Introduction to Clinical Practice Session 9

Introduction to Clinical Practice

• Session 9, covering dates 24-25
• Work through materials at own pace, taking breaks as needed
• Note any questions for discussion next week
• Key topics from last session included communication barriers, using the telephone, and dealing with stressful situations

Recap

• Students should attempt to define terms before checking notes

Proxemics

Haptics

Paralanguage

Today's Session:

• Consent
• Admit & discharge
• Certification
• Group work—research on religious/cultural views on animal treatment

Consent to Treatment

• Questions to include in consent form: yes, no, maybe. (example)
• Legal requirements for consent, including potential treatment without consent
• Features of informed consent
• Potential barriers to informed consent in practice
• Treatment costs
• Admitting and discharging procedures

Autonomy

• Autonomy derived from Greek "autos" (self), "nomos" (rule)
• Encompasses self-rule, freedom from external interference, and freedom from limitations.
• Includes freedom to determine one's own actions and behavior, and the right or state of self-governance
• Animals lack autonomy, with the legal right passing to their owners.
• Requires considering the duty of care to the owner in practice.
• Respect for autonomy involves acknowledging an individual's right to hold personal views, make decisions, and act autonomously.
• Includes acknowledging the value and rights related to decision-making.

Law on Consent

• Two main areas of law related to consent: Battery and Negligence
• Both components of civil and common law but also consider relevant statutes

Professional Conduct

• Guidance from the RCVS states clients need full awareness of treatment options and associated risks before consent is given.
• Ethically, it's not permissible to proceed without consent where it hasn't been provided

Valid Consent

• Types of consent:
  • Implied consent
  • Verbal consent
  • Written consent

Requirements

• Sufficient age and maturity
• Capacity

Information Needed

• Information about the procedure must be clear and understandable for the owner/client.
• Details of person must be over 18 years of age
• The consent forms must be dated
• Procedure
• Contact details
• Details of the client, including name and address
• Details of the pet
• Detail if pre-anesthetic blood is required

Informed Consent

• How many key factors to consider for gaining informed consent?
• Reference to RCVS guidance (link provided)

Consent Forms

• Routine for owners to sign a consent form before procedures.
• Consent can be obtained verbally as well as in writing.
• Consent forms help communicate that consent has been obtained.
• Forms can act as evidence of consent; provide a level of contract.
• Noting that procedures completed without signed consent/verbal agreement may be deemed unethical

Information

• Consent forms must be clear and easy to understand for the client;
• Client must be aware of detailed procedure and all implications
• Client must be 18 or older
• Consent forms must be dated

Role of VS

• Responsibility for discussing and obtaining consent with the client(s).
• Delegation to be allowed, on the advice of the practitioner.
• This delegation needs appropriate training of the individual.

VS (continued)

• Need for VS to discuss benefits and risks
• Impartial information needed for clients
• Client choice regarding treatment options and procedure

Guide to Professional Conduct

• Ensure that client is made aware of procedures performed by non-surgeons.

Procedures Performed

• Exploring the types of procedures support staff may perform within Schedule 3 exemptions
• Information needed on the practice protocols

Costing

• Should provide realistic information on treatment costs.
• Section 1g of the RCVS guide details professional conduct responsibilities on giving costs appropriately

RVN Role in Consent to Treatment

• The VS is responsible for consent, but that responsibility may be delegated
• Supports the client during the decision-making process

Good Practice: VS

• Providing information on treatment including euthanasia, if appropriate
• Information about costs need to be given before consent
• Opportunity for client to consider treatment and risks
• Verbal consent should be given during consultation; ideally, a consent form is signed during this, if not, this should be discussed.

Scenario

• Public brings in a cat hit by a car and needing euthanasia

• Cat has a collar with a phone number but phone call does not reach the owner

• Question for consideration regarding VS action/decision

Euthanasia Guidelines

• Protection of Animals Act 1911 allows action in such circumstances if welfare reasons dictate euthanasia, but action should still be documented

Barriers to Informed Consent

• Time
• Training of staff
• Emergency situations
• Unethical practice

Treatment Costs

• Discussed with client in a transparent manner during consent
• Fee structure for treatments
• Detail and information on pre/post operative checks and tests
• Detail and information regarding follow-up treatment
• Owners should be warned of possibilities of additional charges that may arise in the case of complications.

Admitting and Discharging Procedure

Admission Procedure

• Check patient identification, identifying all contact details.
• Check when last ate/drank.
• Check medication details.
• Check id tag, collar and all possessions
• Confirm procedures (e.g., neutering)
• Gain client confirmation of the procedure plan.
• Give clients details on expected time to collect their animal.
• Procedures to be performed regarding client/patient details

Further Thoughts

Discharging

Further Thoughts

Questions on Consent

Break

Admitting and Discharging (continued)

• Delegation to RVN/SVN.
• Practice protocol.
• Pre-op check to include estimate and consent, before the day.
• Timescale for admissions.
• Difficult cases should receive adequate time

Admission Procedure (continued)

• Key factors to consider regarding patient admission.
• Factors to include in detailed procedure.

Further Thoughts (continued)

• Important factors for consideration regarding further procedures regarding patients.

Task—15 Minutes (Recap)

• Information related to a patient named Charlie, regarding the next session.
• Information related to Charlie's discharge procedure

Charlie's Admit/Discharge

Certification

Certification—Code of Conduct 21

• Certificates provide a written statement and authority from professional status perspective
• Terminology related to certificates, beyond use of the word 'certificate' in all cases
• Detail on the required signing of certificates by Veterinarians

Official Veterinarians (OVs)

• Practitioners authorized to perform tasks (especially those related to certification).
• OVs generally are employed under government/agency settings.

Code of Conduct (continued)

• Veterinary certification’s role in maintaining animal health, welfare, and trade standards within Europe

Self Study Task

• Tasks related to study regarding certification

Group Task

• Group Research on cultural/religious views relating to animals/pet ownership, and its effects on potential pet treatment

Today's Session Summary

• Main subject matter covered in the session.