PACS PC in Dental if not already on. Dell Machine, password Visbion.

2. Make sure Voyager is open Locum and password. Utilities at top. Open HL7 Image and leave it open!!


4. Go downstairs! Dental X Ray lives under the stairs – wheel into dental room and plug in. You will not need

any leaded apron protection due to the low level of kV produced. However you will need to be at least 2

metres from the head of the x-ray when taking a picture. Ensure that it is never pointed at the glass into

reception but always at the animal on the table.

5. On the computer in the dental room open the Trophy DICOM application. This opens a blank work page.

Tool bar top section. Click on Procedures and then Create. Enter the PATIENT ID NUMBER – THIS IS

VITAL THAT THIS NUMBER IS CORRECT OTHERWISE THE IMAGE WILL NOT BE STORED. Last name

and pets name and click OK.

6. New page will now have your patient listed on the work book page. Double click on this. This opens a new

page on the Kodak website and will be dark black.

7. The dental x-ray probe is in a protective case in the dental. Plug the USB cable into the PC. It is waterproof

but needs a protective disposable plastic film, be careful it is quite delicate. Position in mouth and x-ray tube

head at 90 degrees as close as possible to area interested in.

8. Main box on X-ray machine – Capsense – press the on button. KV and mA are already set. Time is set to 0.4

seconds that is normally good for most exposures. If you need to change this use the arrow buttons.

9. Once you are happy with positioning press the grey button on the probe handset wire (looks like a torpedo on

the x-ray plate wire). This will bring up a 90 second timer on the computer screen. You are now ready to take

a picture.

10. Press the radioactive sign on the x-ray Capsense head – this arms (preps) the x-ray head.

11. Take the push button on the wire and leave the room. At a safe distance press the white button and continue

pressing until you hear a buzz. Shortly afterwards an image will appear on the computer screen.

12. Repeat this process as often as needed.

13. When finished close down the Kodak images on the computer screen by saving those you want - they will

automatically appear in Jupiter on that animals’ records.

14. Turn off and unplug the x- ray head and put away. Wipe off the plate with trigene wipes and replace in its

protective case.

Oak Barn Simple (!) Guide to Dental X-Ray. Hopefully this makes sense – if not and you don’t know what you are doing – DON’T USE IT!!! Please ask and


SEPT 2018


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1. Turn on PACS PC in Dental if not already on. Dell Machine, password Visbion.

2. Make sure Voyager is open Locum and password. Utilities at top. Open HL7 Image and leave it

open!!


4. Plug ultrasound into electrics where you are planning to use it.

5. Switch on at wall (1), then at back near the bottom (2) then on the left side (3)

6. Big Bertha will start to charge up – it is noisy but that is normal! Select patient data. New Patient.

7. Fill in clients details. IT IS VITAL THAT YOU PUT THE CORRECT ANIMAL NUMBER INTO

ANIMAL ID!

8. Select a probe and package and scan as normal. (Scanhead and cursor select to change probe

during examination)

9. Freeze and print saves to the hard drive (you will hear a beep)

10. Record will save an echo video to hard drive too. Avoid doing a lot as files are HUGE.

11. To crop a recording of an echo. Freeze on cineloop. 3D cinebutton and select trim. Pause/play and

position left cursor to start then select, repeat with right cursor to pause/play to correct point. Then

capture.

12. When finished exam. Finish/End Patient Exam. Menu. Net Disk select. Hard Disk select. Confirm

patient details are there. At this point you can turn off machine (see end) and move to X Ray if not

in there already.

13. Scroll and select patient. Most recent at the bottom.

14. Plug CAT5 cable into floor box in xray – port is labelled.

15. With correct patient selected. Copy to Network. Select. Will change No to a Yes when it has gone.

If it is a very big file this may take a few minutes.

To turn off – switch off at (3) first, machine will power down. Once screen is blank switch off (2) and

then (1).

16. Again a JPEG image of this ultrasound should be cut and pasted onto the pets discharge sheet for

the client to see on collection.

Oak Barn Simple (!) Guide to Ultrasound. Hopefully this makes sense – if not and you don’t know what you are doing – DON’T USE IT!!! Please ask and


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HOSPITALISATION

HOSPITALISATION Day hospitalisation is charged to any animal which uses a cage not overnight, as this covers the cleaning, feeding

etc.

Hospitalisation is to be charged on the day of arrival per 24hours. There is an intensive care and barrier nursing

charge as separate items depending on the level of care required.

Rounds are performed at 2.30pm every day with all staff members present if possible.

All animal should have a full examination at 8am and 7pm by the vet and nurse, and any plans for the day

relayed

Clients are to be phoned after morning and evening rounds by the vet, unless special circumstances

A daily examination is charged as ‘Examination by Vet’ – Daily rate (Mon to Fri); Weekend or Bank Holiday

Animals purely boarding do not need to be charged if a full examination is not needed

We endeavour to send the majority of our patients home overnight on an outpatient basis with IV catheters

plugged and flushed. If patients are unstable or need attention overnight they they are to be transported by the

Vet to Vets Now overnight at Stockton’s. Overnight treatment plan and medications should be transported with

the pet and discussed with the OOH team. The Vet in charge will also collect the patient and OBV will pay Vets

Now Directly – this cost is then transferred to the owners account. All meds are charged as given. Tablets

should be dispensed as a course as an outpatient would be.

NURSE OVERTIME RATES Overtime is paid at the current rate when the Nurse has to stay later than normal (e.g. to stay behind after hours to

assist with e.g. an Operation).

Oak Barn Veterinary Centre’s Overnight Care of In-Patients Policy

The level of care and monitoring overnight is assessed on an individual basis according to need, as a result of

agreement between the Vet and Nurse, following case discussion during ward rounds with the clinical team.

Unstable patients MUST be transferred to Vets Now. (Transfer fee)

The minimum monitoring level of hospitalised cases overnight includes the following:

In-patient Check at 7pm

In-patient Check at 8am the following morning

- This is provided for patients which are deemed to be stable, low risk cases. IE cats not easily starved overnight if live

in a multicat household, rabbits post op if no warm environment at home.

Under our planning permission we are not allowed to stay at the hospital overnight and this must be conveyed to the

owners. Although we will return to the clinic and monitor their pet if needed there is not continual supervision. This

can only be provided overnight at Vets Now.

We believe this flexible scale of monitoring ensures the very best levels of appropriate care for our patients, with

appropriate charges being made according to need and on an individual basis, whilst also offering the team at Oak

Barn Veterinary Centre a reasonable work/life balance.

Documents

Practice Manual - Oak Barn Vets · Orthopaedic emergencies are not suitable however. (Emergencies to NFR or Anderson Abercrombie). Mark also specialises in perianal surgery (fistulas,