Introduction to Clinical Practice PDF

Introduction to clinical practice Session 9 24-25 Work through at your own pace, taking breaks when you need  Please make a note of any questions and we’ll discuss next week! Last session Communicatio Barriers to Using the Dealing with n communication telepho...

Introduction to clinical practice Session 9 24-25 Work through at your own pace, taking breaks when you need  Please make a note of any questions and we’ll discuss next week! Last session Communicatio Barriers to Using the Dealing with n communication telephone stress/stressful situations Recap…  What do the following terms mean – attempt to answer before checking answer in the note section. Proxemics Haptics Paralanguage   Consent  Admit & discharge Today’s  Certification session;  Group work - research on religious/cultural views to animal treatment  Consent to Treatmen t  Explain the legal requirements for consent to treatment, to include treatment without consent Analyse the features of informed consent Learning Identify potential barriers to informed consent in practice Outcomes Treatment costs Admitting and discharging procedures Autonomy The word autonomy is derived from Greek  autos (self)  nomos (rule, governance or law)  Personal autonomy encompasses, at a minimum, self-rule that is free from both controlling interference by others and by certain limitations such as an inadequate understanding that prevents meaningful choice  Freedom to determine ones own actions and behaviour  The right or state of self government Autonomy We need to It can be said that consider this in animals lack our nursing autonomy and as practice: such is passed to remember our their owners duty of care to the owner The principle of respect for autonomy  To respect autonomous agents is to acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs.  Respect in this account involves acknowledging the value and decision making rights of a person and enabling them to act autonomously Overview of the law on consent There are two main areas of law concerned with consent:  Battery  Negligence Both are part of civil and common law in addition with statutes of relevance Code of Professional Conduct RCVS Guide to Professional Conduct states that a client needs to be fully aware of all the options for treatment and the significance and risks explained to them, before informed consent can be given Therefore it is unethical to proceed with interventions that are not supported by informed consent Consent Derived from the Latin term consentire, meaning to “agree”   Implied Valid  Verbally consent:  Written and in law Requirements  Sufficient age and maturity  Capacity What information needs to be given What information should be given to an owner on the procedure…. List what should be discussed - Informed consent From the code of conduct what 8 factors need to be considered to gain informed consent? https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-p rofessional-conduct-for-veterinary-nurses/supporting-guidance/communi cation-and-consent/ Consent Forms  It is routine for owners to sign a consent from before undergoing any procedures  Does this mean that it would be illegal to perform surgery on an animal without a signed form….? Consent forms The answer is No  From the legal point of view, the key thing is that the owner has given valid consent  That consent could be given verbally Consent Forms The purpose of the consent form is:  To communicate that consent has been obtained to other members of the veterinary team  To provide evidence that the owner has given valid consent Consent forms  However, as money is exchanged during veterinary treatment the consent form can be viewed as a contract  Therefore carrying out procedures that have not been signed for on the consent form can be deemed unethical Information Clearly written consent Easily understood Signed by the client only when he or she fully understands the procedure involved and implications Person must be over the age of 18 Dated Procedure to be taken Contact details Name and address of client Pet Details Pre-anaesthetic bloods if required  1 2 Gaining consent Taking action Role of VS from owner of where consent the animal is either withheld or the person is not available Informed consent  Clients must be aware of the risks  VS should also discuss the benefits of proposed treatments  Allow the client to weigh up the risks and benefits VS? 11.3 Ordinarily it is expected that the veterinary surgeon undertaking a procedure or providing treatment is responsible for discussing this with the client and obtaining the client’s consent. If this is not practical, the veterinary surgeon can delegate the responsibility to someone else, provided the veterinary surgeon is satisfied that the person they delegate to: a.Is suitably trained, and b.Has sufficient knowledge of the proposed procedure or treatment, and understands the risks involved.  Offer a Range of treatment options including prognosis and side effects Clients have freedom of VS choice Information in an impartial manner Guide to Professional Conduct “ensure that the client is made aware of any procedure to be performed by support staff who are not veterinary surgeons” VS responsibility What procedures might support staff perform? Schedule 3 exemption – what is this? What procedures might an RVN or SVN do under this? Costing  Key factor  Realistic information about costs for each option Section 1g of the Guide to Professional Conduct states that a veterinary surgeon has a responsibility to give realistic fee estimates based on treatment options   Consent to treatment is the responsibility of the VS but can be Role of the delegated to appropriated person RVN in  Support the client during the decision making process consent to  Decision reached during consultation with the VS treatment  Signing is merely providing evidence   Give information regarding options this to include euthanasia if appropriate  Give the owner an estimate of cost prior to consent  Give the client an opportunity to consider the options for treatment Good  Explain the significant risks Practice: VS Verbal consent should be given during consultation with the VS, ideally the consent form should be signed. If this has to be done with the nurse the final decision should have already been made with the VS during consultation. Scenario… A member of the public brings a cat into the practice. It was found in the road outside her workplace, having been hit by a car. The cat is very badly injured and the VS decides the only humane course of action is euthanasia. The cat is wearing a collar with a telephone number on it. However, when the VS calls the number it is an answer phone. Twenty minutes after leaving a message, the owner has not contacted the practice. Do you think the VS should euthanase the cat? Euthanasia – Guidelines Euthanasia without any consent Protection of Animals Act 1911 allows a VS to act without consent but they must document fully proving euthanasia was necessary for welfare reasons in case of legal action Barriers to informed consent  Time  Training of staff  Emergency situations  Unethical practices Treatment costs  Discussed with client/informed consent  Higher fee/the greater the need for transparency  Fees written on consent form  Pre and post operative checks, diagnostic tests follow up treatment  Owners must be warned that additional charges may arise if complications occur  Quote, may be binding in law https://www.rcvs.org.uk/setting- standards/advice-and-guidance /code-of-professional-conduct-f or-veterinary-nurses/supporting -guidance/communication-and- consent/  Any questions on consent? Let’s have a break… Admitting and Discharging Admitting for surgical and medical admissions  Delegation to RVN or SVN but can refer back to VS  What’s the practice protocol?  Pre-op check with VS – estimate given and consent signed before the day of routine procedures and VN admits?  Timescale  Adequate time to admit – longer for more difficult cases Admission procedure…  Check patient identification -how?  Check client identification – all contact information  Check when last ate and drank  Check medication – when last given?  Complete ID tag/collar and label possessions  Perform health check – neuterings – time?  Gain client consent – confirm procedure  Advise on time to collect/phone – who phones who? Further thoughts…  Food/water – how/type  Toileting – key words, type of area, type of litter  Grooming  Key words – trained dogs  Health checking – milk, 2 x testicles  Confirming procedure – clip the area?  Understanding the consent form Discharging  Payment  Check patient identification  Check client identification  Prepare discharge sheets – pre printed, dental charts  Prepare medication  Explain the procedure  Any aftercare information - wounds  Anti-lick devices  Items left with patient  Arrange next visit/s  Bring patient to owner Further thoughts…  Adequate time  Open questions  OOH  Delicate cases – preparing the owner Any questions? Task – 15 minutes -we will recap next session  Charlie is a 6 month old crossbreed scheduled for a general anaesthetic and castration today – what are you going to ask the owner? Make notes on the next slides  Later that day you are discharging Charlie – what are the key points you going to discuss with the owner? What information do you need from the VS/team? Charlie’s admit Charlie’s discharge Certificatio n Certification – code of conduct 21.  A certificate is a written statement made with authority; the authority in this case coming from the veterinarian’s professional status.  It should be noted that not all certificates contain the word ‘certificate’. Some documents (for example, forms, declarations, insurance claims, witness statements and self-certification documents) may involve the same level of responsibility even if they do not contain the word ‘certificate’.  Veterinarians are frequently required to sign certificates as part of their day to day professional duties. Some examples include signing pet or equine passports, fitness to travel certificates, fitness to breed certificates or equine pre-purchase examination (PPE) certificates.  What is an OV?  Official Veterinarians (OVs). These are practitioners, who are authorised by the UK Government to carry out certain duties, including certification responsibilities. Veterinarians in salaried employment of the UK Government, mainly Defra and its executive agencies (principally the Animal and Plant Health Agency – APHA) and the devolved administrations are also considered OVs. OVs may be asked to sign certificates relating to live animals or products of animal origin (for example, meat and dairy products, animal by- products, genetic material). Code of conduct…  21.3 Veterinary certification plays a significant role in the control of animal health and welfare, the continuity of European and international trade and the maintenance of public health. Veterinarians have a professional responsibility to ensure the integrity of veterinary certification. The simple act of signing their names on documents should be approached with care and accuracy.  21.4 Veterinarians must certify facts and opinions honestly and with due care, taking into account the 10 Principles of Certification set out below. They should not sign certificates which they know or ought to know are untrue, misleading or inaccurate. This applies equally to hand-written, printed and electronic certificates.  What are the 10 principles of certification? Self study task; What are the 4 C’s of certification? – when would these be used? Group task…  Research the views of your allocated culture/religion regarding animals and the keeping of them as pets and, where appropriate, how this may effect the treatment of the pet.  As a group create a brief document/presentation to present and share with the full group at the start of next week’s class.  Islam – pink team  Jehovah witness – yellow team  Buddhism – blue team  Judaism – green team Today’s session has covered;  Consent  Admit & discharge  Certification  Group work - research on religious/cultural views to animal treatment See you next week!