5/12/17

Added 3 Waivers in patient forms; Nexgard Waiver, Trifexis Waiver, and Trifexis Purchase Waiver.  Please utilize these in any of the instances needed.  Remember; these products have not been evaluated or to be used with caution in dogs that are breeding or have seizures. -EIB

4/6/17

Please make every effort to be here on time. When clients are here and waiting for their appointment to begin at 8am or 2pm they expect it to start on time. Too often technicians are walking in after their scheduled times and the whole day begins late. This also brings up the subject of clocking in. Do not clock in until you are ready to work. That means if you are in the parking lot or doing personal things to get yourself ready for the day you should not be clocked in. Written warnings will be issued to those habitually arriving late. If this continues to be an issue we will remove the privilege of clocking in and out on your phone and we will setup a station in treatment or reception where employees will have to clock in and out. 

3/14/17 - Notes from Melissa: 

  • There have been a few too many labels going out incorrectly on prescriptions (either wrong drug, dose, quantity, etc). Please be in the habit of showing your drug label and reading the instructions with every client on every bottle. This helps prevent inaccuracies. 
  • To clarify discounts on services vs. products: Anything a client can physically leave with cannot be discounted. (If the client asks to have Profender applied, this does not become a service, this is not discounted) Discount can be applied to microchips, injections of any kind, sedation/pain injections, labworks, etc.
  • If you see a hotel attendant unpacking controlled's, they are not allowed to put them away or deal with them at all. Please make it your responsibility and handle them properly, please use the checklist provided in the controlled log book to make certain YOU have completed all necessary tasks involved.
  • To clarify some scheduling concerns: If we have space on the schedule available to book an ear infection (Ex: 6:30 pm on Weds is open, 2:20pm has a 30 min open slot, etc) we WILL offer those same day appt's to the client if it works for them. Please do not only offer other days because tomorrow is never guaranteed - we don't want to lose a client over a 24 hour wait. So if there is time allowed in the same day - offer it.  Please refer to printed guides found on the computers for the appropriate length of time to schedule certain types of appt's.
  • April plans to schedule the hotel attendants time to train on the hospital side. When they are not scheduled, if it is a little slower at either part of the building, please grab an attendant for training. Please help them learn to process labwork, set up slides, find the appropriate sized HG/NG (or whatev), count pills (find these meds for them at first and always double check), make rabies cert, draw blood. The goal is to help them assist the techs so we can be more efficient. Eventually we will teach them more as we grow to trust in their capabilities. 
  • Dremmels now cost $10, please still use the dremmel on low speed. If you prefer Mach 10 speed, then you have to be trained by Holly McDonnell how to properly use the dremmel at that speed. Once she has approved you and is satisfied with your performance - you may then use Mach 10 speed.
  • Melissa is in the process of adding to all prescription drug labels the following text "0 Refills" Until we get used to asking if refills are allowed, please ask the Dr if refills are ok. If they are ok, please specify an END DATE for allowed refills. For example: Its February 1, 2017: Carprofen 100mg's - Dr wants labwork retested before refill. P was given 4 week supply. 0 Refills, P later gets labwork on March 1, 2017 and is approved for more Carprofen. Dr wants P to have bloodwork in 6 months. New prescription of Carprofen reads: Refills ok until September 30th, 2017. This is six months from the date of bloodwork. Example 2: Fortiflora Refills ok until January 31, 2018. This prescription is considered ok to fill as long as exam is current. So to be clear, if a refill is approved - it HAS to have an end date, not a number of refills.
  • If a client wants to schedule services while being groomed or during boarding, do not discourage them from this, we offer this service as a convenience for the client - NOT US :)
  • I understand that Rescue Group appt's can be very time consuming. There is a lot of homework that has to be done, there are special requirements for billing, the head of the association sometimes needs to be called for approval of things, there are fosters involved, etc, etc. We will continue to treat and care for these special clientele just as we would any other client. They have chosen us and that is something to be proud of. We are who we are because of ALL of our clients. Let's always keep that in mind. 
  • Reminders are put on the Davis Info page because people are forgetting things. In an ideal world, we would address the compliance issue directly with the person involved. This is not always possible for various reasons. So the info page will occasionally be used to remind people how to properly perform tasks, etc.
  • Please remember to put the breed and weight on the appt schedule for surgeries and grooming appt's. It does take an extra second or two to complete this. Although it is easy for the next person to simply look it up themselves, when that person has to look up 6 patients, this becomes time consuming. Or if the receptionist is trying to schedule another groom and Holly already has 4 LARGE dogs, she will not want to schedule another LARGE POODLE without approval first. The receptionist will be able to quickly glance at the weights/sizes and can quickly determine if the P can be groomed on a particular day. Having weights available for surgery helps aid in sx pack selection, planning order etc. Rather than having to click through a few P's, the few seconds you spend will ultimately save multiple people many minutes of researching for themselves.
  • When filling out euthanasia sympathy cards please also add "and the Staff at Davis Animal Hospital" so everyone is kinda included, ya know?!For Example: We are thinking of you. Melissa and the Staff at Davis Animal Hospital

 

  • That is all, Melissa :)

3/14/17 from APB:

  • When a bottle of a controlled substance is empty a physical count against the drug log needs to be done on the item (this should be easy as the count should be zero). If this is not the case please do not ignore it and just add another bottle to it - if we get inspected this is a huge red flag that they look for. If you are not able to stop right then and investigate the computer count vs. the log to look for missed entries please make yourself a note to complete it before the day is over. If there is a discrepancy please let April or Dr. Ruby know ASAP. 

 

  • If you are scheduled to work at 8am please be here and ready to grab the first chart at 8am. If you are scheduled to be back at lunch at 2pm please be back and ready for the first chart of the afternoon. Some techs are routinely clocking in late or clocking in on time and then going to make a cup of coffee, go to the bathroom, and are not actually ready to take a room until 15 minutes later. Clocking in means you are here and ready to work. Please don't clock in and then go to the break room and make food, make a coffee and spend 20 minutes just meandering around. Clocking in means you are ready to take a chart right then and get a room going. We are routinely starting our first appointments of the day and afternoon late and clock in times are creeping later and later and more and more frequently this is happening. I do not want to have to write up tardiness so please take this as a serious reminder to get your butt here on time for our clients!

2/24/17

When techs sign sympathy card, need to sign from "All of us" not just themselves.  (EIB)

2/24/17

When you do your callbacks on appointments that need rechecks or next boosters, can you do a quick check to see if an appt was scheduled, and if not, schedule or at least remind O to call for an appt and indicate it on their callback note.  I have come across a bunch that were "not reminded" or "never told" which I highly doubt, but I could not disprove them. (EIB)

2/24/17

Made new Procedure templates for Prescriptions, Called in, Prescriptions, Written, and Prescriptions, Faxed in addition to the VetSource and Road Runner Templates. (EIB)

2/24/17

If you cancel/reconcile a lab panel after saving in the computer, please change the reminder back to the correct date.  It will stay at the newer date and not revert back making it look like the pet had the test done that date, but really didn't. (EIB)

2/24/17

Dr's and Techs: Finish your appointment notes for boarding dogs the day of the appt.  That appointment time if possible!  You never know when a pet is leaving!! (EIB)

1/21/17 Specific Brochures/Handouts

In Pharmacy, there is a folder rack that has "specific" brochures for diseases, testing, product, etc.  I think this is the appropriate place because they do not need to go in all the kits that are distributed.  Please check it out and let me know if you would like some specific brochures that you discuss or when you are running low so I can re-order. - EIB


1/21/17 Tech Appt Travel Sheets

We are going to do the original travel sheet for tech appt vaccines only for now.  (This may change as different types of tech appts come up.)  Just scratch out the areas you don't use, as you do with a regular appt.  When a tech brings the pet back to treatment, they will ask if they need to pick up more HWP, Flea Prev, and food.  A greeter can then check the client out while the technician is taking care of P in the tx area.  This should help with time efficiency.  If you are finding issues with this, let me know and we will brainstorm a different way. - EIB

1/14/17 Care Credit Protocol

Since you are checking clients out, there may come a time where you have to use Care Credit.
Please see EIB if you do not have this installed in your iPad or laptop and I will update it for you!
Requirements to use Care Credit:

  1. Get Picture ID before running the Care Credit through.  We need 2 forms of ID in order to approve the Care Credit.  Ex: Picture ID & Care Credit Card/Credit Card
  2. If the cost is over $200, choose the 6 month program ONLY!
  3. Be sure to fill out all the spaces!  You are in charge of this, so remember to initial the form!

If you need a walk-through, see EIB, APB, DJI, CLM, JAH

1/14/17 Davis Animal Hospital "Files"

Under the Client: Davis Animal Hospital, in the "Files," there are multiple blank forms to print from.  I added an Unopoened/opened container log template so we don't have to keep copying the old one.  Bring me anything else you want added.  (EIB)

New Protocol for Kits

There has been multiple kits being left in treatment or not given to a client at all, so from now on, it will be the greeter's responsibility to give the kit to the client when they are placed in the room. 

The technician will still need to give them a flea/hw sample if called for.

Added 01/11/17

Notes from Melissa:

It is unsafe to use the dremmel on high speed for toe nail trims. The loud noise is also terrifying to our patients. Please use the low speed to dremmel our patients nails.

How to avoid a write up:

1. Keep your phone in your locker. 

2. Follow the flow chart. See example of why this is important below:

Please follow the flow chart! Nobody is referencing them. If you have a drop off patient getting procedures done - unless you have memorized every step - please grab the flow chart to ensure you are accomplishing every task. Marking Holly McD's cage card, report cards, putting name on white board, etc is being missed. These flow charts were made to prevent problems with communication both in the clinic/hotel and with the client. I (Melissa) will be meeting with everyone individually to verify you know how to use the flow chart. I will be updating a small section in the flow chart to update the new implementing of Hotel Attendants escorting patients for their appointments. I will also update the sedate to groom section to reflect the new time protocols.

 

It is imperative we follow the flow chart closely. I will not mention names, but, there was a cat that was dropped off for a sedate grooming. I intervened multiple times to advocate for the patient while it was here. I did this to hopefully prevent any errors/issues while here. Along the way, this patient was handed off multiple times to a new person. 7 people total were involved with the patient. There was many opportunity for something to go wrong had I not stayed involved in the patients care. It wasn't any one person who made an error. Patient was checked in by person A and assigned to person B. Person C came in to sedate patient and person D took over patient care. C and D should have consulted with B first. Person D transferred to person E for grooming. Person E went to person F for reversal and then neither E or F consulted B, C or D! (P was cold and neither E or F consulted with C, B, or D after reversal) Later O called to see if P was ready to go home. Person A asked person E if they were ready. Patient went home. Neither person A or E informed person B or D that patient was told they could go home. Person D called O to set up a discharge time and patient was already home. I was the 7th person involved. See why the chart is so important? Let's use it!

Housekeeping - we are only doing sedate for  grooms between 9am and 10am, This allows for enough time for that patient to wake up before doctors go to lunch. 


Rescue Groups

The greeter is going to find out if the foster bringing in the pet is paying or if the rescue is paying.  It is your job to call the head of the group and verify treatment prior to getting anything done.  You must inform the foster that you have to call the head before doing anything; this means that the foster may need to wait or reschedule treatment until we can get a hold of them.

Health Report Cards

Every patient that is dropped and getting something medically done needs to have a health report card done!  Even Lepto finals!  There are two forms that can be printed when you post the Health Report Card.  Just look underneath it and choose one.

Appointments

Please watch where you are scheduling appointments.  I've found multiple tech appointments on the dr side and dr appts on the tech side.

Boarding/Grooming appointments

The scheduled boarding/grooming appointments are not being done on time, so the Hotel Attendants are going to be bringing the patient up and be put in a room as if they were a normal client.  The appointment will be written up on the board and the chart will be given to you as a normal client.  Hopefully this will keep everyone on time and not having to rush because the client came to pick their pet up and no one had seen the pet yet. 

Travel Sheets

Travel sheets are to be used for EVERY patient; tech appointments also.  This keeps us accountable for that patient; it forces you to do TPRs and ask questions about the patient if needed. (Example; does the P need more prevention?  Is it coming due for vaccines soon?  Does it need a recheck or follow-up?)

These are still to be put on APBs desk or given to MRE when they are done.

Current Exclusions:

  1. TNTs
  2. Anal Gland Expressions
  3. Suture Removal

Patient Kits

Patient Kits will be done the night before by the Communication Rep; (see Greeters & Phones on how to make).  Technicians are in charge of deciding which prevention to offer, if applicable, and ACTUALLY giving the kit to the owner! Please do not forget to do this!!! It's on your checklist!

Vaccination Reminders

Because there have been a couple of cases where vaccines were not looked at and surgeries were performed, I am putting the reminder history back on the travel sheets.  PLEASE look at them.

Merging Patients

TRY NOT TO DO IT AT ALL.

I have found that in NEO, they duplicate every consult and reminder in the merged pet's record.  Please try to avoid merging a patient altogether by checking to see if the patient is already in the system.

I would rather move a patient to a client than have 2 patients that have the same or similar info.  If you need to make a new patient that is already in our system under a new client, PLEASE just move the patient to the new client instead of making another patient record for the SAME pet.

Health Certificates

Health Certs need to be scanned into record and a copy needs to be mailed to the State Vet.  The technician on the case is responsible for getting the original scanned or photographed into Neo.  The original is to be then copied and the copy is to be mailed to the State Veterinarian.  Please deposit the copy of the health certificates in the metal hanging file holder in Communication room labeled Health Certs to be Mailed.


Cleaning Rooms

Please keep your room cleaned after using it.  There have been quite a few instances where I would take a pet into a dirty room.  As soon as you are done with the room and escorting the client to the front, turn right around and go through your room.  Do not leave your room until it is cleaned, and THEN, turn off the light.


Heartworm and Combo Codes

Missed Heartworm Prevention & Cat Fight codes need to be put in the consultation so it can create a reminder to re-test heartworm and FeLV/FIV status.

Please be mindful and put these codes in right away!


Home Care Forms

Updated home care forms; you should see a file attached to spay, neuter, dental, and bandage charge to print from the charge screen.


Scott is doing a great job - thanks - love ya - Dr. Rubers


Exam Room Notes

Please make sure to put your TPR's in Neo. There are several exams where TPR's have not been put in Neo or written on the sheet (therefore looks like it wasn't done at all). It might be a PITA but it's important and legally required to TPR and record it. Please make sure this is getting done!

When a doctor asks you to jot down a note about a patient while they are doing their exam (deciduous tooth, cryptorchid, fractured tooth, etc.) it is important to write it down at that moment. Do not rely on yourself to remember to put it in later. There are too many times that it is forgotten and after a busy morning or afternoon it is difficult for the doctor to remember the small details about the exam. Please help by making these notes for them!

If you light a candle in the treatment room (or anywhere) please make sure to blow it out before you leave! We had a candle left overnight burning a few times. 


Notes from Melissa

- brochures are kept in comm room to help with clutter/cleaner look

- clean up your cages if you discharge a patient so poor Cara doesn't have to do them for everyone.

- remember to select correct check-out payment - so many barters - do clover AND NEO

- Watch your provider closely for OTC, Food, Preventatives, etc.

- keep up the good work with checking out in rooms, scheduling those rechecks in the room, offer preventatives and food, tell our clients about the rebates!

- keep up the good work filling out times!


Boosters

Lepto and Leukemia boosters may be done with a tech unless  it is a puppy or kitten or a doctor specific request that they see that patient again. Bordetella vaccinations may be given by a technician as long as the examination is current. 


Report Cards

When a boarder or groom is dropped off for an exam a "report card" is sent home with the patient to help the client understand what happened at the exam and what areas may need a follow up (dental recommendation, other issue) please make sure that we are calling the owner to give them a summary of this or if they can't be reached leave yourself a follow up to call in a day or two or see if they have any questions about the report card. The best way to fill these out is at the time of the appointment. Open up the report card and ask the doctor any questions you  need filled in. Do not try to wait until the doctor has written up their chart and then go back in and try to fill it in off of that - this method has been frustrating for both the tech and the doctor. Let's see if filling it out at the time of the appointment improves things. 


post-op exams

We will no longer do a post op exam for routine items unless the doctor performing the surgery requests one. The bottom of the surgery form will be modified so that you can check one box that says "no post operative exam is necessary. Please call immediately if you notice any redness, drainage, discharge, swelling or your pet appears uncomfortable" the other box will say "please return to our office in xx days for a post operative exam. Please call immediately if you notice any redness, drainage, discharge, swelling or your pet appears uncomfortable." If a patient has an issue that is directly related to the surgery performed here there will not be a charge for their post operative exam. 


Prescription Labels

Please label all prescriptions with either "no refills" or "refill until xx/xx/xx" This will help with clients calling to refill prescriptions. If it says it is okay to refill you do not need to get the doctor to approve it. If it says no refills or the refill date has passed you will need to get doctor approval. . 


Microchip Physical Cards

We will no longer be doing a white "file card" for microchips. There really isn't any reason to do one when we have it in our computer system and we can look it up online. Remember clients can fill this form out on our computer. You will need to manually take them to the Home Again registration form that is on our website - www.davispetvet.com/homeagain


Inventory (from MKB's notes)

Just a couple of other reminders:

  • If you sign for it, you are responsible for ensuring any cold products get immediately put away.
  • If you unpack it – you are responsible for seeing if it was a special order for a client and then following up appropriately (could mean you call, could mean passing to tech)
  • If you think we might need it, put it on the list – just stick a “?” next to it if unsure.
  • If you take the last one of something, PLEASE put it on the list – I’m more likely to miss the fact that we need something if there are none left vs one left – esp with all the rearranging of things lately.
  • I usually order on Thurs or Fri.  If you need something ASAP – tell me.  You can leave a callback in Neo when I’m not there – no guarantee but I’m on it a lot.  It’s also OK to text me.  Elishia can also order a lot of things.  April, of course, can order anything – if you can catch her sitting still for long enough to do so!

Receiving in controlled substances

  • If you open it – you are responsible for it.  They commonly ship in red bags to make them more obvious.  If you do not have logging privileges, you will need to transfer them to someone who does.
  • ALL interactions with controlled products should be done on the treatment table (just like Peyton’s notes re: Tramadol counting).  This is for your benefit as well as hospital / legalities.
  • Every product should come with a packing slip or invoice.
    •  Confirm that product is correct – name, strength, quantity (per bottle and # bottles), expiration date not within 6 months
    • Record the lot number(s) of the products on the invoice
    • Record the expiration date(s) of the products on the invoice.
    • Record the date received
    •  Initial (or sign) that you received the products.
    • The prior 4 are REQUIRED BY DEA.  It’s also a good idea to note that they were logged into drug log and who put into safe.
    • Photocopy the invoice – both copies initially go to April/Missy (the original will go in the controlled substance folder, the copy will go with the other invoices from that distributor for normal inventory processing)
    •  Record the products received in the Unopened Container Log for that product.
    • Date received, Received from “  “, invoice number, lot #, expiration date, next bottle # in sequence, amt received, total amt now present, initial.
    • Record the assigned bottle numbers (per the log) on the bottles themselves 
    • Ensure that the products get put into the correct safe (Dr R/Dr V/Missy/April).  They need to be put away ASAP, but leave them on treatment table/in camera view until that time. 

12/7/16

Surgical MTPs – it has improved, but there are still mornings when there are no MTPs made for the scheduled surgeries. This leaves the client waiting while the case is researched by the sx tech and an MTP is created to the best of their knowledge from the notes (how many extractions?). The sx techs do review the history on sx cases for the AM and look for MTPs, but when the client also arrives at 7:30am….

 

It can also result in missed additional treatments to be done that were mentioned at the time of the appt by the owner or DVM (vaccines, ablating small mass with dental, etc).

 

MTPs should be made and reviewed with the client at the time surgery is recommended. (for OVH/neuter this is generally at final puppy/kitten boosters).

The technician & Dr in the appt have the best knowledge of everything needed.

This results in the best information for owners over treatments to be performed, expected costs, etc. and speeds up their check-in time on the morning of surgery. When an appointment is made for surgery, please confirm that a MTP has been made.

  • If so – please note on appt that MTP is made
  • If not and the surgery is not immediate (ie next day):
    • Put a callback for the technician associated with the appointment when the surgery was recommended (& note this on appt)
    • That technician should create MTP and call/review with client as indicated then note on appt that MTP is made/reviewed. If not and the surgery is immediate & tech is not present – please inform sx tech if present and leave note on appt that MTP still needs to be made.

When confirming an appointment, please also confirm MTP has been made – there should be an updated note on appt if above was done; if not – proceed as above.

Sx techs to review upcoming cases the day before when possible to also ensure MTPs are completed (obviously if sx was scheduled on sat for the following Tues and no sx tech works sat or mon…)


12/2/16

  • New forms available:
    • Glucose Curve (a printable version and the template)
    • Insulin tracking sheet for the Hotel stay (Techs still need to check those patients in!)
    • Health Report Card
    • Health Report Card - TECH
    • Travel sheet now has why P coming in

 

  • Going to develop a food guide to hand to O in-between first speaking and getting doc.  Hopefully this will help transition the food discussions.