Page 1

Standards of Care, Revised 05/07/09 Specific healthcare standards of care must be followed by all doctors, including part-time or relief doctors: 

For the continuity of care and staff utilization, there can be only one version of the following protocols:

 Our vaccination policy o

Encourage widespread vaccination to fit the needs of the pet

o

Enhance the health & welfare of pets

o

Assess each pet for their vaccine needs based on our excel spreadsheet for age and risks

o

Use the best quality products based on the best research

o

Use vaccines injection sites consistently: Feline Leukemia on left thigh, Leptospirosis on left hip, Rabies on right thigh in cats and right hip on dogs, DHPP or DAP on left hip, and Lymes L epaxial, Injectable Bordetella interscapular.

o

Canine and Feline vaccines recommendations are documented in detail in our excel spreadsheet for age and risks

o

Puppy Programs 

AHBC Stand of Care

Each puppy visit includes a complete physical exam appropriate for their age 

Be sure to develop a friendly rapport with the pet and any children

Vaccination needs as detailed on spreadsheet by age and history

Screen for congenital abnormalities

Nutrition advice = nutritionally complete and balanced premium diets – learn what is available

Behavior topics and problem screening

Breed specific predispositions and genetic disease surveillance

Avoid high risk situations, such as dog parks and boarding, until 2 week after 16 week vaccinations

Flea & Deworming program as detailed in spreadsheet

Discuss the pet’s needs for the next period and schedule the next appointment before the pet leaves.

Any puppy under 8# receiving an injectable vaccination that is 16 weeks or younger will receive a benadryl injection IM at the time of vaccination or oral benadryl 1-2 hours prior to vaccinations.


o

In general, all puppies receive a Bordetella at their first visit (if not done by a veterinarian previously), all receive at least 2 DHPP vaccinations 3-4 weeks (3 weeks preferred) apart with the last vaccination finishing at least 15 weeks of age.

The Rabies vaccination will be given between 12 weeks and 16 weeks of age. No more than 2 injectable vaccinations will be given at a time for puppies under 8 pounds and less than 6 months of age. If injectable vaccinations are separated, they must be given 3 weeks apart.

Leptospirosis vaccinations are given to dogs that are exposed to wooded areas, swim in ponds, are in areas where there are dogs such as dog parks or apartments with high density dog areas.

Lymes disease vaccinations if traveling to the shore or Virginia or more North

6 week visit + vaccination per spreadsheet /fecal/deworm- HWP/flea?

9 week visit + vaccination /deworm/start HWP/ flea control

12 week visit + vaccination/ fecal + schedule spay or neuter for any medium or large breed dog to allow evaluation for JPS at that time (16 wks); discuss microchipping

15 week visit vaccination + schedule spay or neuter if not already; microchipping information to do at spay or neuter (www.akccar.org/microchip)- Make the appointment here- if not made, then make sure to put in a reminder to call the owner to schedule

8-10 months of age nurse visit unless problems = semiannual life cycle consultation visit- checking to make sure all teeth came in ok, skin and ears are normal, pet is on adult diet and discuss BCS, the pet parent is comfortable with dental care, ear cleaning, and teeth brushing and discuss behavior

Currently there is no proof of extended immunity from Lepto, Lyme or Bordetella vaccines, therefore pets receiving these vaccines will need annual revaccination (every 6 months for Bordetella if high exposure- meaning any grooming, boarding, obedience classes)

Semi-Annual Life Cycle Consultation Requirements 

Be sure to develop a friendly rapport with the pet and any children and the pet parents

Each visit includes a complete history and thorough 12 system physical exam appropriate for their age. Body score, weight, pain score, and dental grade are documented. Those scores that are ideal are celebrated with congratulations for being a good pet parent; those not ideal are addressed with the pet parent showing the concern of the whole team.

Breed specific predispositions and genetic disease surveillance

ERD screen and discuss bloodwork screenings for future visits

Nutrition advice = nutritionally complete and balanced premium diets which have shown proof of extending quality and duration of life. Preferred diets= Royal Canin, Eukanuaba, Science Diet, Nutro, ProPlan, Purina One, Iamsrealize that Eukanuba and Iams are higher fat so may not be appropriate for overweigth pets. Remember that Royal Canin diets are preventative and

AHBC Stand of Care


excellent to prevent calculi for small dogs, osteoarthritis for large dogs, and skin or weight problems and we have them here and on our website as well so are super convenient for pet parents. 

Behavior topics and problem screening. Make subsequent appointments to cover additional problems rather than information overload the client or overstress the patient with procedures.

Flea & Deworming program as detailed below

Remember to make the appointment to check teeth, go over dental care, and a thorough physical examination with a doctor every 6 months. Many will need appointments in between with a nurse for weight checks, dental checks.

Discuss the pet’s needs for the next period from the view of a patient advocate who speaks for the needs of the pet and make the next appointment before the pet leaves the clinic

Vaccination needs as detailed in the age/risks spreadsheet

.

 Feline vaccines recommendation are documented in our age/risks spreadsheet o

Kitten Programs 

Each kitten visit includes a complete physical exam appropriate for their age 

Be sure to develop a friendly rapport with the pet and any children and pet parents

Vaccination needs as detailed on spreadsheet

Special screening for congenital abnormalities

Breed specific predispositions and genetic disease surveillance

Remind longhaired cat owners (esp Persians and Himalyans) that we need to screen kidneys with ultrasound for PKD before 10 months- ERD test is minimum.

Nutrition advice = nutritionally complete and balanced premium diets

Behavior topics and problem screening

Confinement advice = confine to house with exception of classes for socialization etc

Flea & Worming & Heartworm program as detailed below

Plan for the pets needs for the next period

Basically vaccinations: at least 2 FVRCP intranasal vaccinations 3-4 weeks apart with last vaccination by 14 weeks of age. If the kitty goes outside, 2 Purevax Feline Leukemia vaccinations 3-4 weeks of age. Purevax Rabies vaccination between 12 and 16 weeks of age.

6 week visit – Felv/FIV testing + vaccination per spreadsheet /fecal/deworm

AHBC Stand of Care


9 week visit - Felv/FIV testing if not yet done + vaccination per spreadsheet /deworm, start HWP/Flea Control – Revolution

12 week visit vaccination/fecal (deworm if not done twice) per spreadsheet. Can OHE/declaw or discuss for next visit (need 2 negative fecals). Declaws are not preferred and all pet parents interested will at first be educated and receive a scratching pack before giving an estimate, but if that is what they prefer that is fine as long as we have educated them.

15 week visit - Rabies vaccination + other vaccinations

16-20 weeks schedule spay/castrate (+/- microchip- see www.akccar.org/microchip) if not yet done

Remember to make a 6month health check reminder to check for retained baby teeth, go over dental care with a nurse at 8-10 months. 810 month visit: check for retained baby teeth, discuss dental care, make sure that they are on adult diet, discuss nail trimming and behavior, and schedule back for dental check at every 6 month intervals.

52 weeks – 1st semi-annual visit

o

Vaccines and eligibility for Skip-year Vaccine Programs (FeLV only). Cats over 3 years of age with minimal but some exposure (occasionally outside off a leash), may have Feline Leukemia administered every 3 years.

o

See excel spreadsheet for details by age and species

o

Semi-Annual Life Cycle Consultation Requirement 

Each visit includes a complete history and complete 12 point physical exam appropriate for their age

Breed specific predispositions and genetic disease surveillance

Be sure to develop a friendly rapport with the pet and any children

Nutrition advice = nutritionally complete and balanced premium diets

Behavior topics and problem screening

Breed specific predispositions and genetic disease surveillance

Flea & Worming program as detailed below

Plan for the pets needs for the next period and make appointments!

Vaccination – per spreadsheet for age and risks

At risk cats (Cats with a history of frequent fights and or abscesses, Cats that live outdoors or spend time loose outside, etc) need Felv (Purevax) and FeLV/FIV testing and microchipping for identification.

 Those not microchipped can be chipped anytime but a good time is at surgery.  Spaying and neutering o

Dogs 

AHBC Stand of Care

Our current recommendation is to spay or neuter starting at 4 months, at or around Rabies vaccination time. (Any time at 3 months or later is safe.) (no


later than 5 months; medium and large breed dogs before 5 months- 4 months is ideal for JPS)

o

Females need to be spayed before their first heat to reduce the risk of malignant mammary cancer.

Males benefit behaviorally from neutering before sexual maturity.

Cats 

Our current recommendation is to neuter males and females at 4-6 months. They may be declawed at the same time if wanted (always discuss entire procedure and exactly what a declaw is, risks, medications and other options at that time- make sure the owner goes home with a scratching pack, soft paws and nail trimming and sticky paws and appropriate scratching items are discussed).

Females need to be spayed before their first heat to reduce the risk of malignant mammary cancer.

Males benefit behaviorally from neutering before sexual maturity (spraying, etc).

 Genetic/Congenital Predispositions o

o

o

Preferred Web Sites 

www.upei.ca/~cidd – University of Prince Edward Island Canine inherited disease database

www.avar.org (Dog disease guide)

www.npwm.com- wellness

www.Veterinarypartner.com – Veterinary Information Network sponsored educational site for clients.

www.Y2Spay.com – for information on spaying and neutering

Client handouts 

Clients need to be provided with appropriate CE material. Many CE forms are available in our database; search subject. Those treatment items with CE in front of the subject indicate an educational form.

Each new client receives a folder for their pet to put in all handouts and information as necessary.

Search subject from medical history area and print as desired.

Semi-Annual Life Cycle Consultation Requirement 

Each annual visit will include a Genetic & Congenital predisposition assessment

Clients will be informed of some of the genetic/congenital diseases their breed of pet may be susceptible to and encouraged to visit the suggested sites for more information so they can join us in keeping an eye on their pet for any early or worrisome changes.

AHBC Stand of Care


 Parasite Prevention & Control o

o

Feline Programs 

Fecal screening, a Giardia Snap test (in house) and a fecal cytology will be performed in dogs and cats with diarrhea

All pets will be examined for fleas and ear mites at each visit. If ear debris is present with coffee ground appearance, an ear swab using oil prep will be examined microscopically. Other ear debris requires a stained slide and cytology read via the microscope outside radiology.

Kittens need deworming of either one Profender or of Drontal Plus Feline at least 2 doses 3 weeks apart and at least 2 negative fecals.

Kittens from 9 weeks can start Advantage Multi monthly for heartworms, intestinal worms and fleas.

Deworming for outdoor kitties needs performing every 3 months if the cat goes outside at all unless on Revolution, Interceptor, or Advantage Multi monthly, year round. (Either Drontal or Profender every 3 months or monthly Pyrantel)

Regular flea control is needed if any pets in household go outside, so if not using Revolution or Advantage Multi (Advantage Multi preferred due to better flea & intestinal parasite control), then Frontline is needed monthly, combined with Interceptor or Heartgard. The preferred choice of all always is Advantage Multi, even in outdoor cats. If the cat has a history of having ticks, then Frontline and Heartgard, or if pet parent prefers.

www.vet.cornell.edu is a very helpful site for feline owners- has videos on how to medicate cats and on how to give insulin injections and lots of useful medical information from The Cornell Feline Health Center

Canine Programs 

Fecal screening, a Giardia Snap test and fecal cytology will be performed in dogs and cats with diarrhea

All pets will be examined for fleas and ear mites at each visit. If ear debris is present with coffee ground appearance, an ear swab using oil prep will be examined microscopically. Other ear debris requires a stained slide and cytology read via the microscope.

Puppies need 2 doses deworming 3 weeks apart and 2 negative fecals. Fenbendazole or Drontal (or the generic Virbantel) are drugs of choice.

Puppies from 9 weeks can start interceptor monthly for heartworms, intestinal worms and fleas. Interceptor is the preferred due to Whipworm protection. After 6 months of age (and less than 7 years), ProHeart6 can be started every 6 months (The last dosage of heartworm preventative should be no longer than 2 weeks prior to starting ProHeart6).

Regular flea (and tick control if exposure) is needed monthly year round. Product appropriate to patient.

AHBC Stand of Care


o

Advantix is the preferred flea and tick control (Frontline Plus only if sensitive to Advantix, but Frontline should not be recommended first and the pet parent will always be directed to buy it online at our website. There has been some resistance for fleas with Frontline). This is only appropriate for dogs that go outside and are exposed to wooded areas.

For little house dogs, Advantage Multi is always preferred if no exposure to wooded areas. If on Revolution, recommend Advantage Multi due to intestinal parasite control.

For pet parent’s resistant to topical medications or for dogs with history of flea infestation or flea allergies, Comfortis should be offered.

Knockout Spray is need to treat the house(s) and car of any pets infested with fleas.

Fecal screening will be performed in dogs twice yearly since not all parasites found here on microscopic examination are eliminated by one type of dewormer. All dog patients’ first visit will have a print out from the web on genetic diseases in their folder for purebreds.

Traveling With Your Pet Programs 

Pets traveling by air require health certificate papers and must be examined by a doctor (will need temperature taken) on the day the certificate is issued. The certificate is good for 10 days.

For airlines requiring a “Certificate of Acclimation,” the wording that must be used exactly can be found by doing a patient name search for “certificate”

International travel, except to Canada requires special papers and special processing for those papers through the state of departure. It is best that the pet’s parent contact the embassy or consulate of the country they will be traveling to ahead of their visit so we will have the correct papers ready for them in plenty of time, or visit the USDA Website.

 Medical Records o

Client “concern” starts each entry

o

All consultation records will be S-O-A-P-ed (Subjective=History, Objective=Examination, Assessment =differentials or definitive diagnoses, Plan= both diagnostic and treatment)

o

Doctor’s Assessment(s) must address “client’s concern” first. Remember that was the reason the owner was concerned enough about that the pet was brought in, even if you find other more important issues, or feel there is no issue to address.

o

Tell clients clearly what is needed. You are speaking for the needs of the pet, not colored by your feelings/opinion/intuition about what the owner is willing to do. Tell them what their pet needs and let them make their own decision without guiding them by your words or body language that the pet’s needs are not important. Pause and wait until they reply. Do not judge them if they want to waive or defer some of those needs. This is their choice, but to make an informed choice, you must have given them the information on what is needed without negative bias.

AHBC Stand of Care


o

Document all “needs” in the record and record the clients response

o

Client’s response is recorded put into plan and put rejected by the client if the client declines.

o

Any medical conditions should be listed in the problem list.

o

All pet parents are offered a folder for their pet’s medical records at their pet’s first visit.

Patient Care o

AAHA Standards are minimum requirements

o

Physical Exams will list all 12 systems as Normal or Abnormal

o

Sequential Weights will have Body Condition Scores (BCS=1 to 9 with 5 being ideal)

o

Animals with teeth will have dental grades (DG1-DG4)

o

Animals in pain will have Pain Score (1-4) documented in the record.

o

Consultation charged by time- if a brief appt or follow-up, is Level I, if a full doctor examination, Level II, if a sick pet or behavior consult, Level III, if an emergency, Level IV.

o

Hospitalization will be charged by care levels

o

Care that owner chooses to waive or defer after they have been presented with what the pet needs (NOT chosen by STAFF OR DOCTOR through avoiding informing owner of pet’s needs) requires that we increase OPN surveillance by using 3R’s principle – recheck, recall, remind. Remember that you speak for the pet and are their advocate. If a pet parent wants to do a service but wants to defer it, but in a recheck call back code to remind the pet parent to make an appointment or make the appointment at discharge.

o

All clients need to know the availability of pet insurance and Care credit when applicable (www.carecredit.com- may apply online).

 Anesthesia: o

All patients will be assigned an anesthetic risk level and this will determine level of testing and level of monitoring.

o

Giant breeds, Dobermans and Cocker Spaniels are at higher risk for DCM so require ECG scans starting at 5 years of age. These are done w/the pet lying on right side.

o

Intravenous fluid therapy (or SQ if vein not accessible) is mandatory for all General Anesthesias.

o

All anesthetized patients need point of care patient monitors during the procedure. This

o

There must be a respiratory monitor, heart monitor, pulse ox, ECG, carbon dioxide monitor, blood pressure and a core body temperature monitor, and a staff member or doctor nearby.

o

All anesthetic cases receive a free nail trim (nail trim anesthesia), and ear cleaning if needed.

 Blood Chemistry Screening o

Minimum mandatory with every anesthesia is 6 panel (preanesthetic) or Feline Young Maintenance panel, Easy Annual panel, or chem11 within 1 month of

AHBC Stand of Care


anesthetic event for pets 6 years and younger. Pets 8 years of age and older, a senior panel out to the lab with urinalysis is preferred (Feline Geriatric Profile for outside cats)- if done in house, a General Health Profile is done. o

Lab test requirements increase with anesthetic risk level.

o

Sequential Laboratory Surveillance of any abnormal test and all disease processes will be scheduled at release.

o

Sequential Laboratory Surveillance of liver & renal parameters is mandatory in patients on NSAIDs prior to long term therapy, then in 1 month, three months, then at six month intervals. For Phenobarbitol and any antidepressant/behavior altering drug, bloodwork prior to beginning the medication and every 6 months thereafter. Phenobarbital or thyroid levels are done 1 month after starting or changing dosage of Phenobarbital, methimazole, thyrosyn and every 6 months thereafter. Potassium Bromide levels are done 3-4 months after starting medication or changing dosages and every 6 months thereafter.

o

See Monitoring sheet for additional surveillance requirements

ďƒ˜ Cardiac: o

All cardiac cases need heartworm testing, radiography, blood pressure, ECG, Ultrasound, and senior screen (chemistry, CBC, T4, urinalysis).

o

Referal to Cardiologist at NCSU is best way to perform all these tests.

o

If the pet parent declines the above tests and referral, an examination every 6 months is required to monitor the heart.

ďƒ˜ Declaws o

If a cat or kitten needs to be declawed, all alternatives must be discussed in person or over the phone with the owner. In addition, after care and appropriate pain medication must be discussed

o

Pain management: Buprenex 0.02mg/kg before and after the procedure for 3-5 days, carpal ring block on both feet while under anesthesia (up to or less than per cat dosage of 1mg/kg 2% Lidocaine and 1mg/kg 0.5% Bupivicaine), and after extubation an IV injection of Rimadyl or Metacam. We do not use Metacam to go home for cats unless all other options not possible.

o

IV catheters for declaws will be placed in the Saphenous veins for IV fluids & anesthesia.

o

Convenia is the preferred antibiotic for declaws.

o

All toes will be sutured closed, not glued and a hard plastic ecollar (not cloth) will be used. Cats <9# will stay 1 night after and cats >9# will stay 2 nights after- mandatory to observe. All cats will have a no charge 2 week recheck with the doctor to check the toes, a second 1 month post op follow up for cats >9# as well. Newpaper litter for 2 weeks and exercise restriction are mandatory instructions.

AHBC Stand of Care


ď&#x192;&#x2DC; Dentistry: o

All Dentistries need prophylactic antibiotic cover. (Minimum cover is an intraoperative antibiotic injection of Clindamycin IV or pre-op Ampicillin â&#x20AC;&#x201C; Polyflex injection).

o

All Grade 1 or higher dental scores deserve a dental prophylaxis in addition to initiating an oral health care plan

o

Oravet is applied post-prophy. Pre and post dental pictures are taken and sent home with owner. An appointment is made for recheck in 2 weeks. The next dental is scheduled for a year.

o

When there are no extractions, a 2 week check up is scheduled for the nurse to cover the oral health care plan. The nurse will ensure that the owner understands the needed care and expectations for return visits. At this time, Oravet will be applied with the pet parent and a dental pack will be sent home and gone over with the pet parent. The teeth will be stained to check for plaque and dental care will be discussed with the owner.

o

When there are extractions, pain medication and antibiotics are used perioperatively as well as sent home for a minimum of 7 days for pain medication and 14 days for antibiotics. An appointment will be scheduled with a doctor for a 2 week check up to determine if healing is adequate and if pain is present and to go over the oral health care plan (no extra charge). When extractions are deemed necessary, or pockets greater than 4mm in a dog and 2mm in a cat, unless tooth is loose, pre-operative dental radiographs are necessary. Nerve blocks (Infraorbital, Mandibular or Mental) with a total per patient of at or less than1mg/kg Lidocaine 2% and 1mg/kg 0.5% of Bupivicaine and a 25 g needle (aspirate first) is necessary- do not insert more than tip of needle into the foramen- caution if both sides of mandible are blocked because dogs may mascerate their tongue. If the tooth fractures off and the root is drilled out, radiographs are taken after extraction to ensure entire root is drilled out. Print outs of radiographs will be sent home with owner. Consil is used in extraction sites if a large defect is present.

o

Pockets >3mm and <5mm in dogs should all have Doxirobe gel applied, with consent of owner and at additional charge.

ď&#x192;&#x2DC; Diarrhea cases: o

All diarrhea cases need a fecal analysis for intestinal parasites, fecal cytology and a Giardia snap test. All dogs of appropriate size need a rectal exam. The fecal cytology and Giardia test should be done in house- sick dogs should have the float done in house as well, but well pets with mild cases may have the fecal sent out.

o

If raw diets are fed or the fed has eaten raw meat, culture feces for Salmonella and Campylobacter.

o

Pets are sent home with appropriate medications, supplements, foods.

o

In cases where food allergy diets are started, the diet is given exclusively for 10-12 weeks for a food trial before other food items or treats are added in (for patients needing trials).

o

Fortiflora should be used in the majority of diarrhea cases- also great for recurrent gastroenteritis cases.

AHBC Stand of Care


 Ears: o

All ear cases need an Otoscopic exam.

o

All infected ears need cytological evaluation. If rods are present, send C&S to lab. If yeast only, review dietary history and look for food allergies as well as treat and appropriate ear cleaners to prevent recurrence.

o

All ear flushes in painful ears need topical lidocaine, IV pain medication, sedation or general anesthesia. These cases require appropriate pain medications and/or prednisone to go home. May require pre-anesthestic bloodwork if general anesthesia used and to stay for the day if general anesthesia or domitor/antisedan is used.

o

Be aware that there are few medications safe to use with ruptured TMs, commonly found in patients with severe or recurrent infections. Be sure what you prescribe will not cause hearing loss. Always prescribe oral antibiotics (Zeniquin for small patients and cats, generic Ciprofloxacin, called into a pharmacy that discounts it, for larger dogs) for a minimum of 30 days in case of suspected ruptured tympanum. If a head tilt is present, skull radiographs under general anesthesia are required.

o

Remember that most ear infections require a combination of therapies to resolve completely and stay under control. Make sure all owners are comfortable with how to clean ears and administer medications.

o

T8 Keto ear cleaner should be sent home for ear with yeast infection- either Conofite (no bacteria- must be BID) or Mometamax (bacteria also) should be sent home as treatment.

o

For ear infections in cats, Tresaderm (BID) is preferred – if moderate to severe yeast, TriOtic is acceptable (conofite often stings in cats, so use caution).

o

For ear mites, clean ears well with Cerulytic or flush, and apply Acarexx in house. Send home Tresaderm to start in 1 week to cover any secondary infection.

o

Very mild bacterial infections with or without yeast may be sent with TriOtic (BID). Moderate infections may have Mometamax. Severe bacterial infections or any infection with rods should start with T8 Keto/Baytril- 4 oz T8 Keto and 12ml 100mg/ml Baytril (only stable 14 days- use 1 to 1.5ml AU BID) and oral Zeniquin (small dogs and cats) or Generic Script of Ciprofloxacin called in or typed no computer (large dogs).

 Eyes: o

All eye cases need thorough physical examination of conjunctiva and globe.

o

All red eye cases need Flouroscein staining, Tonovet eye pressures in all red eyes of age one year or older. Turn off the light when examining a stained eye.

o

All eye cases need a thorough Ophthalmoscopic exam with the scope.

o

Any eyes with thick green or thick yellow discharge need a Shirmer Tear Test and dogs on Deramaxx.

AHBC Stand of Care


 Euthanasia o

We will sedate all patients before euthanasia with Telazol unless they are unconscious or under anesthesia.

o

We will treat the patients with dignity and respect before, during and after they are deceased.

o

We will attempt to console the patients and calm their fears, without putting ourselves or owners at risk of injury.

o

We will never pass judgment on the appropriateness of euthanasia. However, if a euthanasia is for convenience in a healthy pet, we have the right to refuse euthanasia, but never in a sick or injured pet or a pet with poor quality of life. If the owner needs a consult to discuss if euthanasia is appropriate, this will be scheduled as soon as possible. If the pet has never been seen at our clinic, a consultation is required.

o

Owners may be given the option of home euthanasia if appropriate (if at home will need to make special arrangements to perform after closing and there will be an additional fee).

o

All owners will be given options of clay paw print and hair clipping in frame with rainbow bridge poem. (up to two of each at no charge)

o

All owners will be given appropriate literature. (We have books for grievinggreen and deciding when it is time- pink, and for children). We also have euthanasia packs to go home with each client.

o

All owners will be given options for disposal of remains, or to hold body until decision is made (will remember to call owner in 1 week if we have not heard from them.)

o

Faithful Friends is the crematorium of choice. (they can do a group or individual cremation or a burial and special urns are available at extra cost) www.faithfulfriendspetcremation.com or 919-874-0014.

o

City Disposal is for people who cannot afford anything else or chose not to do other disposal options (cost is $25)- this is actually city trash pick up- Dr. Goetz needs to know if this is done so she can arrange pick up.

o

If taking remains home, they must be put in a body bag and then in a cardboard coffin (small box for smaller exotic pets).

o

All attempts will be made to make owner’s transition easier. If possible, any information and payment should be taken in the room by the doctor to avoid forcing owners to be up front in other clients to do this. The comfort room should be used. Doctors will make every attempt to discuss disposal options and have forms filled out by the owner themselves and avoid extra contact with multiple staff members as much as possible to allow easier transition.

o

Payment should be taken over the phone when the appointment is made if the owner knows what disposal options they prefer.

o

If the client is a good client that has been to AHBC for a long period of time, with doctor’s judgement, payment may be made when ashes picked up if owner requests this, but never for new clients.

AHBC Stand of Care


 IV Fluids: o Multiple legs will not be shaved for IV access unless absolutely necessary. Small clipped areas are desired for sterile access. Topical lidocaine gel used for all IV catheters. A small nick made in skin prior to placement of catheter may make placement easier, especially in certain breeds and older cats. o

Maintenance fluids should address electrolyte status and include K+ unless contraindicated or unless perioperative only (LRS is of choice perioperatively unless other diseases are present) o

Electrolytes and CBC/albumin/TP can be run to assess proper fluid status.

o An IV pump is preferred for continuous infusions of any type. Dial-a-flow lines are available if an IV pump is not available. o

Surgical Fluids and Catheters are intended only for short duration perioperatively.

o

Catheters that need to remain in for fluid and drug administration are secured in with a T-set of appropriate size added. Long term catheters should have vet wrap down to the toes with the middle two toes exposed.  Lumps & Bumps: o

All lumps > 1cm need FNA for cytological diagnosis, unless they are very obvious sebaceous adenomas. When there are multiple fatty lumps, all need to be checked.

o

All lumps need to be mapped, measured & described in the medical chart, including a diagram. There are templates on Word with pictures of dogs or cats when there are multiple lumps.

o

It is not appropriate to watch undiagnosed tumors grow, except in terminal cases. In terminal cases palliation and pain control are minimum.

 Orthopedics/lameness’ o

All cases with spinal symptoms need a neurological evaluation

o

All orthopedic cases need radiographic evaluation which requires sedation or pain control at minimum (IVDD is an exception if afebrile)

o

All lameness’ need thorough orthopedic examination

o

In simple terms – if it is favoring or limping, take x-rays.

o

IV pain management and/or sedation as needed for all limping patients when x-rays are being taken. Encourage dropping off if sedation is to be used.

o

Orthopedic surgeries- we will give the following options: Dr. Rebecca Tudor, the Veterinary Specialty Hospital (Cary or N Raleigh), or NCSU vet school. For angular limb deformities or hip replacement surgeries, NCSU is the referral institution of choice. When in doubt what to do, always call Dr. Tudor to get her opinion over the phone. Radiographs may be posted on VIN as well.

o

Any fracture that can be safely splinted or casted should be- no broken bones will be treated without pain management and a splint or cast at minimum and cage rest. Any fracture that will not heal without surgery will be presented as such.

AHBC Stand of Care


 “Over 40’s” Program (7 years and over, 5 years and over in giant breeds) o

All “over 40” pets need increased surveillance per chart for disease screening

o

“Over 40” pets need increased Early Renal Disease (ERD) surveillance

o

“Over 40” Cats also need annual thyroid evaluation

o

All cats 10 years or older need bi-annual blood pressures.

o

“Over 40” dogs also need rectal examinations (all dogs period- need to start at 6 years of age in dogs).

 Pain Management Programs = Pain Care o

Pre-emptive scoring performed in consultation o

Grade 1= no pain

o

Grade 2= mild pain

o

Grade 3= moderate pain

o

Grade 4= severe pain

o

Inpatient Scoring performed and treated as indicated

o

No patient will receive surgery or dental extractions without pain medication

o

Surgical Requirements – patients will receive pre, intra and post-operative pain management as indicated

o

Go Home Protocols – patients will receive pain management as indicated

o

Pre-op pain control: all surgical or dental extractions for canine patients need Hydromorphone SQ 30 min prior or IM 15 min prior to the procedure, with hub of ace as appriopriate (no ace if seizures, boxers, sight hounds, heart disease). Dentals only may have just Acepromazine for sedation only unless severe gingivitis. All surgical or dental extractions also receive an oral NSAID on admission or given by owner that am with NSAIDs to go home for 5-7 days as appropriate. More painful procedures should have tramadol to go home as well.

o

Pre-op pain control cats: SQ Burpenorphine for surgical or dental extractions morning of and to go home for 3-7 days as appropriate. No premeds for routine dental cleanings- IV dolorex (butorphanol) may be given if needed for placement of IV catheter.

o

Local analgesia- 0.5% bupivicaine (Maracaine) 1mg/kg and Lidocaine 2% 1mg/kg mixture (total dosage per patient) for local blocks for tooth extractions, dermal line block for tumor removals or spays, testicular block for neuters, and carpal block for declaws or foot surgeries.

AHBC Stand of Care


 Skin: o

All skin cases with hair loss in dogs <2 years old, or yeasty looking lesions need scrapings for mites (with mineral oil) and yeast/bacteria (blade dry onto slide that is flamed and stained). Thorough parasite control programs. (eg Frontline/Advantix (dogs) / Advantage Multi (cats, dogs) as part of treatment plan) (capstar if live fleas).

o

All localized hair loss cases in young dogs need skin scrapings for Demodex.

o

Crusty lesions on cats should be cultured on the DTM fungal medium.

o

Widespread or recurrent history of skin disease requires diagnostic investigation including RAST allergy testing (Greer), Food elimination trial, skin culture and/or biopsy as appropriate, or referral to dermatologist. Atopic is an option for chronic Atopy patients.

o

Do not use Ivermectin to treat skin parasites in collies/shelties/aussies (daily interceptor instead- call Novartis rep for free expired product).

o

All cases of pyoderma will be treated for a minimum of 14 days with a recheck scheduled- 30 days is appropriate in patients with chronic allergies. Cephalexin is preferred for dogs with pyoderma. In patients too small, Simplicef is preferred. For cats, Clavamox is preferred (Zeniquin if the owner needs once daily administration or if they have vomiting or diarrhea on Clavamox). Dogs with moderate to severe pyoderma should be also treated with Hexadene shampoo (EpiSoothe or Resicort crème rinse if dry coat or if very itchy)- cool water and towel drying, rather than blow drying, should also be done. The underlying allergy needs to be addressed.

o

Puritic patients need to be treated with anti-histamines or prednisone as appropriate (never use prednisone with patients on NSAIDs- must be off NSAIDs at least 7 days first; never use prednisone in immunosuppressed or demodex patients).

o

Any patients with flea allergy, need to be treated with topical parasite control- do not use a stripping shampoo (kertolytic or seborrheic) in patients with flea allergy, as it will decrease the efficacy of the flea preventative (use a detergent free shampoo such as Hexadene, EpiSoothe, KetoChlor, or baby shampoo). These patients also need to have the home environment treated.

 Surgery: o

Sterile gowns, caps and masks covering hair are required for all bone or open cavity surgeries (including spays and dog neuters and tumor removals).

o

IV catheters, preoperative bloodwork as already described.

o

All Dobermans or Miniature Pinchers require VonWillebrand’s testing even if previous surgery has been done! (Including dentals that may require extractions!!)

o

Anesthetic monitoring as prior.

o

All surgeries intubated and on isoflurane.

o

E-collars to home for any patient with an incision (unless just oral surgery only or cat neuters).

AHBC Stand of Care


 Urinary Tract Disorders: o

All UTI cases need a UA + sediment

o

All UTI cases with rods or chronic/recurrent infections or chronic kidney disease or bladder or kidney stones or to differentiate vaginitis versus UTI in female dogs need culture.

o

All dogs with UTI symptoms and USG < 1.025 need biochemistry evaluation

o

All cats with UTI symptoms and USG < 1.035 need biochemistry evaluation

o

Cystocentesis is the preferred method of urine collection for urinalysis in cats. Free catch is acceptable for ERD testing. Make sure owners are aware when a cystocentesis is going to be done. Do not do a cystocentesis in dogs unless needed for a urine culture.

o

All urinary tract infections will be treated with a minimum of 14 days of antibiotics (30 days if kidney disease is present). Clavamox or Convenia is preferred in small dogs and cats. Zeniquin is ok if once daily dosing is preferred or if the other drugs have reactions. Clavamox is preferred in large dogs as well, but if cost prohibitive, cephalexin or generic ciprofloxacin may be used with doctor’s judgement.

o

Urine cultures should be offered initially and every 6-12 months in all patients with chronic kidney disease.

 Vomiting cases: o

All protracted vomiting animals need abdominal radiographs, a CBC + 12 chemistry + lipase + electrolytes added as a minimum database.

o

A chemistry that includes lipase & amylase /CBC can be sent to our outside lab if time allows. If protracted vomiting in a small breed dog with cranial abdominal pain and no evidence of a foreign body on radiographs, a cPLI out to the lab needs to be done.

o

T4 in all cats 7 and over.

o

Protracted Vomiting patients are hospitalized for injectable medications and fluids as required.

o

Delivery of fluids through IV catheter using a fluid pump is preferred unless the patient’s demeanor disallows.

o

In mild/occasional vomiting patients, Cerenia and/or famotidine injectable as appropriate. SQ fluids given on any dehydrated patient. Fasting, GI Health Pack as appropriate. See above if diarrhea.

AHBC Stand of Care


 Wounds & Cat Bite Abscesses: o

All cat bite patients need pain medication. Injectable ASAP and oral to go home

o

All wounds requiring debridement and abscesses requiring lancing need anesthesia or sedation/IV pain medications (also topical anesthesia generally- lidocaine gel or intradermal injections).

o

All wounds & abscesses need adequate drainage and flushing (Hexadene is preferred for flushing and may be dispensed for at home usage if the owner can handle the care. Hexadene is useful as well for hot spots in dogs. We love NeoPredf powder after cleaning hot spots for dogs. Do not use steroids for wounds or abscesses, or in diabetic or cushinoid patients.)

o

If the bite was acquired outside and it is a feline patient, Felv/FIV status needs to be determined (tested) and a follow-up put in the file for retesting in 6 months.

o

All abscesses need broad spectrum antibiotic cover for a minimum of 14 days. Clavamox or convenia are the medication of choice, unless once daily medication is required for ease of administration (Zeniquin).

o

If the abscess is in a location such that it may be due to abscessed tooth, then scheduling for a dental and radiographs is needed.

o

Deep or foul-smelling abscesses need to be cultured, and enough antibiotic dispensed for 5-7 days to cover until the organism and sensitivities are identified, then the appropriate antibiotic filled for an additional 7-10 days if the original antibiotic was appropriate.

o

If the bite was acquired outside, be sure the cat is on heartworm preventive (Advantage Multi or Heartgard and Frontline) since it is at even higher risk for heartworms than the indoor only cats are in this area.

 Allergic Vaccination Reactions: o

All pets with a history of vaccination reactions will have all vaccinations split up until there is adequate history of vaccinations administered safely without reactions.

o

All intranasal vaccinations will be preceded by an IM injection of benadryl (at 1 to 1.5 mg/pound) for vaccine reactors.

o

All injectable vaccinations will be preceded by an IM injection of benadryl as above and an IM injection of Dexamethasone Sodium Phosphate (0.22mg/kg) will be administered. The pet parent will be offered day hospitalization at their expense.

o

All pet parent’s with pets with vaccine reactions if they choose to watch their pet at home will be told to stay home with the pet for 24 hours and not to travel and not leave the hose for at least 8 hours to observe the pet closely.

o

Pets that have a vaccination reaction will be treated with benadryl IM at 11.5mg/pound, Dex SP at 0.5mg/kg IV if urticaria, facial swelling is present and observation for the day is mandatory without cost to the pet parent. Any pet that has white or pale mucous membranes, collapse, or a PCV>60%, will be treated with IV fluids and Epinephrine and hospitalization for the day at minimum.

AHBC Stand of Care


 Processes  Any animal will have the client concern documented as the first medical record entry. Each client concern will show an Assessment, reflecting what the client was told about what was being treated.  If a doctor orders any wellness screening (laboratory, imaging, etc.), the “assessment” of the testing results will be shown on the progress notes (log). Every “consultation” will have a SOAP of the episode, and each SOAP will reflect a 12-system PE (normal or abnormal will be recorded, and abnormal explained), including a pain assessment score if pain is present, sequential weight with a body score, and dental grade (1+, 2+, 3+, or 4+).  Each provider will use the word “need” instead of recommend. When a “need” is stated, the room will fall silent until the client talks. The client response to each “need” will be recorded as either done or “rejected by client” with a note as to whether an appointment was made or the owner will have a recheck to be called about scheduling later on. If the “need” silence must be broken by any staff member/doctor, the statement must be similar to, “Is this the level of care you want for Spike today?”  All diagnostic screening (results) will be formally assessed on the Progress Notes; sequential testing will be scheduled when any value/assessment is atypical.  Informed consent means explaining: WHY there “must be” laboratory screening before anesthesia; WHY there “must be” aggressive pain control before, during, and after surgery; WHICH type of REVERSIBLE or Ultra-short acting anesthetic program is being used and WHY, WHY the procedure is needed and what PROGNOSIS is expected, and ensure they UNDERSTAND BEFORE they are requested to sign the Hospitalization Consent Form. All surgery cases must have a pre-op handout at previous visit or the day of the procedure to explain the anesthesia.  Inpatient admissions will be overtly entered into the Progress Notes with an Anesthetic Risk Assessment (Levels1-5) and pre-emptive pain management program prescribed, appropriate to the expected outcome of the case.  All “needs” will be recorded, and all healthcare delivery will be recorded as it is done (dictation by the doctor and writing by the nursing staff is acceptable, and preferred for surgery cases, so that during closure, the records are written by the attending surgery nurse, and ready to be signed by the time the doctor “pops gloves”). No shift ends if there is ANY workload pending documentation; all healthcare documentation is completed BEFORE any shift ends, doctor or nurse. There is no excuse for loss of continuity of care. This includes the anesthetic monitoring sheet.  Discharge Planning is discussed by the attending doctor with the client by phone BEFORE the discharge is scheduled. All discharges are scheduled with the attending inpatient nurse after the doctor has discussed the inpatient procedures and outcomes with the steward of that animal. During the telephone discussion, the doctor completes the patient-specific DISCHARGE INSTRUCTIONS in the computer file for use by the attending nurse later that day. The discharge planning always plans the NEXT EXPECTATION for contact by the practice.  Each patient is expected to visit the clinic at least TWICE per year – “Think twice yearly for Life”, to ensure patient well-being  The EXPECTED number of visits per year per pet will become part of the narrative for each client contact, and the next contact or return will be established as an expectation.

AHBC Stand of Care


Any new problem that occurs during the episode must be entered on the master problem list. If a recheck of the condition is required or if there is any need for recheck labwork, dental cleaning, weights, then a recheck callback will be put into the medical record as well. When the pet parent is called, then a log is written that the call was placed and which # the message was left on and what message.

No animal will be allowed to depart without being one of the three Rs (recall = phone them, recheck = (Follow up; Re-evaluation) - schedule them, or remind – email or mail to them), and the appropriate 3Rs reminder (using MKAppt code and follow-up lists) will be entered into the computer BEFORE their departure.

All visits deserve a recall the following day after the appointment to see if the owner has any questions and to check on the pet, even if just a recheck or boarding patient.

If a discharge is to be done to a non-owner, then written consent of the owner is required.

Consent of the owner is required for us to obtain any medical records from previous vet clinics or to give out any medical or vaccination information (document in the patient(s) file).

All pet parents must know what options there are for routine dental care, must know about Pet’s Best pet insurance, and microchipping- this is important, so just do it!

 Boarding Patients: o

Any patient of our clinic on medications and all feline patients may board unless the animal is aggressive. We will not board aggressive patients, but we may hospitalize if very ill and in patient treatment is required.

o

Currently we will not board canine patients unless we ask Dr. Goetz first. We will not hospitalize or board any critically ill patient or patient that needs 24 hours observation overnight or on the weekend. Dr. Goetz may choose to board healthy cats or cats with minor medical conditions for current clients only. If a pet needs to board, then arrangements for staff to come in to take care of the patient need to made.

o

We do not supply food unless the owner wants to purchase it. Owners need to be aware that animals eat their own diet better and they have less gastrointestinal upset, as boarding is always stressful in any pet.

o

All dogs must have DAP, Bordetella, Rabies, negative Intestinal Parasite Screen, and Heartworm test up to date- vaccinations are preferred to do 2 weeks prior or longer if more than 1 month overdue.

o

All cats must have a current FVRCP and Rabies vaccination- vaccinations are preferred to do 2 weeks prior or longer if more than 1 month overdue.

o

Any pet that stays in hospital for any reason must be weighed daily and flea combed upon entry. If live fleas are present, a capstar and topical flea preventative is required at the pet parent’s expense (ideally flea comb before the pet parent leaves the building, if not possible, call the pet parent to inform if live fleas present and the at home environment may also need treatment).

o

Dogs will be walked 3 times daily during days we are open and twice daily on Sundays or Holidays.

o

Cages will be cleaned daily and new, clean bowls with fresh food and water given to all patients and new litter boxes to cats 2-3 times daily.

AHBC Stand of Care


o

The eating and elimination habits must be marked in the patient file each time the pet is checked, with the initials of the person who checked the pet.

o

Once daily oral medications/supplements to animals that are not aggressive to medicate (not IV fluids or insulin). Additional fees apply to animals difficult to medicate, injectable medications (even if brought with pet), and twice daily or increased frequency. If greater than twice daily medications and the pet is staying over a Sunday or Holiday, the pet parent must be information that the medication may only be given twice daily those days unless staff is available to cover.

o

All baths and grooms will be done with the groomer only and she will set the prices

ď&#x192;&#x2DC; Day Spa Patients: o

Michelle is our groomer Monday through Friday. She sets all her own prices herself. Any questions about her services will be directed to her. Her services and prices are listed in the document about her day spa services. Any alterations in her policy will not be done without her consent.

ď&#x192;&#x2DC; Travel Sheets: o

Travel sheets will be highlighted by the attending nurse

o

The Doctor will check all travel sheets and invoices and initial them once confirming all charges are in and complete.

o

Once the pet is ready to go, a smiley face will also be put on the Control Panel to let the Front Desk Team the pet is ready.

o

The Front Desk Team will make sure the above is fulfilled before checking out the Pet Parent.

AHBC Stand of Care


It is a yearly requirement that each employee read the current Standards of Care document and sign this paper that says they have done so. This is important so that everyone is on the same page as to what level of care we will provide to our patients and what are recommendations are.

Name______________________________________________

Date________________________

AHBC Stand of Care

AHBC Stand of Care  

The standards for our hospital listed out for every employee and volunteer to read before the first day of hands on work.

Advertisement