Patients and records

The receptionist’s role 2

Communicating with clients 3

Scheduling appointments 6

Patient records 8

Client confidentiality 12

Admission of animals 13

Discharging animals 17

Identifying animals in your care 19

Client / patient separation anxiety 22

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The receptionist’s role

The receptionist’s role includes obtaining important information from clients, such as ensuring that the clinic has up-to-date names, addresses and phone numbers. The receptionist is usually the first person who the client comes into contact with and is therefore responsible for the client’s first impression of the clinic.

How to create a good first impressionThe receptionist must be aware that she or he is the first person that clients encounter at a practice and will therefore set the scene.

Receptionists must be neat, presentable in appearance, pleasant, professional and friendly in manner

Prompt attention on arrival

is important and conveys the message ‘you are important’ to the client

Name badges make identifying staff easier for the client

A clean tidy office

conveys a message of a well- managed business, as does a warm friendly décor, comfortable chairs, and up-to-date magazines

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Communicating with clients

Greeting clientsThe client relationship is one of the most important aspects of a clinic. It is important to acknowledge clients as soon as possible when they enter the clinic.

If you are busy with another client or are on the telephone, you can nod or gesture to the client that you are aware of their presence. If possible, briefly interrupt your conversation and inform the client that you will be with them shortly.

If the veterinarian is delayed for any reason, you should apologise for the delay and keep the client informed of any progress or changes. If necessary, offer some refreshments or reading material.

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Behaviours that influence communication

Verbal behaviour be polite and calm

be non-judgemental

focus on the client’s feelings

summarise or paraphrase to ensure that you understand

use terms the client can understand

answer their questions honestly

do not ‘put words into their mouth’

respond to their concerns

Non-verbal behaviour have good eye contact

maintain a comfortable distance (personal space)

speak at a moderate pace and in a moderate tone (do not shout or whisper and do not rush)

show responsive facial expressions

face them and lean slightly towards them to show that they have your attention: do not keep looking or turning away

avoid yawning, scowling or closing eyes

Telephone answering protocol

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You should answer the telephone promptly, confidently and efficiently by:

saying ‘good morning’ (or afternoon or evening)

giving the name of the practice

speaking clearly and remembering that your greeting will create a favourable or unfavourable impression of the practice as a whole.

Some practices may require that you then state your name and ask:

‘How may we help you?’

Always ask who is calling

If you are unable to deal with the inquiry yourself, obtain as much information as possible and notify the caller that you are placing them ‘on hold’ while you see if someone else is able to assist.

Pre-empt any queries or lapses of memory by surgery staff about the waiting caller by giving them the relevant information before putting the call through:

this will also create a favourable impression with the client

in the meantime keep going back to a caller ‘on hold’ to apologise for any delay

they may be required to call back at a more appropriate time or you may need to obtain details from them so that the call can be returned

Telephone messages

It is a good idea for all telephone messages to be recorded in writing. This may be by using a central message book or a book of separate telephone message receipts which can then be passed onto the relevant person. It’s also worthwhile confirming that the person has actually received the message.

Giving advice to clientsGenerally speaking, the advice given by a veterinary nurse must have the approval of the veterinarian. This does not mean you always have to seek permission before giving advice, only that you need to be aware of the practice policy concerning that advice.

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Scheduling appointments

Methods of appointment scheduling will vary between practices. Some use appointment books, others only use computers while some will use a combination of both.

Most veterinary clinics prefer the appointments to be ‘booked in’ with clients either ringing or coming in to make prior arrangements. This helps in organising the day’s work and minimises client waiting time. It also gives a good opportunity to check client and animal details before they arrive.

‘Walk-ins’ or clients arriving without appointments will occur from time to time. First, ascertain the nature of the owner’s concerns and if the situation appears urgent alert the veterinarian on duty.

If the request is for routine services, there are a number of options:

Explain the appointment system and schedule the appointment at an appropriate time.

If there is time available ask the vet if the client can be seen immediately. If not, ask the clients if they would be prepared to wait until they can be seen.

Important considerations When you schedule appointments, consider these issues.

Which veterinarian?

Some clients only want to see one particular vet.

Which veterinarian is the most appropriate to deal with the presenting complaint? Veterinarians within the practice may have specialised interests, eg medicine or surgery

Time allocation Clinic policy for appointment times, eg consulting hours, surgery days.

Be aware of time intervals required for appointments and how many the owner will bring in.

Beware of over-booking. This needs to be taken into consideration when more than one person makes appointment bookings.

Client preference.

Allowing ‘catch up’ appointment times to keep on

For each hour book a variety of patients which include short or quick procedures (eg vaccinations, suture removals).

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time lf there are a lot of complicated appointments together, the vets may easily get behind time.

This also gives them a chance to clear their minds and start each new case with a clear head.

Emergencies Special consideration must be taken into account for emergencies. They are unpredictable and can sometimes take a lot of time.

Other appointments may need to be rescheduled to avoid lengthy waiting delays for the clients so always get details so that you can contact the client if you need to reschedule.

Call outs Remember to include travel time to and from out-calls. A half hour drive to a client’s property also means a half-hour drive back.

Sometimes, you have to allow extra time just in case the vet gets lost!

It is helpful to use local travel times so you can anticipate how long it will take clients to come in.

Preparations Special treatments/equipment to prepare or order before a particular procedure can be done.

When making appointments, note if there are any instructions that should be given for the preparation prior to the appointment—eg fasting 12 hours before arriving at the clinic. You may need to check if it is a non-routine procedure.

Appointment outcomes

Think of the likely outcomes of the appointment and whether that should influence the schedule—eg surgical admission, grooming booking, euthanasia.

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Patient records

The importance of medical records It is important to create and keep accurate and complete records of a patient’s history, examination, diagnosis and treatment.

This is necessary because:

It is a legal requirement to keep them in a permanent form (eg paper file, card, computer disc) for seven years (and at the workplace for the first 3-4 years. After that period they can be stored elsewhere).

They document an animal’s progress and response to treatment

They ensure appropriate care and treatment are given by all staff involved in the animal’s care

They can be used as evidence in legal disputes.

The forms, record method and abbreviations used will vary between clinics but aim to follow a systematic approach so that all problems will be identified and dealt with. Whether it is a consultation at 10am or out of hours at 3am, nothing should be missed!

Don’t forget that these records are legal documents and must be complete Memory is rarely as good as clear written documents.

You should always encourage and practise the following when creating medical records.

Objectivity: avoid bias or be aware of it.

Precision and accuracy: avoid ambiguity. Use correct terms and figures.

Consistency: record detail, not interpretation.

Uniformity: repeat the steps each time so it is possible to compare.

Reliability: ask yourself, would the same results be obtained by a different observer?

Legibility: make sure what you write can be read by others.

Avoid offensive language

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Types of records

Types of records that may be associated with a patient data file include:

medical records including results of physical examinations, differential diagnosis treatments and animal’s response to treatment

vaccinations, worming, heart worm (date and type)

laboratory reports

radiographic and ECG findings

referral reports

surgical and anaesthetic reports

dental records

post mortem reports

client financial history with the clinic.

Methods of keeping records

Methods of record keeping may include:

manual card filing systems

record books

envelopes, eg radiographic films

folders, eg for pathology reports

computer-based records

photographs

video clips.

Remember to always file accurately. A record that cannot be found is useless!

General considerations for gathering client and patient dataGood communication skills are needed!

Obtaining and recording relevant information from clients requires good communication skills to get the most from interview techniques, and a systematic approach is needed for you to be thorough and accurate.

Remember to use open questions and avoid asking leading questions accidentally. Be brief but accurate.

As it requires owner involvement, showing interest can be a good PR tool, but it may take tact and patience especially with

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anxious clients. It is important not to be judgemental or disapproving. Suppress feelings of condescension, affection, pose, revulsion and apathy. Many owners already feel guilty!

Diagnosis (and prognosis) is the responsibility of the veterinary surgeon!

Nurses often assist the vet, particularly in the early stages of collecting patient information, history and distant examination or observation.

They may be called on to restrain animals for physical examination or to ascertain the so-called ‘cardinal signs’. Vet nurses may also be required to measure these, particularly when monitoring hospital cases. The level of involvement varies from practice to practice.

History collection

Vet nurses should establish their practice policy on how much history they collect.

Determine the difference between observation and interpretation by the owner; clarify ambiguous phrases or conflicting information; avoid leading questions.

Use general questions initially, to prevent influencing the owner’s answer. Use appropriate vocabulary. Recheck the points for accuracy, order and importance.

Routine admissions

Even routine admissions (eg boarding, de-sexing) should entail collection of some basic information for the medical record, weight, history and results of a clinical examination or record of cardinal signs.

Identify and record the presenting complaint.

Dealing with owner requests

Depending on the request, you may need to check clinic policy or refer the request to your supervisor.

Other paperwork you may need to deal with

Authorisation forms (eg consent forms for surgery, euthanasia, treatment).

Cost estimate forms.

Specific patient history details and data Find out what details your workplace requires from clients and how to enter them into the filing system. History includes both medical and environmental information about the animal.

It may relate to the past of the animal or its present condition.

It is the first step in diagnosis and often the most useful information.

It is a description of important events and environment prior to the appointment.

Components of the historyPatient details name and case number

breed

sex

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age

reproductive status

temperament

Presenting (or chief) complaint

the reason for the visit—the owner’s concerns

triage. The animal may require immediate treatment by vet

History of presenting complaint:

brief notes of observations including: onset, duration, severity, signs, therapy and response

Past history: medical including specific tests and treatments

surgical

trauma

vaccinations – and dates

parasite control – gastrointestinal and heart worm

diet

family and environmental history

Environmental history:

housing, numbers, in contact

travel

diet

uses (work, breeding)

litter mates/siblings

Specific information:

immediate medical history

weight on admission/arrival

have there been any changes since the animal was last seen?

when was the animal last fed/ate – fasting?

fluid intake

last medication given

any allergies, eating habits

last bowel motion/urination and any observations

last ‘in season’ if female – oestrus phase

any items to be left with the patient

obtain signature of owner on standard consent forms

useful to enquire about proposed method of payment

note any further relevant details

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Client confidentiality

Security and confidentiality of the practice files is very important.

Staff in the veterinary practice must keep the practice files secure and confidential. This includes patient medical records, client financial records and information and practice’s financial records.

Just as doctors are bound by a code of ethics, veterinarians also have a similar code. Staff should not discuss names and details of clients or their pets outside of the veterinary practice.

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Admission of animals

In most veterinary practices, it is the responsibility of the veterinary receptionist to greet clients and admit animals into the hospital.

It is very important that all animals admitted to the hospital can be easily identified and the details of which procedures they are going to receive are accurately recorded.

Admission may be for various reasons:

observation and treatment

diagnostic tests

surgical procedures

boarding

grooming

lost or stray animal.

Client and patient details Task the following into consideration then admitting animals to a veterinary hospital.

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The admission of animals to a veterinary hospital is best carried out by appointment, allowing the owner to discuss the case with the veterinary surgeon, and be reassured about what is to happen, when to call back and what to expect on return.

Before admitting an animal to the hospital you need to check that the client and patient details are still current.

If it is the client’s first visit to the clinic, you need to establish a new file before the client leaves or is seen by the veterinarian.

Emergency admission

With an emergency admission—example, an animal that has been hit by a car—it is essential to record all information before the client leaves. As it often not possible to always do this on admission.

As a general rule the following information should be confirmed on admission.

Client details name, address, phone numbers (contact phone number, mobile, work and home)

Animal details breed, name, age and date of birth, sex/desexed, colour, medical history, prophylactic medications (heartworm (daily/monthly), worming, vaccinations

any medication currently being administered to the animal. adverse reactions to drugs or anaesthetics are also important if the animal is to be admitted into the hospital for any procedures

temperament

any special dietary requirements

when the animal was last fed

The animal’s possessions brought with the animal by the owner. These must be clearly marked and/or listed for future identification. This includes carry cages, leads, blankets, toys and any special foodstuffs.

On admitting the animal, the nurse should ensure that

all necessary documentation is signed

the animal is correctly identified

the animal is appropriately restrained to prevent escape

the owner knows when to next contact the clinic

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Admission forms

Routine authorisations and consent forms

Authorisation forms are not required by law but are useful to protect the practice by ensuring that the client fully understands the type of treatment, procedure, risks or costs that are involved.

The forms provide documented proof that that the owner’s consent was given before a procedure and that the clients were fully aware of what they were agreeing to at the time. To ensure this occurs, it is important that some form of verbal communication or interpretation be given to the client as well when they are signing the form.

Some examples of consent forms are:

permission for surgery and anaesthesia

permission for euthanasia

detailed estimate agreements

consent for tattooing

boarding admission

grooming admission

acknowledgement of the amount and method of payment for the procedure

credit agreement.

Each form should contain:

identification of the owner and the animal

description of the procedure

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date

signature of the owner, veterinarian and a witness.

Some clients may need assistance with filling in forms, to ensure that they are fully aware of what they are agreeing to. Verbal agreements should also be recorded in the client history.

Updating records after treatment

After the veterinarian has examined the patient:

It may be the responsibility of the veterinary nurse to update the patient’s records.

This may include filing pathology reports, x-ray reports or notes from other veterinarians.

Depending on the veterinary practice, these may need to be put into paper-based records or be put onto computer records.

Care must be taken when updating records especially if it has been a busy day. Make sure that the treatment details or information go into the correct file.

Ensure that the records are legible!

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Discharging animals

Preparing a patient for discharge An animal should only be discharged from hospital under the direction of the attending veterinarian.

Before discharging the animal, the nurse should ensure the following:

The animal is cleaned and groomed.

The owner has full details of what has been done.

The owner fully understands the necessary after-care and is provided with the necessary care sheets.

The medication is clearly labelled and is ready to give to owner before the owner arrives.

The owner is well prepared for any drastic changes in appearance—eg areas shaved.

All dishes, blankets, collars are returned with the animal.

Arrangements for payment, as per practice policy, are dealt with.

It is generally best to do all of the above before bringing the animal out or the owner will be distracted by the animal and not pay attention to what you have to say about routine information and home care advice for the client.

Generally vets will discharge animals and speak to clients about more complicated surgeries such as orthopaedics. Providing written discharge instructions in addition to verbal information will help clients remember all that is required of them.

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The owners should be informed of any special aftercare requirements including the following:

exercise—are there any restrictions to the amount of exercise; does the patient need any physiotherapy?

care of the surgical site, drain, cast, splint, dressing—eg avoid getting a dressing or cast wet, when to have dressings/casts changed, drains to be removed, etc

suture care and removal

food and fluid intake and any special dietary requirements

medication instructions and the expected response to treatment

follow-up appointments.

It’s often a good idea to make appointments for repeat visits at the time of discharge while the client is still there and to give them a reminder card to take home with them.

Does your workplace have printed discharge sheets for various procedures?

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Identifying animals in your care

Correct animal identification ensures the appropriate procedures or treatments are administered and that embarrassing and potentially hazardous mistakes are avoided!

The method of identification should be:

easy to use

easily identifiable even if there are multiple animals of the same colour, sex, breed—eg three black cats

transportable with the animal so it goes with the animal when it changes cages

removable when the animal goes home

inexpensive.

Methods of identificationTemporary methods

paper collars

cage labels

details on a whiteboards that correspond to cage numbers

collars and tags

photograph record

Permanent methods

tattoo number

microchip (generally not practical for quick identification of hospitalised animals)

Collars

On admission the animal’s details—including name, owner, body weight and reason it is in—are written onto the appropriately coloured collar eg:

blue collars could mean a medical procedure

red collars for animals undergoing surgery

white collars for boarding animals

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An example of a coloured paper collar used to identify dogs and cats in a veterinary clinic

Whiteboards

.

This whiteboard is used to identify animals in cages. The cages are numbered to coincide with the numbering on the board.

Information may include:

animal’s name and description

owner’s name

the problem

treatment or procedure.

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Cage labels

Cage label attached to a clip board

Many veterinary clinics can now generate the computer printed cage labels. This allows treatments and observations to be written onto the sheet which can be transferred to computer records later.

TagsCage tags can be used as extra warnings to veterinarians and nurses about the animal within eg: bites ; do not feed ; collect urine; special diet

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Client / patient separation anxiety

Avoid dragging a reluctant animal away from the client. Instead ask the client to take the animal to its cage or move the animal into a consulting room with the client and wait for them to leave. Alternatively, if possible, pick the animal up yourself and carry it to its cage. Animals will often calm down and become more manageable, once their owners are out of sight. Ensure that a cage is prepared before admitting the animal.

Carry cages Animals should always be restrained in a veterinary clinic to avoid escape and unnecessary injury to staff, clients and other animals. Permanent loss of the animal poses a legal liability to the clinic as well as causing undue stress to the owner.

Most veterinary clinics lend out cat carry cages to clients to transport their pets.

The container should be:

portable

well ventilated

escape proof

allow easy access to the animal

lockable

have a waterproof base.

It should also give the animal a feeling of security.

For long journeys think about:

water and food

ventilation

motion sickness.

Nervous travellers:

Tranquillisers may be prescribed but these cannot be bought over the counter unless dispensed by the veterinarian .

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This is a plastic-coated cardboard type of cage that comes flat and needs to be assembled. It is good for quiet animals but will not hold an animal that is serious about getting out. Nor is it particularly waterproof so it will leak urine if the animal goes to the toilet, not pleasant for car journeys! Also the ventilation is not very good for long journeys in the heat.

A plastic (and therefore urine-proof!) cage with a flat lid so the animal has limited vision out. Cover with a towel for nervous or small wild animals to reduce stress.

A plastic bottom and wire top cat cage. More expensive than the previous cage but able to take larger cats and is generally more robust.

This one is for tamer cats and small animals, as it would not keep in the determined moggy. Nor will it be particularly waterproof. But it does have good ventilation.

The type of cage required by airlines if you are to transport a cat or dog on a plane. Strong, solid floor, secure doors and good ventilation.

The downside is that it can sometimes be difficult to remove animals from these types of cages.

Does your workplace have a policy on lending cages to clients?

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