5 ways to improve patient care


Expert tips to boost your skills.

You love animals. This is probably the reason you got into the veterinary industry in the first place. But in the daily grind of upset clients or quarrelsome co-workers, you can lose sight of your mission: Bettering animals' lives. It's time to refocus on pets by taking a cue—five, in fact—from some patient-care pros.

Rework your records

After one too many staff members grumbled that they weren't sure how to proceed with a patient from reading its record, Annie Wian, patient care coordinator at Veterinary Medical Clinic in Tampa, Fla., pulled every file for an audit. If a record was missing a treatment plan, she'd return it to the correct source to complete.

"Was it time consuming? Yes. Was it effective? Most definitely," she says. Now, with a completed care plan in every file, Wian says her team can easily follow up on recommendations and make sure pets receive the care they need.

To keep records in tip-top shape, Wian does three things. She gets her staff on the same page, so to speak, with mandatory record-keeping CE lunches every six months. She puts a master sheet at the front of every patient's file to see problems, alerts, and chronic conditions at a glance. (Click here by searching for "master sheet.") And she and team members review the day's records to make sure they're complete before refiling them.

Do any of the above and the likelihood of recommendations falling by the wayside decreases, Wian says. "We're trying to provide the best medicine," she says. "Compliance is the best medicine."

Watch vitals like a hawk

Vigilant observation is essential when patients undergo anesthesia. But sadly, not all hospitals educate the entire staff on the importance of monitoring. While technicians may be the ones actually monitoring vitals during a procedure, all team members should understand what to look for and why.

Take temperature, for example. All team members need to be aware that a patient's body temperature drops under anesthesia. And if a pet's body temperature gets too low, its organs can't function properly, says Jessica Janowski, receptionist and patient care coordinator at Merrimack Veterinary Hospital in Merrimack, N.H. The heart rate slows and blood pressure drops, and if that gets too low, the kidneys can start to fail.

But what's too low? A normal core body temperature measured rectally for a dog or cat is around 101 degrees Fahrenheit, says Pamela Stevenson, CVPM, management consultant and owner of Veterinary Results Management in Durham, N.C. But don't rely on averages. You should always take a patient's temperature beforehand so you'll have a base number to work with, she says.

Regardless of how hot or cold a pet naturally runs, you want to maintain the body temperature as close to normal as possible. And you definitely don't want a patient's temperature to drop below 96 degrees Fahrenheit. For suggestions on how to keep patients warm during procedures, see "Tips to Prevent Hypothermia".

Don't let pets suffer in silence

Many clients are under the false impression that pets have a higher pain threshold than people. Or they incorrectly think that if their pets aren't crying, they're not in pain. But animals are masters of disguise. Pets show pain, but many people just don't know what to look for.

"Clients will bring in their dogs that aren't using a leg and say they're not in pain because they're not crying out," Janowski says. "I tell those clients, 'If your pet isn't using a leg, trust me, it's in pain. If you weren't using a foot, you'd probably be hurting.'"

Of course, not all pain indicators are as obvious. Subtle signals, like a hunched back, a hanging head, or tensing when touched, indicate that a pet's experiencing discomfort. To be able to read the signs, you'll need training, Stevenson says. A good place to start—for you and your clients—is the International Veterinary Academy of Pain Management's Web site, ivapm.org, which features the video, "Is Your Pet in Pain?"

Once you can recognize pain, you can provide better patient care—and even plan ahead to prevent pain. For example, a surgery patient will undoubtedly experience some discomfort while healing. But why not ask the doctor to minimize that pain with a postoperative analgesic?

"You'd be surprised how many spay and neuter patients go home without pain medication of any sort," Janowski says. "Some practices are of the belief that if you don't give pain medication after surgery, pets won't move as much and they'll recover faster. I don't think that's justifiable. Pets that are uncomfortable are more likely to pick at their incision and less likely to eat." Avoid putting pets through unnecessary pain by encouraging the doctor to prescribe medication when appropriate.

Ensure at-home care is carried out

Clients are often overwhelmed after hearing their pets' diagnoses or picking up their pets after surgery, says Anna Rotton, patient service coordinator at Santa Cruz Veterinary Hospital in Santa Cruz, Calif. Therefore, it's helpful to review the home-care instructions in a quiet location.

"Scheduling an actual appointment time allows the staff to be prepared and arrange for a technician who is familiar with the case to answer any questions," Rotton says. "You want clients to understand what's happening with their pets." Otherwise, at-home care could be quickly compromised.

To avoid this, tell clients what they can expect and what they should look for at home. For example, if diarrhea is a common side effect to a prescribed medication, let them know it's normal for their pets to have an accident. Then offer suggestions to prevent the mess like putting extra litter boxes around the house or watching closer to when their dogs are standing by the door.

Because owners may not be taking in all the information, always give them a take-home sheet with the instructions to follow. They may not have questions right then. So remind clients that you'll call in a day or two to follow up on their pets, but that if questions pop up before then, they can call the hospital.

A little T.L.C. goes a long way

During a busy day, it can be hard to find the time to give special attention to each patient. Like when a huge pile of paperwork stares you in the face, you might not be able to justify jumping to the back to give a dog a quick brushing. But you should take an extra five minutes to check on patients and make them as comfortable as possible, Stevenson says.

For example, with a perineal urethrostomy case, you should head to the hospital kennel or intensive care unit at least four times throughout the day. Besides making sure the patient received the prescribed treatments, you should check for soiling because the pet will have less control. "It doesn't take long to place your hand under a patient to see if its pee pad needs to be changed," Stevenson says, "or to put some ointment around the area to avoid urine scald."

Other simple tips to keep in mind include moistening a pet's gums and providing shy animals with privacy curtains. Also use some foresight when arranging the kennel. A cat that's never been around dogs before would probably be less stressed and recover from her spay more quickly if her cage was across the room instead of on top of a barking dog's cage, she says.

When you provide superior care, everyone wins. The patient gains a better quality of life. This is enough in and of itself. But there's more: The client enjoys peace of mind. The practice reaps revenue. And you earn the satisfaction of knowing that you're partly responsible for all of the above.

Please send your questions, comments, and tried-and-true patient-care tips to firstline@advanstar.com

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Angela Elia, BS, LVT, CVT, VTS (ECC)
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