Technicians

Make it Easy:
All the pet owner has to do is say yes. We will take care of the
scheduling and planning. This will include the pre-op visit (if needed),
lab work, AVImark scheduling, etc.

Drill/Quiz for “Dental Cleanings: How to Recommend”:
1. Explain the results statement in your own words.
2. What would happen if we didn’t recommend dental cleanings the same way from all staff?
What happens most often, for example, when we don’t use a demo piece? For the client? For
you? For the pet?
3. Grab a dental info sheet or report card. With you trainer acting as a client role play following all
the steps above and recommend a dental cleaning. Get a pass and sign off when both you and
your trainer are confident you are comfortable and successful at least TWICE in less than 5
minutes each (preferably less than 3 minutes each).

























































[51]

21036 – Dental Cleanings: Pre-Op Visits:

Results Statement: To efficiently prep for upcoming dental cleanings so that it’s easy for the
client, safe for the pet, and simple for our staff.




Primary Responsible Position: Technicians

Participating Positions: TA’s, Veterinarians

Lab Work: If patient has had an acceptable blood test with good results in the last
60 days it will NOT be necessary to repeat the pre-op blood test. Ask a
doctor to be certain. If repeat lab work is not needed it will lower the
cost of the surgery.

What We Do:

1. Receptionist:
a. Schedules a FREE pre-op consult appointment.
b. Checks the client out for all services performed TODAY, during pre-op visit.
2. The doctor examines the patient for free and determines:
a. Any pre-operative lab work needed (ECG or blood test)
b. What will be included in the surgery itself
3. The technician or TA (in this order!):
a. Creates a treatment plan the includes the surgery AND all pre-ops needed.
b. Reviews the treatment plan and cost with the owner.
c. Schedules to things:
i. The surgery (while the client is in the exam room)
ii. The Express TA check-in the day of surgery (7:30 AM at the latest)
d. Informs the client to pull all food by midnight the night before surgery.
e. Posts the portions of the treatment plan completed today to the patient’s record.
i. Note: We must charge the client for the things the complete today. DO NOT
WAIT UNTIL the day of surgery. Sometimes the client doesn’t arrive for surgery
and then we have to try to call to get them to pay for services we already paid
for.
f. Routes the client to the check-out receptionists to pay for today’s services only.
g. Takes the patient to treatment while checks out and:
i. Collects need blood/urine samples
ii. Completes the pre-op ECG TODAY!











[52]

Drill/Quiz for “Dental Cleanings: Pre-Op Visits”:
1. Why do we perform pre-op dental visits this way? What happens if everyone does it a little
differently?
2. What does the client pay for during pre-op visits? If they don’t decide to do the surgery do they
have to pay for anything today?
3. Why does the client have to pay for the lab work and ECG TODAY if they got them today? Why
can’t they just pay on the day of surgery?
4. Explain what the doctor does on pre-op dental cleaning visits.
5. Explain what the tech or TA does (open book). Explain the importance of this order of events.
6. Why is it best to get the clients paperwork, scheduling, and up front to check out BEFORE you
take the patient back for the samples? How does this help the client?






























































[53]

21038 – Dental Cleanings: Performing
Results Statement: To assure great patient care by performing a dental cleaning safely,
efficiently and effectively.





Primary Responsible Position: Technicians

Participating Positions: Doctors

How:
 Wait for the doctor’s approval to start the dental.
 Tech Assistant remove the pet from the cage/run walk outside to make
sure they eliminate.
 Place the patient on the wet table with the help of the tech assistant.
 Start induction on the wet table.
 Make sure the IVC flushes appropriately
 Administer the induction meds and intubate.
 Have your patient Left or Right lateral and connect your patient to the
anesthesia machine and O2. Having your TA connect all leads and IV
fluids.

 Take a BEFORE PICTURE before cleaning any teeth
 Starting on one side cleaning the outside of “up” teeth and the inside of
the “down” teeth.
o Scale every tooth inside and out appropriately breaking the
tartar and debris free.
o Polish each tooth inside and out.
o Take the AFTER photo on the same side as the before photo
o Flip patient to the other side (with help of the TA unhooking
the anesthesia lines).
o Repeat on the other side.
o Each side should take roughly 15 minutes or less, for a total of
30 minutes.
 Pull out the dental prophy pack for the doctor.
 Ask the doctor to check the teeth and gums.
 Fluoride is applied on to the outer side of each tooth and gums.
 Recover the patient as with all surgeries.












[54]

Drill/Quiz for “Dental Cleanings: Performing”:
1. Why do we have this specific procedure to have it done this way every time?
2. What would happen if we didn’t? For the patients? For the staff?
3. Explain how you clean the teeth with dog on one side and the other.
4. How long should it take in total roughly to clean most pet’s teeth?
5. With your trainer watching clean a patient’s teeth start to finish. Repeat on as many pets as
necessary to do a good job in less than 30 minutes.
6. Get a pass when both you and your trainer are completely comfortable and CERTAIN you will do
this every time.

































































[55]

21040 – Dental Cleanings: Set-Up

Results Statement: To assure great patient care by consistently setting up the needed
equipment and supplies for dental cleaning the same way every time.

Primary Responsible Position: Technicians

How:
1. Place a towel on the grate of the wet table
2. Retrieve the dental machine. Set it up by the wet table.
3. Ensure water is at the fill line on the bottle (distilled water ONLY)
4. Attach polisher cup and scaler
5. Plug in unit and attach water tank
6. Prepare this equipment (see separate procedures):
a. Anesthesia Machine
b. Fluid pump
c. ECG/Blood Pressure Machine – plug in near wet table
d. Prophy Pack/Tray – clean one for each patient.
7. Prepare these supplies:
a. Latex Gloves
b. Mask
c. The tooth polish (prophy paste)
8. Assure everything is properly working BEFORE getting patient.

Drill/Quiz for “Dental Cleaning Setup”:
1. Do all technicians set up equipment and supplies the SAME way every time? Why or why
not?
2. If each technician or doctor had dental cleanings set up differently how would that work for
everyone? Would it be more confusing? Would it take longer? Would there be more
chances something might be missed?
3. Go to the treatment room and set up for a dental cleaning so you would be ready to go if
you had a dental patient (open book).
4. Trainer: Go check the setup in the step above. Make sure everything on the machines are
working as set up. Make sure the trainee was able to set up all of this in LESS than 15
minutes.
5. Sign off when all of this is done correctly.


















[56]

21042 – Dental Radiograph Sensor

Result Statement: To assure we have working equipment for our patients and financial
viability for our practice. For this procedure, we ensure the dental
radiograph sensor is meticulously cared by each fully accountable
employee that handles it.



Primary Responsible Position: Technicians

Participating Position: Technician Assistants and Doctors

Why This Procedure: The digital radiograph sensor (DRS) costs approx. $10,000. If damaged,
it cannot be repaired. It must be replaced at full cost to the hospital.
We most often cannot bear this cost without many weeks to months of
planning for this expense. This means our patients will go without
dental radiographs during this time.


What the DRS is: The digital radiograph sensor (DRS) is a thumb-sized flat plastic piece
attached to a long cord that plugs into the digital dental radiograph
machine.

WHERE the DRS is Kept: In the doctors’ office in the upper cabinet with closed doors along the
east wall. It is kept in the hard case with foam. This office is kept
locked when doctors are not working.

HOW to Make Things Easy:
1. Get the DRS only when you need it, not before.
2. Inspect the DRS for any damage BEFORE you check it out.
3. Get TWO signatures when BEFORE you check it out (you plus the
doctor)
4. Keep it with you at all times. Don’t leave the room or let someone else
use it.
5. Don’t put it in a pet’s mouth until you assure the pet is safe, under full
anesthesia, AND does not have jaw-tone (muscle tone in the jaw when
opening it.
6. Check the DRS out with two signatures (you plus the doctor). This step
proves is was not damaged when you were done.
7. The above steps will allow you to feel completely comfortable using the
DRS. With proper care and respect for this equipment is very easy. It
should not be scary.


What is Negligence/Mis-Use:
 Not properly checking the DRS in or out. See above.

[57]

 Throwing, tossing, swinging the DRS
 Stepping on the DRS
 Placing the DRS in a dangerous position (dog’s mouth with jaw-tone,
on the floor, next to something that could fall or move and damage
it, in a sink, etc)
 Pulling on the DRS cord
 Other common-sense actions that could clearly damage it.

What Happens with Mis-use: Failure to comply with the policy may result in disciplinary action and a
maximum fine of $10,000.00(replacement and or repair of sensor).
Negligent/mistreatment of the Dental Radiograph Sensor will be subject
the above corrective action.
What Happens if Lost: If you check-out the DRS and DO NOT check it back in THAT SAME DAY
(lost or stolen), you may be subject to unpaid leave and disciplinary
action up to and including termination of employment.


Drill/Quiz for “Dental Radiograph Sensor”:
1. What is the DRS? Where is it kept? Why?
2. Approximately how much does the DRS cost?
3. Why do we have this procedure?
4. What likely happens if we did not have this procedure? How does this affect YOU, our
patients, our entire staff?
5. In your own words describe the steps you can take to assure you can use the DRS without
worry and fear.
6. With your trainer acting as the doctor physically go to the doctor’s office and check the
DRS out. Immediately check it back in. Use the form, check the DRS for damage, get the
signatures.
7. Get a pass and sign off on this procedure when both you AND your trainer are comfortable
you will follow this procedure and WANT TO FOLLOW IT.































[58]

21044 – Drop-Offs: What to Do

Results Statement: To ensure, when pets are dropped off, patients get proper care, clients
don’t have to wait more than 4 minutes, AND our team has complete
clarity on what each pet needs without having to “remember”.




Primary Responsible Position: Tech Assistants, especially Express TA’s.

Participating Positions: Techs, Kennel Attendants, Bathers

WHO handles:
 For Boarding: Kennel Attendants
 For Grooming: Bathers
 For Vet and/or Tech Services: Tech Assistants
 Express TA Services (Vet care): Express TA’s

HOW to handle Drop-Offs: Ideally every drop-off with vet care needed are scheduled with express
TA’s. See separate procedures for express TA’s.

1. You will hear a receptionist page “Available (Position) to the front for a drop-off
please…(pause)…(position) to the front for a drop-off.” (this page may be made by walkie talkie
to the kennel team.
2. Someone from that position MUST come to the front or call the front WTHIN FOUR MINUTES
MAX, preferably immediately.
a. Assure you have a hospital leash before going up front or on the way.
3. First collect the patient’s record (clip-board) from the reception counter facing exam room 104
in the labeled bin.
4. Look at the pet’s name, size, and breed.
5. Find that client and pet in the lobby. Great the pet first, BY NAME with a smile. Great the client
with a smile too. THIS IS NOT OPTIONAL!
6. If pet is getting any vet exams or surgeries: Assure the release appointment has been
scheduled BEFORE you take the pet back. This can be confirmed in AVImark or verbally with
the receptionists.
7. Take the pet to the appropriate location.
8. Take the record and pet belongings to the appropriate location
9. Write the appropriate needed treatments/boarding/grooming on the appropriate board. This is
the critical part to avoid the staff forgetting to take care of everything the pet needs! DON’T
FORGET THIS STEP!

[59]

Drill/Quiz for “Drop-Offs: What to do”
1. Why do we have this procedure this way? What would happen if we did not? For the clients?
For you?
2. Explain, in your own words, what express TA appointments are for? Why have these?
3. How long is the MAXIMUM time a client should be waiting to drop off? Who do you call if there
is a valid reason you cannot get up front in this time?
4. What do you grab and do BEFORE you go get the pet?
5. How do you greet the pet or client? Is this optional?
6. If the pet is getting vet services done while being dropped off what do you assure is scheduled
before you take the pet back.
7. For boarding, where do you put the clip board? The belongings? What about for grooming or
treatment?
8. How do we assure the pet gets the treatment it needs without people having to remember?





















































[60]

21046v – E-Collars

Results Statement: To ensure patients prone to lick or chew at areas they should not are
properly fitted with an e-collar. Clients are properly charged for this e-
collar also.




Primary Responsible Position: Technicians

Participating Positions: Tech Assistants

How to Assemble:
1. Place e-collar around patient’s neck to check the proper sizing
2. Take the longer plastic piece of the e-collar with the rectangular slot
that fits the size around the neck and loop it through the sizing
slots.
3. (*Note: When folding e-collar over for size fitting the rectangular
slot needs to be on the outside, they need to be visible). These will
be looped through the slots away from the patient. Then take the
small tabs of the e-collar and loop them through the slots from the
outside.
4. Tear off an adequate amount of string gauze and lace through the
loops of the e-collar.
5. Put proper item charge in AVImark on that pet’s record.

How to Fit on Pet:
1. Place over the animals’ head, pulling the ears through, and tie
snuggly while leaving enough space for two fingers to slide between
the collar and the animals’ skin.
2. Tie the string gauze in a bow for easy removal.


Drill/Quiz for “E-Collars”:
1. Demo: With your trainer watching, not helping, put together and e-
collar properly and fit it on one dog of the appropriate size. Leave it
on the pet for at least one minute to assure stays on and is safe for
the pet.
2. Get a pass when you and your trainer is certain you can do this for
any pet.
3. Dis-assemble this e-collar and put it back where it goes.











[61]

21048 – Ear Packing

Results Statement: To provide an efficient, safe, and effective way to treat ear infections
beyond the normal client-applied ointment at home.



Primary Responsible Position: Technicians.
Participating Positions: Veterinarians
What is Oti-Pak: Combination medication that delivers select medication to the inside of
the ear. It stays in the ear killing bacteria and yeast. It dries and
eventually falls out.
It is lanolin based and the Oti-Pak-E variant contains:
o Enrofloxacin 0.23%
o Ketoconazole 1%
o Triamcinolone Acetonide 0.1%
Dosage:
o ~ 3 cc per ear for dogs over 35 lbs
o ~ 1.5 cc per ear for dogs under 35 lbs
o ~ 0.5 cc per ear for cats

AVImark: Code – 51139 Oti-PAK E (per cc)


Reference Procedure. No need for drill/quiz. This will be trained on-the-job.




































[62]

21050v – ECG’s

Results Statement: To assure accurate and efficient service of performing ECG’s on patients

Primary Responsible Position: Technicians

Participating Positions: Tech Assistants

How:
 Turn tablet on
 On main screen; double click on the “Bee Doctor” App
 On home screen the following should be visible
o Current patient
o Client #
o Clinic number: 8251
 Click on the CURRENT PATIENT tab
 Add new patient
 Fill in the following
o Name- Pets Name, Gender, Age , Weight, Breed
o Email ( [email protected])
 Click Next
 The next page should be “Questionnaire Form”
 Fill out required fields
o If it is a Pre-OP ECG then type what procedure is being done
 Hit “OKAY”
 Plug in tablet to the USB port on the computer
 Attach clips to patient as required.
 When the pop up appears – tap “OK”
 To run the ECG- hit the green power button in the middle of the
screen
 Hit the record button on the right hand side of screen after there is
flat line present ( total recording time = 30 seconds to 2 minutes)
 After recording is stopped it will then transmit over to IVS for a
reading.
 Email will be sent as requested back to the desired email.
([email protected])

Drill/Quiz for ECG’s:
1. Using a stuffed animal or actual pet set up and run a pre-op ECG in front of your trainer. DO
NOT CLICK SEND.
2. Get a pass when both are and your trainer are 100% comfortable you can do this procedure in 5
minutes or less.




[63]

21051 – Emergencies

Results Statement: To assure all pets who need a doctor immediately (and clients who feel
their pets need to see a doctor immediately) get that service, are
charged appropriately, and satisfied. To assure cases are properly
triaged if we have multiple emergencies in the same time frame.



What is an Emergency?: If the pet or the client needs a vet RIGHT NOW, it IS an emergency. It
does not matter whether we are fully booked, totally caught up, client
does not have money, gets euthanized, etc. It is an emergency.

When Do We See Them? ANYTIME WE ARE OPEN.

When Client Calls Ahead: Receptionists as much information about the pet and relay the
information to the treatment staff.

What if a doctor is not here? See procedure 21052 Emergencies with No Doctor.


Three Types of Emergencies:

True: Pet is critical and client knows it.






Pet Only: Pet is critical but client does NOT KNOW IT.











Client Only: Client FEELS pet is critical although it is NOT









[64]

How Each Type is Treated: All three types are treated exactly the same. We get a doctor
immediately! See the next page.

Steps to take for Each Type:


True Emergency: Pet is critical and client knows it. This is the type that is the most common.

1. Page overhead “Technician to reception STAT!” Technician will get the pet to the
doctor IMMEDIATELY
2. Client stays in the building. THE CLIENT DOES NOT LEAVE UNTIL THEY HAVE
SPOKEN TO THE DOCTOR. We need to make life and death decisions NOW. A
doctor needs to speak to that person in person before they leave!
3. Client signs a full treatment plan recommended by doctor and pays the FULL
AMOUNT of treatment plan as a deposit BEFORE leaving. Certain exceptions to this
deposit will be made by doctors and management only.

Pet Only Emergency: Pet is critical although the client does NOT KNOW IT.

1. IF IT IS AN OBVIOUS EMERGENCY (NOT BREATHING, EXCESSIVE BLEEDING, ETC.):
Page overhead “Technician to reception STAT!”…or…Technician will get the pet to
the doctor IMMEDIATELY.
2. IF IT IS NOT AN OBVIOUS EMERGENCY: Get a technician to determine if the patient
should be treated as an emergency. Do this by paging “technician triage”.
3. If it should be treated as an emergency, client will need to be informed that the
animal is having an emergency and will need to see a doctor IMMEDIATELY! The
emergency exam fee applies because we will not let their pet suffer and go
without immediate treatment.
4. Client stays in the building. THE CLIENT DOES NOT LEAVE UNTIL THEY HAVE
SPOKEN TO THE DOCTOR. We need to make life and death decisions NOW. A
doctor needs to speak to that person in person before they leave!
5. Client signs a full treatment plan recommended by doctor and pays the FULL
AMOUNT of treatment plan as a deposit BEFORE leaving. Certain exceptions to this
deposit will be made by doctors and management only.

Client Only: Client FEELS pet is critical although it is not

1. Page overhead “Technician to reception STAT!” Technician will get the pet to the
doctor IMMEDIATELY
2. Client stays in the building. THE CLIENT DOES NOT LEAVE UNTIL THEY HAVE
SPOKEN TO THE DOCTOR. We need to make life and death decisions NOW. A
doctor needs to speak to that person in person before they leave!

[65]

3. Client signs a full treatment plan recommended by doctor and pays the FULL
AMOUNT of treatment plan as a deposit BEFORE leaving. Certain exceptions to this
deposit will be made by doctors and management only.


Which Doctor? Below is a basic guideline of which doctor would be best to see the
individual pet emergency. It is a form of triaging of which doctor should
handle the case.

GUIDELINE: In numerical order starting with the MOST likely doctor to
take the case to the least likely doctor. For example: If one doctor is on
the phone (#4) and the other is in an exam room (#5), the doctor on the
phone politely hangs up and takes the case.

1. Doctor completely caught up and NOT leaving for lunch or end-of-
shift within 30 minutes.
2. Doctor only working on medical records
3. Doctor standing in treatment room
4. Doctor is on the phone.
5. Doctor is in an exam room.
6. Doctor is in surgery.

NOTE: It is understood that there can be exceptions using good
judgment. We always keep the priorities in line with:
1. Pets’ health staying the highest priority and
2. Client service staying #2.
3. Doctor’s convenience or preference is a DISTANT third

Emerg. Surgeries when Open:
Reschedule other clients?
 Whenever emergency surgery will delay other clients, receptionists
must be informed call to re-schedule those appointments.
 Those receptionists will explain to the reason for the re-scheduling or
delays.
 It’s easier to re-schedule existing clients than new clients. You will want
to be more creative and accommodating to get new clients seen.
 We can offer clients incentives such as free bath or NT as a thank you.

Block-Offs:
 Block off time in the schedule to allow the DVM and their team to
devote themselves to the patient needing the surgery.












[66]

How we handle the other appointments:

o ALL OTHERS WAIT: With emergencies all other appointments and surgeries all go “on-
hold”. We do NOT have enough scheduled support staff to be handling emergencies
AND regular appointments at the same time for one doctor.
o WATING CLIENTS ARE GIVEN OPTIONS: The staff joins to together to inform ALL waiting
client and upcoming appointments of this delay. The client is given options.
o UPCOMING CLIENTS ARE CALLED: ONLY Receptionists, Department Heads, or Execs (not
techs or TA’s) will use good judgment to call upcoming appointments that are likely to
be delayed. The doctor will give estimate of how long the delay may be. The doctor will
over-estimate. Clients will be offered options (longer wait, reschedule for later,
reschedule for another day if NOT sick or injured).
 Note: Good judgment on these calls are critical. For example, if a doctor is in
emergency surgery we may be forced to reschedule a vaccine appointment for
another day. An itchy dog appointment may need to be seen today regardless
because the pet is uncomfortable or painful.



Drill and Quiz for “Emergencies”:

1. What would happen if we did not have the procedure?
2. WHEN do we see emergencies?
3. When should you page “Tech Stat”? Should you wait 30 seconds?
4. On the PET only emergency, what would happen if you did not tell the client about the
emergency fee as you paged “Tech Stat”.
5. What could happen if the client left before talking to the doctor personally?
6. What could happen if we did not get FULL payment before the client leaves? What if they did
not sign the treatment plan?
7. What do we do with the other waiting or upcoming appointments? Who does this?




























[67]

21052 – Emergencies with NO DOCTOR

Results Statement: To properly handle an emergency with no doctor in the building
in a way that is best for THAT PATIENT, not what is best for us.















Primary Responsible Position: Technician

Overview: Occasionally clients will walk in with emergency cases when we
do not have a doctor in the building. This typically would
happen before 8 AM on weekdays or during lunch hours. This
procedure gives you the exact steps to take in order to get the
patient cared for as soon as possible.

See “Emergencies” procedure for definition and three types of
emergencies. This procedure applies to all three types of
emergencies. In most emergencies it is safe to wait the 10-15
minutes on our doctors while our techs do what the doctors
advise by phone.


























[68]

What to do on emergencies with NO DOCTOR:

1. Before 8 AM:
a. Page a technician to come take the patient to the back and monitor.
b. Immediately call the appointment doctor that is scheduled to arrive at 8AM on that
doctor’s cell phone number.
i. If not reached leave a voice mail.
ii. Call the surgery doctor or any other doctor scheduled for that same day.
iii. The doctor WILL call back before they get here.
c. Communicate very clearly with the client on the following:
i. We do not have a doctor in the building at this time but are calling our doctors
to get an estimated time they can be here AND anything that can be done for
their as the doctor directs us by phone.
ii. If we are unable to immediately reach our doctors the client has the option of
taking them directly to the emergency clinic where they are open with doctors
on staff. They can also wait until our doctor calls back.

2. On lunch or during doctor meetings out of office:
a. Same as above but:
i. Call the doctor who is next scheduled for appointments. That doctor WILL have
his/her phone available and cut their lunch short to return here and treat the
patient.
ii. Keep in mind that the doctor may not be able to immediately answer their
phone but should be able to call back within less than 5 minutes.
iii. Tell the client what you are calling the doctor to get them back to the clinic
ASAP.
iv. The emergency clinic is NOT open but the client always have the option of going
to the closest clinic to us which is Stonebriar Vet 1 ½ miles south on Legacy. We
want whatever is best for the patient, regardless of which clinic.



Drill/Quiz on “Emergencies with NO DOCTOR”:
1. Why do we have the procedure? What might happen if we did not?
2. Explain what YOU would do and say in your position when this happens:
a. Before 8 AM
b. During doctor lunches or doctor meetings held outside the building











[69]

21054 – Euthanasia House Call Supplies

Results Statement: To all our doctors to be fully prepared for at-home euthanasia without
needing to consult with doctor.






Primary Responsible Position: Technicians

Participating Position: Tech Assistants

Supplies Needed:

½ Inch Tape Muzzles
1 Inch Tape Needles 18g, 20 g, 22g, 25g (3 of each)
Clippers New Client Form if needed
Directions to Home Pen
Doctor Bag Platinum Pet Book
Domitor Pre Invoice
Euthanasia Form Scissors
Euthansol Stethoscope
Extension Set Syringes 3cc, 6cc, 12cc (3 of each)
Flush (6) T- Ports (3)
Gauze Telazol
Gurney Tourniquet
Home Number Towels
HydrogentPeroxide with Gauze Vetwrap – 2 inch
IV Catheters 18g (3), 20g (2), 22g (5), 24g (2)


Reference Procedure Only. No drill/quiz needed.
























[70]

21056 – Euthanasia

Results Statement: To complete euthanasia’s in way that is both sympathetic to the client,
comfortable and ethical for the pet, medically prudent, and financially
sound for the client and hospital.

BEFORE the Appointment:

 See “Communication Scripts”, “Appointment Making – DVM’s” and
“Scheduling Guidelines” for making the appointment.

 The receptionist will print the euthanasia form for the client sign
along with the treatment plan.

 A doctor consultation and/or exam is REQUIRED if:
o It is a new patient or
o We haven’t treated the patient for a chronic illness.
o This is required so that the doctor that be comfortable it is
the right decision before it’s completed. If in doubt, ask the
doctor.

DURING the Appointment:
 Receptionist, tech or TA escorts the client into the exam room ASAP,
immediately if possible. This is an extremely emotional event and
clients do not want to be out in the open for others to see.
o Tech and TA responsibility only (not receptionists):
o After the doctor examines the patient, if exam is required,
the technician will go into the exam room to discuss final
arrangements (private or group cremation) and offer a Paw
Print.
o The technician will have the client sign the Euthanasia form.
o The technician will enter the amount of Euthasol used in
AVImark on the patient’s chart.
o The technician will call the receptionist from the back and
let them know the client is ready to pay.

 The receptionist will go into the exam room and process the
payment from the client BEFORE the euthanasia WITHOUT THE
CLIENT leaving the exam room.

 Unless a special circumstance exists payment is BEFORE the
euthanasia. This allows the client to leave after at their
convenience without having to do anything.
 After the client has paid, the receptionist will call the back to let the
technician know payment has been collected.







[71]

For Techs and TA’s ONLY:
 AFTER the Euthanasia:
 Go Online to start the process of requesting cremation services with The Pet Loss Center.
 For online instructions go to: Staff Shares  Procedures Manual (most current date)  Forms-
Misc.  “Cremation Instructions for Pet Loss Center”.
 The technician will complete the tag with the correct information and attach with a rubber band
to the bag.
 If the patient is put on hold, the technician is to complete the “Hold” tag with the correct
information and attach with a rubber band to the bag.
 After the patient is tagged, ANOTHER tech or TA must verify that the patient has the correct tag
and enter notes on the patient’s chart in AVImark that he/she confirmed the patient was tagged
correctly.
 Put the deceased pet in the freezer ONLY AFTER ASSURING it has the correct tag.


Drill/Quiz for “Euthanasia”:
1. Explain in your own words what the result statement is. What are we obtaining with this
procedure?
2. What would happen if we did NOT follow the steps of the procedure? What if the client was not
escorted into the exam room immediately? What if the client had to check-out AFTER the
euthanasia? What if they had to come out into the reception area to check-out?
3. Using demo pieces for the pet, the client, the exam room, the reception area, etc. explain the
basic steps of how the euthanasia works smoothly. Show your trainer.







































[72]

21058 – Exam Room Efficiency

Result Statement: To have EACH veterinarian see appointment in TWO exam
rooms with each appointment staggered by at least 10 minutes.
To have support staff properly scheduled and trained in their
position so that we are increasing quality patient care, client
satisfaction and staff well-being. We are doing this while being
prepared to handle emergencies and urgent care….keeping
appointments on time at least 90% of the time.


Primary Responsible Positions: Receptionists, Techs, TA’s, Express TA’s, and Doctors

CRITICAL FACTOR: These three critical factors are true every day for all positions. They are
even more critical for exam room efficiency. If they are not followed
1. DON’T ABANDON YOUR POST!
2. HELP OTHERS…after you have handled your own post.
3. DO ONE THING AT A TIME, IN THE RIGHT ORDER: In most every
situation, we have specific positions to handle it. If you have two
responsibilities at the same time know what to do first! Get help if
someone else is caught up. Follow this order.

CRITICAL PETS:
a. Emergencies: If you are needed, help! If not, move on.
b. ICU/Critical Pets: Treatment Techs and TA’s handle this.

CRITICAL CLIENTS:
c. Doctor Appointments: Doctors and Room Techs
d. Express TA Appointments: Express TA’s

UNSCHEDULED:
e. Walk-ins/Urgent Care Visits: Only after appointments
f. Advance Appointments: Extra unscheduled services come
after scheduled appointments.
g. Drop-Offs: Finish when caught up or in-between above.



















[73]

Exam Room Techs:
 Room Techs can spend up to total length of appointment time (20-40 minutes) total.
 Assure your appointments are finished on time in order to start the next on time IN THE SAME
EXAM ROOM.
 Any times spent longer than above puts us behind.
 Transfer ALL treatments and labs done OUTSIDE THE EXAM ROOM to the treatment tech or TA
team.
o If they are too busy to take the patient right then:
- Label a cage card with patient name and client last name.
- Put the patient in an ICU cage.
- Write on the Tech board exactly what labs/tx’s you need done.
 On Saturday, if something is going to take longer than the allotted schedule time coordinate first
with the staff veterinarian to recommend a patient drop off in order for the treatment team to
complete the work.
o Have client sign “Medical Release Form” and clarify a good phone number to reach
them
 Any pets left for the treatment team must be:
o Personally handed to the treatment team with instructions… -- OR --
o Placed in ICU cage with cage card and instructions on treatment board.

Treatment Technicians and TA’s:
 Complete all treatments and labs as indicated by the veterinarian and room technicians
 Turn patients back over to the room tech when done.
 Turn lab results in to doctor when they are done.
 Watch Tech board closely and mark any items as completed on Tech board.
 Triage patients appropriately. (Example: Emergency, ICU, Appointments, surgery, then drop
offs, boarding, etc.)
 Make sure all patients STAY labeled appropriately and no pets are left unattended outside of a
cage.
































[74]

Veterinarians:
 Efficient visits
o Start and End on Time – Appointments must be finished within the scheduled time (20-
40 minutes) at last 90% of the time.
o Spend less than 10 minutes for
 Time in exam room and
 Time to dictate tech sheets to exam room technician
 Records must be completed between appointments 90% of the time. It is
acceptable to delay an appointment up to 3-4 minutes in order to complete the
last patient’s records.
 Any times spent longer than above puts us behind resulting in
 Unsatisfied clients
 Stressed staff
o Maintain good and clear communication with clients and staff
o Client CALLS are conducted during breaks, lunch, before or after hours
 Exception:
 Pets currently under care or in the hospital
 Referral calls from other veterinarians

















































[75]

BLOCK-OFFS:
Saturdays
 Exam Room 3 (Start Time 8:00 am)
o E-Slot (20 minute)
 9:40 – 10:00 am
 1:40 – 2:00 pm
o Buffer
 11:40 – 12:00 pm
 3:40 – 4:00 pm
o Out of Office (Lunch)
 12 – 1 pm
 Exam Room 4 (Start Time 8:10 am)
o E- Slot (20 minute)
 10:00 – 10:20
 1:50 – 2:10 pm
o Buffer
 11:40 – 12:00 pm
 3:40 – 4:00 pm
o Out of Office (Lunch)
 12 – 1 pm
Sundays
 Exam Room 3 (Start Time 10:00 am)
o E-Slot
 11:40 – 12:00 pm
o Buffer
 1:40 – 2:00 pm
 Exam Room 4 (Start Time 10:10 am)
o E-Slot
 1150 – 12:00 pm
o Buffer





























[76]

Scheduling (receptionists):
 Stagger appointments so that no appointment starts at the same time.
 Schedule appointments 10 minutes later than appointment on opposite room
 FOR OWNERS WITH MUILTIPLE PETS - schedule in THE same exam rooms to maintain exam
room efficiency. Schedule each pet the appropriate length of time for THAT INDIVDUAL PETS
APPOINTMENT so both pets’ times are added together.

Example: If one owner is bringing in two pets for annual visits each pet is scheduled for 20
minutes back-to-back in the SAME ROOM as it happens. We realize there may be another
appointment 10 minutes after starting this one. It may be delayed a few minutes. That’s okay.

 IMPORTANT!!!:
o DO NOT add space or block-offs between appointments.
o DO NOT scheduled the same TYPE of appointment within 10 minutes of each other.
o Appointment schedule is NOT to look like a checker board with empty spaces in
between appointments. The goal is to have one doctor to be able to see double the
normal number of appointments.




















































[77]

Drill/Quiz for “Exam Room Efficiency”:
1. What would happen if we did not follow this exactly as written? How would it affect you? How
would it affect those you work with?
2. Do you stagger appointments by 10 minutes?
3. Do you add spaces or block-offs between appointments so it looks like a check board? Why or
why not?
4. With a diagram or floor plan drawn out on paper we use demo pieces to represent the:
a. client,
b. patient,
c. room tech,
d. treatment tech,
e. treatment TA
f. doctor
g. clients and patients in exam room waiting
5. Draw on another sheet of paper appointments in two exam rooms staggered with times as per
the scheduling grid. Basically draw the schedule as it would look in AVImark with the doctor
name. Write the tech name above each exam room.
6. Using the demo pieces show where all of the demo pieces would go as the appointments in the
two exam rooms as you verbally say the 10 minute times.

Example: Ear infection –
 At 10 AM the room tech escorts the client to the exam room.
 From 10 to 10:08 Dr. Julius in the exam room with room tech, client and patient.
 From 10:08 to 10:10 Dr. Julius moves to his office with room tech to dictate the tech sheet with
ear flush.
 From 10:10-10:14 the room tech prints the treatment plan and goes over it with client.
 At 10:15 the room tech moves the patient to the treatment room, transfers info to the treatment
tech team to complete things.
 10:15-10-20 – the room tech prints all meds and release instructions.
 10:20-10:25 – the room tech goes over all meds, schedules recheck, and escorts client the
reception area.
 10:25 – the room tech escort the patient to the client in the reception area after all treatments
have been completed.
 10:30 – the room tech cleans the exam room and gets it ready for the next appointment. They
have 10 minutes to spare. They can help others, make a couple client calls, or be ready for the
next appointment early.




















[78]

21060 – Exam Room Stocking

Results Statement: To assure patients get the care we recommend by having readily
available education and demo materials in each exam room at all times.







Primary Responsible Position: Technicians

Participating Positions: Tech Assistants.

How: Daily stocking of exam room supplies based on the pictures and lists
inside the cabinet door and tech procedure “Brochures in Exam Rooms”.
This is done daily and assured that it’s done via the tech checklists.

Drill/Demo for “Exam Room Stocking”:
1. Why would we have exam rooms stocked the same way in each exam room?
2. What will likely happen if we don’t do this daily? How would it affect the client, the pet, you?
3. Show your trainer where the brochures are in an exam room.
4. Show your trainer where the back-stock of brochures are kept.
5. Show your trainer where the pictures and lists of how to keep exam rooms stocked are.






































[79]

21062 – Eye Stain Supplies: Dr. Julius
Result Statement: To ensure Dr. Julius can quickly perform an eye fluorescein stain without
needing to inform his technical team of everything to get.




Primary Responsible Position: Technicians and Tech Assistants
Items Needed:
 Eye Irrigating Solution
 1 Eye Fluorescein Stain Strip
 Woods Lamp
 Gather above supplies. Dr. Julius will take care of the rest.



Reference procedure only. No drill or quiz needed.



















































[80]

21063 – Fentanyl Patches


Results Statement: To assure consistent patient care, staff confidence, and avoid
most client concerns by applying fentanyl patches in a standard
way for the vast majority of patients.







Primary Responsible Position: Doctors
Participating Positions: Techs and TA’s

How to Apply:

1. The pet’s coat is shaved to the skin (avoiding clipper burns)
to a clean square shape that is approx.. twice the size of the
patch to be applied.
2. The shaving is done either side of the chest just behind the
elbow (craniolateral thorax).
3. The shaved area is cleaned routinely and rinsed with
alcohol. No loose hair should remain in this area after.
4. The patch is warmed via your hand or skin for at least one
minute so the adhesive will stick better. This adhesive
sticking is THE only way it gets absorbed into the pet’s
bloodstream.
5. 1 drop of tissue adhesive (super glue basically) is applied to
each corner of the patch before it’s adhered to the skin.
6. Patch is held against the skin with your hand for at least one
minute to assure the adhesive sticks.
7. Elasticon is adhered to the skin and patch after application
covering the entire patch.



Drill/Quiz for “Fentanyl Patches”:

1. Why do we all adhere fentanyl patches the same way every time? What happens if we don’t?
For the clients? For the staff as a group?
2. Show your trainer how you would apply a patch and explain all steps in your own words.









[81]

21064v – Follow-Up for Techs and TA’s

Result Statement: To assure all client have caring and punctual follow-up phone calls on
technical and medical issues. Clients feel well served. Clients
appreciate each and every call. All tech follow-up calls are completed
DAILY WITHOUT FAIL.


Primary Responsible Position: Technician who initials checklist as follow-ups completed.

Resources: Computer with AVImark, Phone, Individual trained on “AVImark 101”

Steps:
1. Start follow-up list at 9 AM or after day.
2. Go to: Work With > Follow-Up List.
3. Identify the calls needing to be completed by techs or TA’s TODAY:
a. All calls in red (calls to be made today) AND
b. Are listed as “TTC” (Tech to Call”)
4. Start at the top of the list and complete EVERY CALL IN RED. Call the
client.
a. Start the description with your date/time stamp.
b. Finish the description with brief (<1 minute to type) description
of what the all was. Example: “LMOM informing the client their
special order was ready to be picked up.”
c. Post that follow-up call to the patient record. (right click > post)
5. Move on to the next call in the follow-up list.
6. Leave a hand-written phone message for the doctor on any “DTC”
follow-ups that should have been called by now (first day due AND the
next day the doctor is working).
7. Type a note on that “DTC” follow-up that you left the doctor a note. DO
NOT POST
8. When all calls are completed INITIAL THE LINE ON YOUR CHECKLIST on
Follow-Ups as completed.
Notes and Tips:
1. Negative fecal exams or heartworm tests alone are for techs to call, not
doctors
2. Lab panels and positive results are for doctors to call.


Drill/Quiz for “Follow-Up Lists for Techs and TA’s”:
1. Why would you COMPLETE your position’s follow-up list every day?
2. What would happen if you skipped it or only did 90% of it? For the clients? For you?
3. PRINT on of your position’s checklists. Show trainer where the follow-up line is?
4. Pull up the follow-up list in AVImark for your trainer. Make one call from it to an actual client.
Complete the procedure above. You get a pass when your trainer confirms you can do it.




[82]

21066 – Good Samaritan Cases

Results Statement: To help ALL pets in emergency situations, including those pets
brought to us by non-owners (good Samaritans). As a result, we
are helping the community by providing certain emergency
services free of charge.

Primary Responsible Position: Receptionist

What is a Good Samaritan case? A pet who is found (NOT by the owner) in need of immediate
emergency medical care AND is

What can we do for a Good Sam case?
 Provide a FREE emergency doctor exam
 Stabilize the pet for any critical issues.
 Manage any acute pain.
 This allows a Good Samaritan to have the pet examined
and stabilized with no financial obligation.
 The doctor can give the good Samaritan an estimated
cost for continued non-emergency care.
 Offer the contact info for local rescue groups for any
non-emergency care.


What is NOT a Good Samaritan case? A pet in good health that is found by a person who intends to
keep the pet and is willing to take financial responsibility for the
patient whether they keep the pet or not.

A pet in good health that is found and NOT in need of
immediate emergency medical care.

What can we do for a non-Good Sam case?
 Take care of the pet at the expense of the person that
brought us the pet.
 The person who brought the pet signs all routine
paperwork and pays any required deposits.
 We can offer a New Client Free Exam coupon after
routine paperwork and check-in.
 Offer the contact info for local rescue groups for any
non-emergency care.

Drill/Quiz for “Good Samaritan Cases”:
1. Why do have this procedure? What would happen if we did not? If the staff did not know it?
2. Explain in your own words what is Good Samaritan cases and what we can do for them.






[83]

21068 – Gown Packing for Surgery

Results Statement: To assure we are FULLY ready for surgeries at the beginning of each day
by having all surgery gowns autoclaved before leaving EVERY EVENING.

Primary Responsible Position: Technicians

Participating Positions: Tech Assistants

Resources Needed: Surgery wrap, a gown, a blue towel, an indicator strip, and a piece of
indicator tape.
How:
1. Fold the gown:
a. Make sure the arms of the gown are pulled out. (There’s an outside of the gown and an
inside of the gown. You can look at the stitches and identify the sides.)
b. Fold the top corners of the gown together. The ‘inside’ of the gown out.
c. Pull the inserts for the arms out and hold together, then lay the gown flat on the
counter.
d. All stings are inside except for the two strings around the neck.
e. Now horizontally fold the gown accordion style, from the side of the arms to the other
side, making sure to keep the strings pulled out.
f. Finally, we’re going to fold the gown accordion style vertically, starting from the bottom
up. Placing all the strings at the final fold.
2. Fold the blue towel:
a. Fold it accordion style both ways as well.
3. Place the blue towel on top of the folded gown with the indicator strip in under the blue towel.
4. Lay out the surgical wrap in a diamond shape and place the folded gown and blue towel in the
center
5. Fold the corners in as you would in the surgical pack: Pull the corner closest to you, while
holding down the contents of the pack and pulling the surgical wrap tight, and fold over
accordion-style.
a. Tip: use your elbow to keep the contents from moving as you pull the towel tighter)
6. Rotate the pack 90 degrees making sure you maintain the tightness of your fold.
7. Repeat step 5 again making sure the contents remain tight.
8. Rotate the pack 180 degrees to fold the opposite side from which you just folded and repeat
step 5.
9. Rotate a final time to where the final flap is pointing towards you and repeat step 5. This is
when you make sure you make the pack real tight. You then insert the flap under all the
previous folds keeping a small part of the flap exposed so the user can easily open the pack.
10. Place a strip of indicator tape, closing the pack. Write the date, type of pack (Gown), and intial.
11. Place in the autoclave. See separate procedure.

Drill/Quiz for “Gown Packing for Surgery”:
1. Why do we have this procedure so everyone does it the same way? What would it be like if all
technicians did not do it this way?
2. How often do we have gowns ready? Why? How would YOU be affected if we did not?
3. With your trainer watching pack a gown exactly as listed. Get a pass when you can do it alone.

[84]

21070 – Grooms Needing Sedation
Result Statement: To assure the highest quality patient care and client service for pets
requiring sedation with grooms. We assure the pet is properly
scheduled for the client and our staff. We also assure the sedation is
safe.



Primary Responsible Position: Receptionist

How to Schedule: Follow the surgery scheduling guidelines (see separate procedure).
o Only scheduled on weekdays we are open until 8 PM.
o Scheduled on the DOCTOR’S schedule and GROOMER’S
schedule for the same time on both.
o Scheduled for one hour
o Scheduled before 3:00.

What to Tell the Client:
 No food or water after 10 PM the night before the groom
 Arrive between 7 and 7:30 AM
 Like surgeries there is no promised completion time.

Safety Requirements: Doctor exam is required if:
o A new patient or
o Hasn’t had an exam in the last 6 months,
Bloodwork is required if:
 Has not had a blood panel in the last 6 months (assures
organs can handle the medications).
 If bloodwork was done at another practice, our doctors
must review it prior to the sedation

How It Works: The doctor’s technician will monitor the sedation for safety.

For patients who have had a current exam AND blood test in the last 6
months the doctor will direct the technical staff on the time and type of
sedation/anesthesia without further testing.

For patient who have NOT had an exam OR blood test in the last 6
months a note will be left for the doctor to review the patient’s record.
The doctor will determine what time of tests or anesthesia will be
needed for that patient. This could vary based on level of patient’s
aggression, age, medical history, etc.









[85]

Drill/Quiz for Grooms Needing Sedation:
- Why do we have this procedure? What if we did not follow this? What could happen to the pet? To
the client service? To the staff?
- Explain how we schedule sedated grooms.
- Explain how you would perform the sedation on a cat, for example.
- Get a pass when both you and your trainer are sure you can do this independently.



































































[86]

21072 – Heartworm Positive Dogs
Results Statement: When dogs test positive for heartworms we follow the
guidelines of the American Heartworm Society. Clients can be
directed to their website if they have questions or concerns
about our plan at www.heartwormsociety.org

Primary Responsible Position: Associate DVM’s

Why we do it this way: Because the treatment involves a drug with a narrow margin of
safety, a large expense, and varies from vet-to-vet we will take a
detailed series of steps. This will assure two things:
1. Patients get the safest most effective treatment
2. Clients understand why this is the ONLY safe way to treat
their pet and decided upon by a group of professionals in
this field, not us.
Steps to take:
1. Call the owner to return with pet for a 20-minute doctor appointment at NO EXAM/CONSULT
CHARGE.
2. Print 4 treatment plans for the is visit – “Work With” > Estimates
a. Heartworm Workup – customized for what else is needed. Write on the page with a
sharpie “Testing” for the owner.
b. Heartworm Tx __ lbs Day 60 - Write on the page “Day 60” with a Sharpie for the owner.
c. Heartworm Tx __ lbs Day 90 – Write on the page “Day 90” with a Sharpie for the owner.
d. Heartworm Tx __ lbs Day 120 – Write on the page “Day 120” with a Sharpie for the
owner.
3. For this appointment the tech:
a. Presents the estimate for:
i. Heartworm Antigen test through Antech (It is not financially feasible for us to
carry the in-house snap tests.).
ii. Heartworm prevention if not on already
iii. Microfilarial test.
b. Draws the blood,
c. Gets the doctor.
d. Runs the blood slide and looks for microfilaria. If positive we do not have to run the
Antech test….If negative we do.
4. The Doctor goes and on a blank sheet of paper writes down the the four steps – Tests, Day 1,
Day 30, and Day 60. The doctor discusses what we do at each stage an why. The doctor also
discusses how it may be done by skipping steps at another vet but is not entirely safe. After the
vet assures the client understands the plan they turn it back over to the tech.
5. The tech or TA goes back into the room with the 4 pre-printed Treatment Plans. The owner
should schedule the “Testing” treatment plan at this point. If we get lucky and the follow-up
rd
test comes up negative we can cancel the treatments all together or run a 3 test.
See next page for doctor info on treatment protocol








[87]

Treatment guidelines per The American Heartworm Society as of February 2014

Day 0: Dog diagnosed and verified as heartworm positive.
 Positive antigen (Ag) test verified with 2nd Ag or microfilaria (MF) test
 Clinical signs with one positive Ag test and MF test (for status)
 Begin exercise restriction.
 The more pronounced the symptoms, the stricter the exercise restriction
 Testing recommended by LVH to be safe:
Chest Rads, CBC/Chem/Lytes, UA, Blood pressure (“Heartworm Workup” in AVImark)
 If the dog is symptomatic:
o Stabilize with appropriate therapy and nursing care.
o Prednisone prescribed at 0.5 mg/kg BID 1st week, 0.5 mg/kg SID 2nd week, 0.5 mg/kg
EOD 3rd and 4th week

Day 1: Administer heartworm preventive.
 If microfilariae are present, pretreat with antihistamine and glucocorticosteroid, if not already
on prednisone, to reduce risk of anaphylaxis.
 Observe for at least 8 hours for signs of reaction

Day 1–28: Administer doxycycline 10 mg/kg BID for 4 weeks.
 Reduces pathology associated with dead heartworms
 Disrupts heartworm transmission

Day 30: Administer heartworm preventive.

Day 60: Administer heartworm preventive.
 First melarsomine injection 2.5 mg/kg intramuscularly (IM)
 Prescribe prednisone 0.5 mg/kg BID 1st week, 0.5 mg/kg SID 2nd week, 0.5 mg/kg EOD 3rd and
4th week
 Decrease activity level even further.
 Cage restriction/on leash when using yard

Day 90: Administer heartworm preventive.
 Second melarsomine injection 2.5 mg/kg IM
 Day 91 Third melarsomine injection 2.5 mg/kg IM
 Prescribe prednisone 0.5 mg/kg BID 1st week, 0.5 mg/kg SID 2nd week, 0.5 mg/kg EOD 3rd and
4th week
 Continue exercise restriction for 6 to 8 weeks following last melarsomine injections.

Day 120: Test for microfilaria. If positive treat with microfilaricidal and retest in 4 weeks.

Day 271 (9 months): Test for Heartworm antigen (6 months after completion of treatment)

Drill/Quiz for “Heartworm Positive Dogs”:
In your own words describe all the steps you will take when you get a heartworm positive case.




[88]

21074 – Heating Pads
Results Statement: To provide great patient care by having a safe and effective way to use
heating pads.




Primary Responsible Position: Technicians

How to Set Up:
 Unravel the pump hose and set blue heating pad on surgery table.
 Before you turn the pump on, make sure the water reservoir is filled.
(tap or distilled may be used)
 Cover with a pillow case during each use and changed after each use.
Do not cover heating pad with towel, it decreases the heat.
 Plug pump into a wall outlet.
 Make sure the hoses are unclamped before turning the pump on.
 Turn the pump on.

How to Use:
 Set temperature by holding down the up and down arrows key located
on top of the pump for 1 sec it will beep 3 times. While flashing you can
change the heating pad temperature (The unit has a preset temp 105 f
do not change the setting otherwise instructed by a doctor) after you
have the correct temperature the unit will beep once.
 The check “Flo” display may occur within the first few minutes of service
if the pad has not been fully connected to the pump hoses or the pad
has been folded to tightly a beep accompanies this display.
 The “HI” displays indicate that the primary or secondary limit has been
triggered an audible beep accompanies both displays. (see manual for
trouble shooting)
 When using the heating pad with CATS, the patient should be sedated
PRIOR to putting them on the heating pad. Never place an un-sedated
cat on the heating pad. Cat nail punctures can ruin the heating pad.
 When not in use, turn pump off by unplugging pump, clamp hose, wrap
hose and cable neatly around pump and roll up heating in a loose roll…
not tightly.
 Clean the outside of the pump and heating pad with soap and water
only…NEVER use bleach. Change water monthly.
 Do not leave patient on heating pad for more than 3 hours without
moving.

[89]

Drill/Quiz on “Heating Pads”:
1. Why do we have a specific procedure on heating pads? What can likely happen without this
procedure? For the patient? For the staff?
2. Can you put an awake cat on a heating pad? Why or why not.
3. What is the maximum time you can put a pet on a heating pad? Why?
4. Do you cover the heating pad with anything? A towel? Why or why not?







































































[90]

21076 – Hospital-Use Items

Results Statement: To assure we provide great patient care by using certain items for
operations that are ALSO sold to clients. These items are both:
a. Kept accurate in AVImark for on-hand quantity
b. Use appropriately so it’s cost-effective





Primary Responsible Position: Inventory Manager (but used by nearly all positions)

Examples of Hospital-Use:
 Candles to be burned in the reception area
 Treats and chews used in exam rooms or reception area
 Pill Pockets

Steps in AVImark:
1. Enter “Julius” into client selection field
2. Choose “Kent Julius”
3. At bottom of account choose “Hospital Use”
4. Hit “F2” and then type either the item # or item description and
choose from list
5. Enter quantity used and “DO” for doctor
6. Hit “Done”
7. Highlight the item and choose “Notes” from side column
8. Time stamp and then notate the manager that approved and what
the item is being used for
9. Post the item in AVImark. This is the ONLY step that takes it out of
our on-hand quantity. If you don’t do this step, we will run out of it.

Form to Use:
1. See “Staff Shares”  Procedures Manual  Forms-Misc  Hospital
Use Forms (alphabetical order)
2. Print the form.
3. Fill it out COMPLETELY
4. You MUST get a manager approval signature BEFORE using the
product.











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Hospital-Use Form







Date: ____________________________
Product: ____________________________
Reason : ___________________________________________________
Manager Approval: ____________________________
Entered in AVImark: YES or NO
Posted in AVImark: YES or NO







Drill/Quiz for “Hospital-Use Items”:
1. Why do we have this procedure? Why this way? What would happen if we did not do it this
way?
2. Demonstrate you can do this by going to “Practice Client”. Pretend you need to burn another
Pet Odor Candle in the reception area. Follow ALL the steps in front of your trainer WITHOUT
help other than getting manager signature
3. Get a pass when you can do it all in less than 5 minutes. Practice as many times as necessary.
4. Trainer: Delete on the candles used in both the Practice Client record and in the accounting.
Assure you have the same “on-hand” quantity of candles as when you started.



























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21078 – ID Collars

Results Statement: To ensure proper pet care and identification for all patients that
are kept in the hospital for any time, for any service.



Primary Responsible Position: Receptionists

Why:
 If we do not use ID collars it puts pets lives in danger, both
this pet and others. Without proper labeling at ALL TIMES
pets receive the wrong service, or don’t receive the service
they need.
 Our services on the WRONG pet could cause death. Or
services not given to the pet that needs it may cause death.
 Even the wrong groom on the wrong patient will likely
cause hours of wasted time and frustration for many. It
may also cause financial death of our practice or a job.
 There have been multiple stories of other vets amputating
the wrong pet’s leg, spaying the wrong pet, or overdosing a
pet that did not even need a medication. IT IS BAD!!!

Who: ALL patients kept in in a cage, run or suite for ANY time.

When: No later than THREE MINUTES of patient being put in cage,
preferably before

How:
 Printed and kept with each pet’s paperwork when prepping
for tomorrows visits.
 When patients were not expected to be checked in until
TODAY we print the ID collar BEFORE the patient is put in
the cage, run, or suite…or no later than 3 minutes after.
 ID collar is wrapped around the patient’s neck and sealed
with adhesive backing AT THE TIME OF CHECK-IN.

Temporarily Removed?
 GROOMING around the neck only. In this case it is taken off
during this portion of the groom, laid on the grooming
table, and replaced when this portion of the groom is
complete and BEFORE the patient is returned to the cage,
run, or suite.
 BATHING is done with the ID collar kept ON.
 BLOOD DRAWS are done in almost all case with the ID collar
kept ON. Only special cases require removal and it is
replaced immediately after

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Drill/Quiz for “ID Collars”:
1. Why do we have the procedure? What might happen if we didn’t?
2. WHEN should be ID collars be printed?
3. WHEN should the ID collars be put on the pet? How long is too long?
4. Pull up a patient under “Practice Client” in AVImark. Print an ID collar for this patient.
Attach it around your own wrist.
5. Get a pass when you can do the last step in less than 5 minutes. Practice as many times
as it takes to get a pass.



































































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21080 – Inconvenience Gift Cards
Result Statement: To ensure excellent client service by respecting their wait times, and
understanding their point-of-view.




Primary Responsible Position: Receptionist

What: A $5 gift card is offered to clients when appropriate (see below under
“when”) as an “I’m sorry” for inconveniencing them. Clients can use
this coupon to get a drink/coffee/snack while they wait. The store or
restaurant of these gift cards varies.

When: When a client’s wait time is long than expected or longer than promised
AND they are showing any signs of frustration.
When a client’s invoice was larger than expected AND they show signs
of frustration.

How:
1. Hand the gift card to the client. Tell them something like “I’m sorry
you are having to wait longer than expected. Here is a $5 gift card
to ______. Feel free to use it to get something while you wait.” Use
your own words.
2. Fill out the “Inconvenience Gift Card Useage Form” completely and
IMMEDIATELY.
a. This form is found under Staff Shares  Procedures Manual
(date)  Inconvenience Gift Card Usage Form. It should
take you only 1 minute. This is how we assure gift cards are
not being abused or stolen.
b. If an employee is stealing or abusing this procedure it is
theft. That person will lose their job and will be prosecuted.
3. Submit this form to the inbox of the director of administration
IMMEDIATELY.

Where: A small number of these gift cards are stored in a drawer in the
reception area and in a labeled space. This location is in a location
visible on the video recordings. The director of administration keeps a
log of how many we have and how many are used.






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What they are NOT: A pacifier for a client’s invoice was more than expected. In these cases,
we most likely made an error in not thoroughly informing and getting
approval on cost BEFORE the service was provided. We will own this
error, make it right, and prevent it. Get a manager!
A fun thing to hand out to clients or for staff members to use whenever
they like. This is theft and will be handled with termination and
prosecution as listed above under “how”.

Drill or Quiz for “Inconvenience Gift Cards”:
1. In your own words, what is an “Inconvenience Gift Card”?
2. Why do we have them? When do we use them?
3. What are they NOT used for? What would happen if someone is stealing them?
4. Show your trainer where these cards are.
5. Print an “inconvenience Gift Card form” from the manual. Fill it out completely with pretend
information. Submit it where you are supposed to. Do this in from of your trainer who will be
timing you. Get a pass only when you can do this in less than 4 minutes.


















































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21082 – Insulin Administration

Results Statement: To provide great patient care at all times by properly administering
insulin by the properly trained person at the proper time and dosage.



Primary Responsible Position: Technicians

Why Have a Procedure: For some patients, insulin given at the right time, in the right manner, in
the right dosage is the only thing keeping that pet alive. If given
properly it can maintain and save lives. If given inappropriately (even if
by accident) this medication can cause death.

Who Decides: Insulin will be given to patients as prescribed by the doctors.

Who Gives Insulin: Insulin will be given by a Technician unless otherwise approved by
management.

How:
 When a boarding patient requires insulin, the client shall be charged
“Insulin Admin w/ boarding per day” for each day the patient is at the
hospital.
 The pet’s name and information will be added to the technician board in
treatment.
 When a boarding patient requires insulin on the weekend:
 On Saturday evening: The patient may be given insulin at closing time.
The patient must have eaten prior to receiving insulin. Note time given
on Boarder Med Sheet and documented in AviMark under “Insulin
Charge” by selecting notes, time stamp, and enter notes. (Ex: JJW: 08-
22-12 at 4:00pm: Gave 2 units of name of insulin sq BSB after watching
patient eat.)
 On Sunday morning: The opening technician is responsible for giving
insulin as prescribed by the doctor before 9:00am. Note time given on
Boarder Med Sheet and documented in AviMark under “Insulin Charge”
by selecting notes, time stamp, and enter notes. (Ex: JJW: 08-22-12 at
7:00am: Gave 2 units of name of insulin sq BSB after watching patient
eat)
 On Sunday evening: The closing technician is responsible for giving
insulin at closing time. The patient must have eaten prior to receiving
insulin. Note time given on Boarder Med Sheet and documented in
AviMark under “Insulin Charge” by selecting notes, time stamp, and
enter notes. (Ex: JJW: 08-22-12 at 6:00pm: Gave 2 units of name of
insulin sq BSB after watching patient eat.)





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Drill/Quiz for “Insulin Administration”:
1. Why do we have this procedure?
2. What could happen if our staff did not follow this procedure? For the pets? For YOU and the
entire team?
3. Can a kennel attendant or TA give insulin if you, the tech, explains exactly how? Why or why
not?
4. Explain who gives insulin on a Saturday evening…and a Sunday evening.
5. Show your trainer how you document it. Get a pass only when both you and your trainer are
100% comfortable with this procedure and WANT to follow it.

































































[98]

21084 – Internet Pharmacies

Results Statement: To assure the highest quality patient care and client service. We
do this by assuring patients receive the safest and most
effective medications at a reasonable cost. Clients get this by
choosing the best pharmacy for them and their pet.



Primary Responsible Position: Receptionist

Participating Positions: DVM’s, Techs, TA’s

Who We DO Work with:
 We will approve ANY and ALL pharmacies endorsed by
the TVMA or AVMA.
 At the time of this procedure was written the
pharmacies we are aware of that are endorsed by
TVMA or AVMA:
o Our Website: www.legacyvet.com
o Vet’s First Choice
o Vetstreet
o Local Human Pharmacies approved by our dr’s
Who We DON’T Work with:
 We will not approve any meds from websites NOT endorsed
by the TVMA or AVMA.
 This include 1-800-PET-MEDS, Foster’s and Smith, and
others.
 Why Only Certain Pharmacies?
o Medications purchased from these discounters are
not guaranteed by the manufacturers.
o Our doctors cannot comfortably prescribe meds
using a place they cannot assure is effective and
safe.
 For example:
o If a client purchases heartworm prevention from a
discount website and the animal tests positive for
heartworms, the manufacturer of the medication
WILL NOT pay for medical treatment.
o If the client purchases heartworm prevention from
us or a TVMA or AVMA approved pharmacy and the
animal tests positive for heartworms, the
manufacturer WILL pay for medical treatment.








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What to do:
 If the owner insists on using a non-approved pharmacy, our
doctors can write a script and the client may get it filled at a
place of their choice at their own risk.
 When we give the owner the written script, we will also give
the “Pet Internet Pharmacies” brochure while describing
the benefits of using a reputable pharmacy.
 Determine the difference in daily or monthly cost of using
our pharmacy vs. the one they want. Show the client the
difference.
 If it’s an approved pharmacy you give the script to the
doctor for approval.

Drill/Quiz for “Internet Pharmacies”:
1. Why do we have this procedure? What happens if we don’t know it? If we don’t use it?
2. What pharmacies do we approve from? Why?
3. What pharmacies do we NOT approve from? What could we do if the owner insists?
4. A client requests a med from 1-800-PetMeds. Role play with your trainer acting as a client.
Explain to the trainer (client) what you say to the client. Keep practicing until both you and your
trainer are comfortable you can do it while keeping a happy client and we have done all we can
to keep their pet safe.













































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