PROCEDURE MANUAL For House Officers
PROCEDURE MANUAL For House Officers 2013-2014 The Ohio State Veterinary Medical Center Procedure Manual for House Officers Table of Contents Mission Statement………………………………………………………………………………………………………. Hours of Operation……………………………………………………………………………………………………… Floor Plan……………………………………………………………………………………………………………………. VMC Organizational Structure…………………………………………………………………………………….. Faculty……………………………………………………………………………………………………………. Staff………………………………………………………………………………………………………………… Administrative Information…………………………………………………………………………………………. Accounting Procedures…………………………………………………………………………………... Building Repairs……………………………………………………………………………………….……… Faculty, Staff and Student Pets within the Hospital…………………………………………. Feeding Program…………………………………………………………………………………………….. Hospital Tours…………………………………………………………………………………………………. Media Requests………………………………………………………………………………………………. Administrative and Financial Policies…………………………………………………………………………… Appointments for Faculty, Staff and Students…………………………………………………. Client Credit……………………………………………………………………………………………………. CVM ID Badge…………………………………………………………………………………….…………… Discounts…………………………………………………………………………………….………………….. Dress Code………………………………………………………………………………….………………….. Emergency Closing…………………………………………………………………….……………………. Food Storage and Consumption……………………………………………………………………… Gift/Conflict of Interest…………………………………………………………………………………… Good Sam……………………………………………………………………………………………………….. Good Sam Medications…………………………………………………………………………………… Social Networking Website and Photography…………………………………………………. Written Estimate, Charge Capture and Adjustment………………………………………… Client Services……………………………………………………………………………………………………………… Hospital Phone System………………………………………………………………………………………………… Long Distance Phone Codes……………………………………………………………………………. Injuries/Bites/Health…………………………………………………………………………………………………… Incident/Accident Reporting…………………………………………………………………………… Incident Forms……………………………………………………………………………………………….. Student/Volunteer Accident Report…………………………………………………………. Animal Bite Report…………………………………………………………………………………… Incident Involving Animal…………………………………………………………………………. Client Accident Report.………………………………………………………………………..…… Page 1 Page 1 Page 2 Page 6 Page 7 Page 10 Page 13 Page 13 Page 13 Page 13 Page 14 Page 14 Page 14 Page 15 Page 15 Page 16 Page 17 Page 19 Page 20 Page 23 Page 29 Page 30 Page 34 Page 35 Page 46 Page 50 Page 53 Page 56 Page 56 Page 57 Page 57 Page 59 Page 59 Page 60 Page 61 Page 63 Medical Records………………………………………………………………………………………………………….. Parking Policies……………………………………………………………………………………………………………. Patient Visitation…………………………………………………………………………………………………………. Security……………………………………………………………………………………………………………………….. Vet Star (Hospital Information System)……………………………………………………………………….. Page 64 Page 68 Page 70 Page 70 Page 71 Sections and Services Anesthesia…………………………………………………………………………………………………………………… Biosecurity/Infectious Disease……………………………………………………………………………………. Blood Bank………………………………………………………………………………………………………………….. Central Supply……………………………………………………………………………………………………………… Clinical Labs…………………………………………………………………………………………………………………. Test Directory…………………………………………………………………………………………………. Euthanasia…………………………………………………………………………………………………………………… Small Animal Protocol……………………………………………………………………………………… Small Animal Checklist…………………………………………………………………………………….. Euthanasia Request Form………………………………………………………………………………… Identification and Handling of Deceased Patients……………………………………………. Honoring the Bond………………………………………………………………………………………………………. Microbiology………………………………………………………………………………………………………………… Pathology/Biosciences/Necropsy…………………………………………………………………………………. Pharmacy…………………………………………………………………………………………………………………….. Charge Form…………………………………………………………………………………………………… Rabies Vaccine……………………………………………………………………………………………….. Chemical Handling…………………………………………………………………………………………. Radiology…………………………………………………………………………………………………………………….. Small Animal Emergency and Critical Care…………………………………………………………………… Small Animal Surgery…………………………………………………………………………………………………… Small Animal Veterinary Assistants………………………………………………………………………………. Page 105 Page 109 Page 131 Page 132 Page 134 Page 136 Page 144 Page 144 Page 147 Page 150 Page 151 Page 153 Page 154 Page 156 Page 175 Page 178 Page 180 Page 180 Page 185 Page 187 Page 190 Page 195 Mission Statement: The Ohio State University Veterinary Medical Center This mission of the Veterinary Medical Center is to serve the citizens of the State of Ohio through the support of the clinical education of veterinary students, post graduate veterinarians and others, and promote animal wellbeing through the operation of a state-of-the-art veterinary medical center. Goals: 1. To provide and maintain a comprehensive state-of-the-art examination, diagnostic, and therapeutic facility. 2. To offer the highest level of professional veterinary medical care to our clients and patients. 3. To serve our referring veterinarians with the highest level of consultation and support. 4. To engender a courteous, compassionate, and professional atmosphere for our patients and clients. 5. To maintain a working environment for our faculty, staff, and students that fosters respect for the individual, promotes teamwork, and enables all to perform to the full extent of their capabilities. 6. To foster and maintain a fiscally responsible attitude among our faculty and staff toward the delivery of veterinary services and operation of the hospital. Veterinary Medical Center Hours of Operation The Veterinary Medical Center is open 24 hour a day, 7 days a week for emergencies for both large and small animals. Office hours by appointment generally fall between 8:00 a.m. and 5:00 p.m. Monday through Friday. 1 2 3 4 5 6 The Ohio State University Veterinary Medical Center Associate Dean, Clinical and Outreach Programs Executive Director, Veterinary Medical Center Chair, Veterinary Clinical Sciences Practitioner Advancement Boards VCS Staff VCS Faculty Interns Residents Director Veterinary Medical Center VMC Board Executive Assistant Assistant Director Business & Finance Clinical Research Advisory Committee Marketing and Development Advisory Committee Assistant Director Patient Care Assistant Director Client Services Facilities Manager Finance & Equipment Advisory Committee Pharmacy and Supply Advisory Committee Medical Records Advisory Committee Finance Teams and Supervisors Client Services Teams and Team Leads Business & Accounting Emergency Admissions Pharmacy Medical Records Central Supply Call Center Clinical Labs Small Animal Admissions Patient Care Advisory Committee Service Teams and Coordinators Teams Anesthesia (Small Animal) Onco/BB SAIM Anesthesia (Large Animal) Cardiology Neurology SA Surgery ECC/ICU Ophthalmology Community Practice Dermatology Equine Surgery Radiology Food and Fiber Equine ICU Equine Medicine RVT Training Canine Rehab Purchasing Receiving Large Animal Admissions Human Resources Manager Large & Small Animal Support Services Custodians Honoring the Bond Program Coordinator THE DEPARTMENT OF VETERINARY CLINICAL SCIENCES The Ohio State University Veterinary Medical Center Anesthesiology and Pain Management Food and Fiber Animal Turi Aarnes, DVM, MS Assistant Professor - Clinical Jeffrey Lakritz, DVM, PhD, DACVIM Associate Professor Richard M. Bednarski, DVM, MS, DACVA Associate Professor and Section Head Andrew Niehaus, DVM, MS Assistant Professor- Clinical and Section Head John A. E. Hubbell, DVM, MS, DACVA Professor D. Michael Rings, DVM, MS, DACVIM Emeritus Faculty Phillip Lerche, BVSC, PhD, DACVA Assistant Professor – Clinical Katharine Simpson, DVM, DACVIM Assistant Professor - Clinical Equine Small Animal Surgery Equine Ambulatory (Field Services) Matthew Brokken, DVM, DACVS Clinical Assistant Professor General Surgery Christopher Adin, DVM, MS, DACVS Associate Professor Michael Schmall, DVM Associate Professor Kathleen Ham, DVM, DACVS Assistant Professor - Clinical Christine Schneider, DVM Clinical Instructor Mary A. McLoughlin, DVM, MS, DACVS Associate Professor Equine Emergency and Critical Care Margaret Mudge, DVM, DACVS, DACVECC Associate Professor – Clinical, Section Head Lillian Su, DVM, MVSc Clinical Instructor Equine Internal Medicine Teresa Burns, DVM, DACVIM Assistant Professor – Clinical Sam Hurcombe, BSc, BVMS, MS, DACVIM Associate Professor - Clinical Catherine Kohn, VMD, DACVIM Emeritus Faculty Ramiro Toribio, DVM, MS, PhD DACVIM Associate Professor Equine Surgery Jim Belknap, DVM, PhD, DACVS Professor Katy Townsend, DVM, MS, DACVS Clinical Instructor Orthopedics Matthew Allen, MA, VetMB, PhD Associate Professor Jonathan Dyce, MA, VetMB, MRCVS, DACVS Associate Professor and Section Head Bianca Hettlich, Med Vet, DACVS Assistant Professor Tatiana Motta, DVM, MS Assistant Professor - Clinical Comparative Theriogenology and Reproductive Medicine Alicia L. Bertone, DVM, PhD, DACVS Professor and Trueman Chair Marco Coutinho da Silva, DVM, MS, PhD Assistant Professor Rustin Moore, DVM, PhD, DACVS Professor and Department Chair Carlos Pinto, DVM, PhD, DACT Associate Professor and Section Head Margaret Mudge, DVM, DACVS, DACVECC Associate Professor – Clinical and Section Head Liz Santschi, DVM, DACVS Associate Professor – Clinical 7 THE DEPARTMENT OF VETERINARY CLINICAL SCIENCES The Ohio State University Veterinary Medical Center Small Animal Medicine Cardiology and Interventional Medicine John Bonagura, DVM, DACVIM Professor and Section Head Brian Scansen, DVM, MS, DACVIM Assistant Professor- Clinical Karsten E. Schober, DVM, DECVIM Associate Professor Comparative Ophthalmology Matthew Annear, BVSc, MS Assistant Professor Anne Gemensky-Metzler, DVM, MS, DACVO Professor – Clinical, Section Head David A. Wilkie, DVM, MS, DACVO Professor Dermatology and Otology Lynette Cole, DVM, DACVD Associate Professor and Section Head Andrew Hillier, BVSc, MACVSc, DACVD Associate Professor Wendy Lorch, DVM, MS, DACVD Assistant Professor Diagnostic and Clinical Microbiology Joshua Daniels, DVM, PhD Assistant Professor- Clinical Gastroenterology and Internal Medicine Julie Byron, DVM, MS, DACVIM Assistant Professor – Clinical Chen Gilor, DVM, PhD Assistant Professor Susan Johnson, DVM, MS, DACVIM Professor, Section Head Neurology and Neurosurgery Laurie Cook, DVM, DACVIM Assistant Professor – Clinical Ronaldo da Costa, DMV, PhD, DACVIM Associate Professor and Section Head Sarah A. Moore, DVM, DACVIM Assistant Professor Nutrition C.A. Tony Buffington, DVM, PhD, DACVN Professor Valerie Parker, DVM, DACVIM Assistant Professor – Clinical Oncology/Hematology C. Guillermo Couto, DVM, DACVIM Professor William Kisseberth, DVM, MS, PhD, DACVIM Associate Professor and Section Head Cheryl A. London, DVM, PhD, DACVIM Associate Professor and Shackelford Professorship Urology and Nephrology Dennis J. Chew, DVM, DACVIM Faculty Emeritus Stephen DiBartola, DVM, DACVIM Professor/Assoc. Dean of Administration and Curriculum SA Emergency and Critical Care Edward Cooper, DVM, VMD, MS, DACVECC Assistant Professor- Clinical and Section Head Julien Guillaumin, DV, DAVECC Assistant Professor- Clinical Andrea Monnig, DVM, DAVECC Assistant Professor - Clinical Valerie Parker, DVM, DACVIM Assistant Professor – Clinical Barrak Pressler, DVM, DACVIM Assistant Professor Bob Sherding, DVM, DACVIM Emeritus Faculty Karen Tefft, DVM, MS, DACVIM Clinical Assistant Professor 8 THE DEPARTMENT OF VETERINARY CLINICAL SCIENCES The Ohio State University Veterinary Medical Center Community Practice, Shelter and Outreach Medicine Susan Barrett, DVM Clinical Assistant Professor Molly Cassandra-Cox, DVM Clinical Assistant Professor Kevin Cox, DVM Clinical Assistant Professor Larry Hill, DVM, DABVP Associate Professor – Clinical, Section Head Christine Kellogg, DVM Clinical Assistant Professor Laurie Millward, DVM Clinical Assistant Professor Behavior Meghan Herron, DVM, DACVB Assistant Professor-Clinical Tracy Shreyer, MA, Applied Animal Behaviorist Program Specialist Dentistry Susan Barrett, DVM Clinical Assistant Professor Molly Cassandra-Cox, DVM Clinical Assistant Professor Kevin Cox, DVM Clinical Assistant Professor Diagnostic Imaging and Radiation Oncology Wm. Tod Drost, DVM, DACVR Associate Professor Eric M. Green, DVM, DACVR Associate Professor – Clinical and Section Head Amy Habing, DVM, DACVR Assistant Professor - Clinical Lisa Zekas, DVM, DABVP, DACVR Associate Professor – Clinical 9 Veterinary Medical Center Staff/Phone List Accounting Kris Burns – 4-3850 Juan Du – 2-6959 Jana Cromer – 2-2594 Ellie Hoskins – 7-8213 Connie Rinehart – 4-8943 Central Supply Rick Teasley – 2-6975 Mary Jean King – 2-0191 Sheila McElhatton – 2-0191 Tomi Spyker – 4-8671 Mario Ventresca – 2-0191 Administration Sue Chmura-Asst. Director-Client Services – 7-4785 Stan Highley-Facilities Manager – 2-6148 Annie Jones-Asst. Director Pt. Care – 7-4475 Ken Luke-Asst. Director Finance – 8-8453 Dave Sammons-HR Manager – 7-4474 Jeannette Schmidt-Asst. to Director – 2-7158 Karin Zuckerman – Director – 7-0040 Client Services Call Center - SA Stephanie Yochem- Call Center Coordinator – 4-6006 George Edmisten – 4-6326 Judy Harper – 4-6268 Patty Owens – 4-6375 Sandra Weber – 46278 Anesthesiology-LA Technicians – 7-7954 Carl O’Brien- LA-Service Coordinator – 2-9587 Amanda Cardenas Devin Heilman Anesthesiology-SA Technicians – 2-7607 Theresa Hand- Service Coordinator – 2-5186 Heather Cruea Sue Huck Gladys Karpa Robyn Victorine Dan Wallon Behavior Traci Shreyer – 7-4633 Biomedical Media* Marc Hardman – 7-6943 Jerry Harvey – 8-8231 Ken Matthias -2-9531 Tim Vojt – 2-2153 Blood Bank Technicians Cristina Iazbik – 8-8460 Amanda Simons – 4-9074 Canine Rehab Tracy Pejsa– Service Coordinator – 7-1830 Marcella Kimmick – Vet Assistant Cardiology Technicians Patty Mueller– Service Coordinator – 7-8311 Tammy Muse – 2-2106 Client Liaisons – 4-6409 Bill Hoza – a.m. Frances Robbins – p.m. Medical Records Katrina Fagan- Coordinator - 46228 Kelly Funk – 2-7958 Krystal Phillips – 4-8844 Bobbi Schmidt – 4-8944 Jennifer Stallings – 7-1957 Celia Ruckel (intermittent) –2-7958 Reception – SA – 4-6179 st Lori Klinge-Coordinator 1 Shift – 2-4301 nd rd Amy Moore-Coordinator 2 /3 shift – 4-6038 Melanie Bernava Meredith Cherubini Kate Churchill Mark Eades Matt Julian Christy McLeod Anna Shepherd Margo Wright Clinical Labs Jana Fletcher – 2-7951 Mary Boyd-Brown – 2-7951 Kathleen Canter – 2-7952/2-7955 Teresa Corbett – 2-7952/2-7955 Megan Fisher – 2-7952/2-7955 Andrea Morgan – 2-7952/2-7955 Nicole Tebbe – 2-7944 Clinical Labs Chemistry Lab – 2-7952 Hematology – 2-7955 Microbiology – 2-7956 Parasitology – 2-8328 *College or Clinical Sciences staff 10 Clinical Sciences* Dan Aldworth-Fiscal Associate – 2-7986 Gail Azcarraga-Carter-HR Manager – 2-0656 Heidi Hamblin- Office Asst. – 2-9896 Debra Henrichs-VCS Adm Manager – 7-2135 Lara Lacey-Asst.to Assoc Dean – 2-0378 Amy Shaw-Edu Prgm Coordinator – 2-0687 Clinical Trials/Tissue Bank Dr. Holly Borghese (TB) – 2-7954 Dr. Luis Feo (Intern) – 8-1147 Tamara Mathie (CT) – 7-8706 Nadia Ruffin (TB) – 8-1105 Ashley Smith (CT) – 2-4559 Nicole Stingle (CT) -688-5713 Columbus State Lenore Southerland – 2-9136 Community Practice/Dentistry Technicians Dawn Eblin– Service Coordinator – 4-2511 Michelle Dumond – 2-8730 Amber Hardesy-Unit Clerical Associate – 2-1573 Jen Henne-Dentistry – 8-1102 Dermatology Technicians Deb Crosier – 4-6395 Educational Design and Systems* Clare Allen – 7-2536 Trudy Busby – 8-8756 Theresa LeMaster – 2-0942 Lorri Noce – 7-2088 Janeen Sylvester – 20942 Emergency Critical Care Technicians (ECC) – SA – 2-5502 Courtney Beiter- Service Coordinator- 8-1148 Renee Cahill- Service Coordinator - 81149 Kiffy Brickey Alicia Byrd Stacey Cooper Shellie Creager Jennifer Edwards Kayla Fields Jessica Fussnecker Billie Garbers Carrie Jacin Jessica Lynch Amber Mason Dawn Miklos Liza Pawlak Jim Quang Michelle Rettig Thomas Skidmore Sarah Lumbrezer Johnson (Intermittent) Joan Sicree (Intermittent) Equine Center/LA office – 4-3704 Janelle Duncan Marge Hauer Lorie Kipp – 4-4441 Margie Price Equine Surgery Technicians Mallory Carnes- Service Coordinator – 4-8638 Tom Burgett – 4-0159 Jessica Rosebrook – 2-5908 Equine Medicine Technician Amanda Hutcheson- Service Coordinator – 4-3845 Equine ICU Technicians – 4-1389 a.m./4-7092 p.m. Olivia Holt- Service Coordinator – 4-1389 Abbie Bohler Samantha Briggs Heather Couch Julianne Furukawa Laura Peirson Adriel Sitzes Kirsten Swenson Nicole Miller(Intermittent) Barb Sohayda(Intermittent) Food Animal Technicians Beth Miller – 7-6898 David Fredrick – 7-1577 Honoring the Bond Joelle Nielsen – 7-8607 Housekeeping – 614-558-3280 Internal Medicine Technicians Pam Pugh– Service Coordinator – 8-3817 Joy Quang – 4-8675 Robin Richardson – 8-8338 Microbiology – 2-7956 Nancy Martin Stephen Anderson Neurology Technicians Amanda Waln- Service Coordinator – 7-2167 Heather Myers – 8-1111 Oncology Technicians Stacey Gallant- Service Coordinator – 2-8871 Tasheena Ebert – 2-2628 Kentee Fitch – 2-9252 Ophthalmology Technicians Kelley Norris- Service Coordinator -2-4574 Chris Basham – 7-8227 *College or Clinical Sciences staff 11 Pharmacy – 2-1010 Andrew Whicker-Pharmacy Manager Mary Widders-Head Pharmacist Christina Baldwin Nissa Howard Amber Phillips Radiology Technicians -2-1040 Julie Morris-Service Coordinator – 2-6863 Danelle Auld Denise Bailey Jenny Bolon Nicole Pastorek-Rad Onc – 7-9987 Charles Smith Amanda Warchol-Rad Onc – 8-8376 VIS/Computers* – 2-4146 Cathy Bindewald-CIO – 2-74346 Rory Gaydos-Associate Director – 2-7735 Adam Britt – 2-8750 Brian Kildow – 8-7990 Reno Lemons – 2-7905 Dee Lohmeyer – 2-0029 Fred Marker – 2-2482 Sravani Paladugu – 2-3893 Chris Wells -2-3995 Ward Technicians (evenings and nights) Chi Crompton/Night Coordinator – 7-1648 Marjorie Turpening/Evening Coordinator – 7-1613 Receiving Dock – 2-7440 John Kindall Craig Miller SAOP* - 2-7866 Linda Bednarski Mary Casey – 2-8057 Erin Waggoner Security Guard – 2-6677 Surgery (SAS) Technicians Mary Ross-Service Coordinator – 2-0461 Nikki Brown – 4-2611 Kristie Brush – 2-0694 Michelle Gilliam – 7-7923 Mathew Kerzee – 4-9987 Kim Penrod – 2-1374 Heather Storey-Unit Clerical Associate – 2-8233 Amy Weatherall – 7-1854 Theriogenology Chelsey Messerschmidt – 2-7397 Vet Assistants - LA Ryan Lentz-Team Lead – 8-3291/731-0712 Isaac Asare Jerry Peterman Tom Reeb Donald Wolf Vet Assistants - SA Jaime Board – 8-1638 Caitlin Fleming – 8-1646 Cathy Leuszler – 7-8427 Deanna Lopez – 8-1634 Todd Tensley – 8-1631 *College or Clinical Sciences staff 12 Administrative Information Accounting Procedures 1. Credit policies are strictly enforced. Any exceptions to current policies will be made by the Accounting staff only. 2. Keep clear and accurate client communications documented in the chart. 3. All admissions and releases will be handled by the Reception staff. Do not release animals to clients waiting in the lobby without being paged or asked to do so first by the staff. This typically takes place after the client has paid their bill for reasons of safety, uninterrupted medical discussions, and process efficiency. 4. Do not talk money with clients. All money questions, concerns or problems should be directed to the Accounting offices or night-time staff. The Accounting phone number is 292-1360. The Front desk phone number is 292-3551, and Equine Reception is 292-6661, or extension 4-3704. 5. Enter charges on client accounts in a timely manner to ensure accurate bills on discharge and provide good customer service. Building Repairs All requests for building and equipment repairs and maintenance are to be channeled through the Facilities Manager. Call 2-6148 from 7:00 a.m. – 4:00 p.m. After hours, contact the client services department for assistance. Faculty, Staff, and Student Pets Within the Hospital As faculty, staff, and students at this veterinary college, we all like animals. The problem is that there are 600 of us who like animals. If on any given day we all brought our animals to work, we would have no room for our patients. In light of this, the rule has been and will continue to be that no animals other than active, current patients of the hospital are allowed in the building. At no time are animals to be in the business office, or roaming free about the hospital. This includes weekends, evenings, and holidays. Any student or staff desiring to have his or her personally owned animal examined and/or treated by the Veterinary Hospital must follow the following procedures: Unless otherwise arranged with a specific clinician, an appointment must be scheduled through the reception desk. A patient medical record must be prepared for all privately owned animals. Hospitalization of a patient must be authorized by a responsible clinician and the patient properly identified with a neck band, cage label, and accompanied by a regular medical record. 13 Feeding Program Various lams and Purina pet food are available for purchase by students, faculty, and staff at discounted rates thru our front desk. A valid College of Veterinary Medicine ID must be displayed at the time of sale. Sales times are Monday- Friday, 9:30 a.m. – 3:30 p.m. You will need your receipt in order to pick up your order within those hours. Dock Hours are Monday- Friday, 8:00 a.m. – 4:00 PM. Hill’s foods are available online thru the SCAVMA organization and pick-up is at the VMC dock. Please note that clients come first and we ask that you do not hover near the cashier when a client is paying his or her bill. If you have any questions or concerns, please feel free to contact Accounting at 614-688-4030. Hospital Tours Requests for tours should be directed to the Student Affairs Office (phone # 247-1512) or the Assistant to the VMC Director, phone # 292-7158. Hospital Administration should be notified of all group tours of the building. Media Requests Any media requests or publicity for the VMC should be directed to the College Communications Director, Melissa Weber at 292-3752 or the Hospital Administration Office at 292-7158. Requests for speakers should be directed to the Office of Veterinary Clinical Sciences at 292-0378. 14 Appointment Policy for Students, Faculty, and Staff All faculty, staff and students of the College of Veterinary Medicine are welcome to have their personal pets treated at the OSU Veterinary Hospital. Anyone employed or registered as a student at the College of Veterinary Medicine receives a 20% discount on services. When you register your pet for the first time, please show your College/ Student ID. Your student, faculty, or staff status will be notated in the hospital billing system. You will then receive the 20% discount from that point on until you are no longer affiliated with the College. All animals seen, regardless of the reason for the visit, must be registered prior to the visit by the reception staff. This includes all drop off/overbook, blood donor, employee/student, special/weekend and emergency visits. All animals coming to the hospital must be registered and have a chart generated for documentation of the treatment and services performed. No exceptions. A number of clients, staff and students have been bringing their animals to the hospital for treatment without getting the animal registered for the visit. This creates a number of problems: • It places us in a compromised position legally if anything happens to the animal while in our care. • Patients’ long term care is compromised, as diagnoses, treatments and test results are not getting documented into the patient record. • Also, charges and revenue for the services performed are not being recorded correctly and clinicians are not receiving credit for seeing these cases. Please do not put the clinicians in an awkward position by requesting services from them that fall outside the normal appointment process. 15 Client Credit Policy We are dedicated to helping our clients care for their animals and realize that payment for treatment often is a concern. Please understand our financial requirements. The Hospital is self-supporting. Please let us know if you have budgetary limits before we start diagnosis and treatment. Estimates & Deposits: You will receive a preliminary estimate in advance of surgical or medical procedures once the initial evaluation is completed. If your animal is transferred to another service within the Medical Center you should receive an additional estimate for care under this new receiving service. The estimate may be revised if results of diagnostic testing alter the plan for treatment or if complications arise related to a serious illness. Outpatient: The Ohio State University Veterinary Medical Center operates on a payment-at-time-of-service basis for all outpatient office visits, spay, neuter, and declaw surgeries, prescription and lab services. This policy applies to both routine and specialty clinics. Payment for elective surgeries such as spay, neuter, and declaw surgeries are due in full when the animal is admitted. Inpatient: A minimum deposit equal to 50% of the high end of the estimate range provided is required for all inpatient (hospitalized) cases prior to admission. For example, if your estimate is $1,200-$1,400, you would be asked to leave a $700 deposit. Please keep in mind that estimates and deposits can change if complications occur. Please ask how changes in your animal’s condition will affect the cost of treatment. The required deposit may be higher based on the current estimate, your credit history, the urgent nature of your case, and other extenuating circumstances. Payment for the balance of charges is due upon release of an inpatient from the Medical Center. Financial Arrangements may be possible for inpatient (hospitalized) patients with balances over $300 upon credit verification and approval by the Accounting department. The credit application must be complete, including proof of owner’s social security number and other contact information. If approved, one-half of the unpaid balance will be required upon release of your animal and the remaining amount due may be financed in three monthly installments. Interest of 1.5% per month (18% APR) is assessed on all accounts with balances over 30 days. We do our best to provide a complete invoice at the time of discharge, but due to the nature and timing of certain procedures, all charges may not be posted at the time of release. In such instances, you will be billed for the remaining charges incurred for patient care during treatment of the animal but posted in the billing system after release. These additional charges will be billed by mail and payment is expected within 30 days of billing or 1.5% per month (18% per annum) interest will apply. The Veterinary Medical Center reserves the right to refuse to provide care if an existing client’s account is not current or a client is unable to pay for the services. We accept cash, checks (with valid ID), Discover, MasterCard, VISA, and American Express. * Prices subject to change. Verify with Accounting. V02.09 16 CVM Human Resources Policies ID Badge Policy Revised: May 2011 Applies to: All General The College of Veterinary Medicine (CVM) is committed to providing a secure workplace. As part of this goal, CVM has established an identification badge system for all faculty, staff, students, visitors, contractors, and volunteers and other authorized personnel. Failure to follow this policy will be considered a violation of university policy and may result in disciplinary action. Policy Guidelines Definitions A. BuckID – the official university ID for faculty, staff, and students. The BuckID can serve a number of purposes. See www.buckid.osu.edu or call (614) 292-0400 for additional information. Because Athletics recognizes only the BuckID for entry into athletic events, the CVM ID badge will not be used as a replacement for the BuckID. B. CVM ID Badge – The official identification for all CVM employees, volunteers, students, visitors, and contractors and other authorized personnel. The badge is designed for identification purposes and to gain access to facilities after hours or that are restricted. The CVM ID badge displays the CVM logo, an image of the individual, and the full name, title, and department. The badge is encoded with the BuckID ISO number on the magnetic strip on the back. Requirements A. Because the policy and procedures described herein are intended to provide for the safety and security of the CVM community, all employees, students, visitors, volunteers, contractors, and other authorized personnel are expected to fully comply with all provisions of this policy. B. CVM Human Resources will coordinate the implementation and management of the badge program in CVM. Departments, the Veterinary Medical Center, and CVM Student Affairs must identify one individual who will manage ID badge application forms for their respective areas. C. As part of new student, faculty and staff orientation, new individuals will sign an acknowledgement form, which will be housed in the appropriate department. D. The CVM ID Badge must be prominently displayed at all times while on college grounds and prominently worn so the photo is clearly visible. Individuals will be provided with either a lanyard or a badge retractor at the time they obtain their initial badge. Individuals may elect to wear their own lanyard or badge retractor as long as it is professional in appearance. E. Individuals are responsible for safeguarding their own CVM ID Badge and BuckID. Any lost or damaged CVM ID Badge or BuckID should be reported immediately to the department’s HR Professional or CVM Student Affairs (VME Students only), who is responsible for notifying access coordinators and providing the necessary forms for the individual to obtain a replacement. CVM Human Resources Policies/ID Badge Revised: May 2011 Page 17 F. Departments may issue a Visitor badge to an individual who has forgotten to bring his/her badge in for the day. The Visitor badge must be returned to the department at the end of the day or shift. No one shall have more than one CVM ID badge. G. CVM ID Badges and BuckID’s are the property of the university and shall be returned to the department HR Professional upon separation from the university or being placed on administrative leave. Students (all) may keep the BuckID as can employees transferring to other university departments. CVM ID Badges should be collected for student positions. H. Visitors and volunteers must have a CVM ID Badge while in College areas. Visitors and volunteers should obtain a badge from the department representative for the area for which they are visiting or volunteering. Each badge is numbered and can be used for access to secure areas via the badge identification number. The badge should be returned to the department at the end of the visit or volunteer assignment. Departments will receive a limited supply of Visitor badges. Responsibilities A. Administration – ensure that this policy is fully implemented and adapted to the needs of the College and departments. B. Department Human Resources Professionals – responsible for the management of ID request forms and the collection of ID badges when an individual is no longer associated with the University. C. Supervisor/Managers – employees in supervisory titles are responsible for the reinforcement of this policy. D. ALL – all faculty, staff, students, volunteers, visitors, and designated others, are responsible for identifying individuals on college grounds without an ID prominently displayed and either request to see an ID or to report the individual to the immediate supervisor, departmental chair, Associate Dean, Student Affairs (VME students only), Director, CVM HR; and/or department HR Professional. In addition, individuals should verify people have appropriate identification prior to allowing individual’s access to secure or locked areas. Failure to ensure proper safety can place the CVM community at risk. Replacement Lost or damaged CVM ID Badges should be reported to the department HR Professional, CVM Student Affairs, and/or the CVM HR Director within 24 hours. After notification, the individual is responsible for obtaining a replacement. A CVM ID Badge Application is required and can be obtained from the department HR Professional, CVM Student Affairs, and/or the CVM Human Resources Director. Individuals will be responsible for any possible costs associate with replacement of the CVM ID Badge or the BuckID. Scenario Associated Cost First-Time Badge No Cost Damaged, Name Change, or Status Change – must turn in current badge before receiving a replacement. All Badges distributed by BuckID Lost CVM Badge – requires both the BuckID and the CVM Badge to be replaced due to coding. Staff must produce one current form of photo identification such as a driver’s license, passport, etc. a) If current ID is turned in, no charge to the staff member b) If current ID is not turned in to BuckID Services, employee pays $5 for the CVM ID Badge and $20 for the BuckID when ID is issued. BuckID - $20 replacement CVM ID Badge - $5 replacement Resources BuckID Services – 3040 Ohio Union, 1739 N. High Street, 614-292-0400 CVM Human Resources Policies/ID Badge Revised: May 2011 Page 18 VETERINARY MEDICAL CENTER DISCOUNT POLICIES – Revised 09-24-2010 GENERAL REQUIREMENT: ALL DISCOUNTS ARE CONTINGENT ON THE CLIENT PROVIDING TIMELY PAYMENT AND MAINTAINING AN ACCOUNT IN GOOD STANDING. Please note that only one discount per individual may be applied. For example, someone eligible for a Golden Buckeye discount and another discount would only be eligible for one discount on a given visit/patient. Golden Buckeye – Amount: 5%. Eligibility: Any Ohio resident with a valid golden buckeye card presented at the time of service. Faculty/Staff/Student – Amount: 20%. Eligibility: Any Faculty/Staff member who works for the College of Veterinary Medicine and any CVM student. Valid employee or student ID is required. The discount applies to personally owned animals only and is for supplies and services provided to external clients. *Please note: The waived exam fee is ONLY offered for animals seen during off-peak and non-emergency periods of a service’s schedule. In this case, employees’ and students’ animals will be seen between other client appointments that day. Employees can opt to schedule their animals for a specific time slot in the schedule, but will be charged the exam fee for securing that specific appointment. o Emergency-Critical Care cases will be assessed an exam fee. The emergency (ER) fee will be waived unless the case is determined to be non-emergent by an ECC Faculty. The above 20% discount is applicable to the exam fee and/or ER fee. o There may be exceptions to the Faculty/Staff/Student discount policy for select services. Retired Faculty/Staff – Amount: 20%. Eligibility: Any Faculty/Staff member who retires from the College of Veterinary Medicine may keep the discount for life; the discount that applies defaults to the policy for active faculty/staff/students at the time of service and applies to personally owned animals only. DVM – Amount: 10%. Eligibility: Any veterinarian. Rescue Organization – Amount: 10% on first visit per animal. Eligibility: Any rescue organization that provides a letter on their letterhead stating the name of animal, name of director, address of the office, foster parent information, amount that is allowed for the visit, and their tax ID number. Subsequent visits for the same animal are not eligible for the discount. Law Enforcement Animals – Amount: 10%. Eligibility: Animals owned by law enforcement agencies. The discount applies for all visits on eligible patients. Please note this is only applicable to governmental agencies. Franklin County Dog Shelter and Capital Area Humane Society – Amount: 20%. Eligibility: Discount per agreement and requiring Hospital Director’s approval. Columbus Zoo/Wilds – Amount: Negotiated %. Eligibility: Special agreement that requires Hospital Director’s approval. Guide/Service Animals – The Hospital may offer special one-time discounts, such as reducedpriced exams or other discounted services, with the Hospital Director’s prior approval. 19 The Veterinary Medical Center Dress Code Guidelines In an effort to promote professionalism, infection control, and safety, the Veterinary Medical Center (VMC) requires faculty, residents, interns, staff and students (personnel) to maintain personal cleanliness, neatness, good hygiene and appropriateness of dress when on service/working in the VMC. A. General Dress and Appearance Guidelines 1. General Expectations of Appearance: Whether we wear scrubs or our own clothes, the way we appear to our patients, clients, visitors and one another says a lot about how we deliver the services we offer in each of our respective positions. Our dress should make everyone we encounter confident that we are a professional committed to excellence in patient and client care. Clothing should be wrinkle free, clean and in good repair and should be selected to wear within the work environment with the intent to present a professional image. The contents of this policy are not exhaustive in the items that may or may not be permitted. It is recommended and expected that personnel will inquire prior to wearing an item of question. It is also recommended and expected that service heads/supervisors/managers will set a vision for the expectations in their respective departments meeting this policy at a minimum. 2. Clothing: In certain areas of the VMC, scrubs and other uniforms are currently provided annually based on percentage of FTE. In other areas, professional attire is expected. Scrub/Uniform Guidelines: a. Personnel provided uniforms are expected to be dressed in a clean uniform at all times. b. Uniforms must be clean, in good condition, wrinkle free and fit appropriately. c. Uniforms are to be worn in their entirety if they come with tops and bottoms – both must be worn. d. Personnel will be responsible for all uniforms issued. This includes returning each uniform in a reasonable condition at termination, taking into consideration normal use. e. Personnel may not wear their uniforms outside of the VMC, unless traveling to and from work. f. Solid color tee shirts, mock turtlenecks or turtlenecks may be worn under scrub tops. No tee shirt writing may be visible. g. Color coordinated solid color scrub jackets, coats, fleece, vests or coveralls may be worn over scrubs/uniforms for warmth. This clothing should be removed when it could interfere with patient care. 20 h. In an effort to help our clients identify our personnel, we will color coordinate scrubs/uniforms as follows: i. Faculty/residents – Misty green (hospital issued) or Caribbean Blue ii. Interns – Misty green iii. Technicians and Technician Students – Navy blue or Navy top/Khaki bottom iv. Laboratory technicians – Gray and Black v. Veterinary Assistants -‐ Green vi. Client services – Wine vii. Central supply – Black viii. Veterinary Students – Ceil blue Professional Attire Guidelines: a. Clothing must be clean, in good condition, wrinkle free and fit appropriately. Tight fitting or revealing clothing is not permitted. b. Clothing may not be see-‐through. c. Undergarments should be properly concealed. d. Jeans are strongly discouraged. Jeans are acceptable clothing for large animal veterinary assistants and the receiving dock. e. Examples of clothing which are NOT appropriate include, but are not limited to: mini-‐skirts, tank tops, halter tops, and tops exposing midriff; spandex, shorts, sweat and wind suits, muscle shirts, and dresses or tops with plunging necklines, bare back, spaghetti straps or shoulder-‐less. f. Skirts should be of a professional length (no more than 3” from the top of the knee). g. Coveralls are acceptable in the Hospital for Farm Animals. Student Guidelines: When on services receiving patients, students should follow the professional attire guidelines listed above. Clean, standard white lab coats should be worn over appropriate clothes. Ceil blue scrubs should be worn when rotating in the following areas: Operating rooms, Emergency Department, Intensive Care Unit, Procedural areas (for example, interventional medicine suite, endoscopy) 3. Shoes, Socks, etc.: Footwear must have a closed toe. All shoes worn in the work place must be clean and in good repair. 4. Hygiene: Skin and hair must be clean. Regular bathing, use of deodorants/antiperspirants, neatly groomed facial hair, and regular dental hygiene is encouraged. Makeup, cologne, and perfume must not be distracting. With some patient care populations, fragrances may not be permitted. 21 5. Hair Care & Accessories: Hair must not jeopardize the safety and well-‐being of the individual in the course of his/her job duties. Hair must be clean and neatly groomed. Extreme hair styles and colors that do not occur naturally are not permitted. Head coverings may be worn where required by weather or safety regulations. Hats are not to be worn inside, unless it is a required part of a uniform. If hair/accessories are a part of religious requirements – please see # 10. 6. Ties and Scarves: Ties and scarves must not jeopardize the safety and well-‐being of the individual in the course of his/her job duties. Tie clips/tacks or other means of preventing clothing from dangling is encouraged. 7. Artificial and Natural Nails: Fingernails must be clean, well groomed and of appropriate length to be able to perform job duties. Artificial fingernails must be maintained to prevent harboring of bacteria and infection. Nail polish and decorative designs are acceptable if maintained. 8. Jewelry: Jewelry must not jeopardize the safety and well-‐being of the individual in the course of his/her job duties. Hoop earrings, facial hoop rings or other dangling jewelry is strongly discouraged in patient care areas. If jewelry is part of a religious requirement – please see # 10. 9. Pins and Buttons: Pins and buttons of any type are prohibited, unless approved by the VMC. 10. Religious Requirements: Per Title IV Federal Regulations, reasonable accommodations will be considered that don’t jeopardize the safety and well-‐being of the individual in the course of his/her work. Requests for reasonable accommodations should be made to the human resources manager. 11. Identification Badges: CVM identification badges must be worn above the waist with the name and picture visible while at work. Lanyards to hold ID badges must be breakaway and must not interfere with patient care. 12. Casual Days: Casual “dress down” days are only permissible when specified and approved by the Director of the VMC. All other standards in this policy are to be followed. 13. Enforcement: Service heads/managers/supervisors are responsible for enforcement of the VMC dress code guidelines. Human Resources is available to assist when addressing non-‐ compliance with personnel. Failure of any personnel to adhere to the standards may result in corrective action. 22 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 The College of Veterinary Medicine (CVM), Veterinary Medical Center (VMC) and the Department of Veterinary Clinical Sciences (VCS) follow the University’s Weather or Short Term Closing (Policy 6.15) and University State of Emergency Policy (6.17) during situations that necessitate short- or long-term University closure. As the Veterinary Medical Center is a health care facility that provides 24/7 care to its patients and many of the employees who staff the hospital are employed by the Department of Veterinary Clinical Sciences this joint policy has been developed that will apply to employees in both units (VMC and VCS). According to the University policies, employees must be designated as Essential, Alternate or Standby by their department or unit. Essential, alternate and standby designations are defined as follows: Essential Employee – one who has been designated as critical to the operation of the unit, whose presence is required during a short term closure, and whose absence from duty could endanger the safety and wellbeing of the patients, campus populations, and/or physical facilities. Alternate Employee – one who has been designated to serve as a back up to an essential employee. Alternate employees may be changed to essential at any time. VCS faculty, residents and interns are designated as Alternates; however, if they are on service when the University announces a short-term closure their status automatically changes to Essential. Standby Employee – any employee not designated as essential or alternate. Standby employees may be changed to essential at any time. VMC and VCS Employees who have patient care responsibilities are subject to being designated as “Essential” in the event that the University closes. Weather or Short Term Closing (Policy 6.15) The University may close part or all of the Columbus campus during extreme conditions due to severe weather, major utility failure, or other reasons. A short-term closure generally does not last more than 5 days. Should the University close mid-day, close prior to the start of regular business hours (defined as M-F from 8:00-5:00), or there is weather or another condition on the weekends that would normally close the university, the VMC must have sufficient personnel available to continue basic patient care. As the VMC depends upon VCS personnel to deliver patient care, the roles of both VMC and VCS personnel involved in patient care activity are addressed in this policy. Employees are responsible for identifying the status of the University. Personnel should listen to WOSU-FM radio (89.7 FM) or WOSU-AM (820 AM) for the official statement of closing, call the University phone line at 614-247-7777 or go to http://www.wosu.org. Other radio and television broadcasts may not list the distinction between “classes cancelled” and “university closed”. To determine the VMC operational status, personnel should call 614-292-3551 and press the # key; or call 614-292-6661 and press the # key after the greeting. A recording will provide the status. In addition, an e-mail will be sent to all VCS faculty, residents and interns, VMC staff, and students indicating the operational status of the VMC in the event of a University closure. 23 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 Definitions and explanations of the different “closing” categories are as follows: Classes Cancelled –The VMC will operate “business as usual.” All of the following are required to report to work as scheduled, regardless of shift: o o o o o Faculty Residents Interns Staff Senior students on clinical rotation University Closed Prior to the start of a Business Day – All of the following are required to report to work as scheduled, regardless of shift: o For each service, at least one Faculty member and one Resident who is On Service o Interns o “Essential” staff (see list below) o Senior students on clinical rotation All personnel who are in-house when the University closure is announced must remain in house until their replacement arrives unless they are directed to leave by the appropriate Department Chair, VMC Director, or VMC Assistant Director. Despite some anticipated cancellations, services must be ready to receive any previously scheduled appointments. If the patient is already in-hospital and there is sufficient staff present to provide appropriate care, procedures/surgeries should be performed as scheduled. If there is not sufficient staff to provide medical care to patients/clients who are scheduled, then the Client Services staff members who are in-house will contact clients to reschedule appointments where possible. In this circumstance, faculty/residents/interns/students/staff whom are in-house may be redeployed to areas of need. University Closed in the Middle of the Business Day – Enough patient care staff must remain to ensure that all patients are seen, and treatments are completed. Each supervisor/service coordinator will arrange coverage for proper patient care, and then begin releasing their staff accordingly. All Essential Staff will remain at the hospital until such time as a replacement staff member arrives. All second and third shift VMC personnel are considered essential (reception staff and technicians) will report as scheduled. VCS faculty and residents On Service will remain at the hospital until such time as their patients have been appropriately cared for. Interns will work as scheduled. Senior students on clinical rotations must report as scheduled. University Closed on Evenings, Weekends, & Holidays – All of the following are required to report to work as scheduled: o Small animal and equine/large animal Emergency and Critical Care (ECC) faculty, residents and staff o Residents who are “On Service” o Interns o Staff o Senior students on clinical rotations 24 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 All personnel who are in-house when the University closure is announced must remain in house until their replacement arrives unless they are directed to leave by the appropriate Department Chair, VMC Director, or VMC Assistant Director. Below is a list of all VMC/Department staff designated as “Essential”. Essential staff must report as scheduled. If Essential Staff are unable to report to work, it is their responsibility to contact their Alternate. However, if Essential Staff are on vacation, at a business meeting, hospitalized or on a long-term sick leave, then the Alternate automatically becomes Essential. If both the “Essential” and the “Alternate” employee are unable to report to work, a “Standby” employee should be called. No essential service is to be left unattended. Student employees are not covered by this policy and are not required to report to work. Employees should consult the University Weather and Short Closure Policy (6.15) at http://hr.osu.edu/policy/policy615.pdf for additional information on this policy including University rules about leave time and pay during short term closures. Alternate Name/Phone As designated by Director As designated by Chair Interns Essential Name/Phone Karin Zuckerman 614/425-3434 Dr. Rustin Moore 614/264-6269 Faculty who are “On Service” and all large and small animal ECC Residents who are “On Service” and all large and small animal ECC All Interns Asst. Director, Patient Care Annie Jones 614/205-3851 Asst. Director Facilities Accounting Craig Miller 740/881-5270 Kris Burns 614/519-4275 Kelley Norris (SA) 614/216-1045 Olivia Holt (LA) 440/670-2433 Ryan Lentz 740-506-4359 Connie Rinehart 727/735-3998 Anesthesia – Small Animal Theresa Hand 614/759-1179 Dave Sammons 740-739-2320 Jeannette Schmidt 614-668-4382 Kim Morrison 614/404-8004 Anesthesia – Large Animal Amanda English* 614/327-2907 Function Hospital Director VCS Chair VCS Faculty Residents Administrative Support Faculty not on service Residents not on service Notes At least one Faculty and Resident must report to work for each service At least one Faculty and Resident must report to work for each service HR staff in VCS and/or VMC may be designated as essential if closure occurs on a payroll deadline Carl O’Brien Cell: 614/634-6217 Hm: 614/237-7708 25 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 Function Essential Central Supply Rick Teasley (Supv) 614/557-5938 Client Services Sue Chmura – Asst. Director 614/833-9724 Clinical Lab Equine Field Services Equine Medicine Equine Surgery Technicians Farm Animal Lori Klinge 614/561-5231 Katrina Fagan 614/746-8716 Stephanie Yochem 614/256-6871 Amy Moore 614/843-1504 All Small Animal Cashiers All Small Animal Phone Agents Janelle Duncan (Equine) 614/288-5298 Lorie Kipp (Farm Animal) 614/266-0806 Jana Fletcher (Supv) 614-226-6987 Dr. Emily Schaefer Dr. Chrissie Pariseau 614/315-1320 Mandy Hutcheson * 330/283-0709 Mallory Cames* 937/902-5257 Beth Miller 814/289/6779 Dave Fredrick Cell: 614/268-7874 Hm: 614/218-8468 Alternate Notes Mario L. Ventresca 614/579-4156 Mary King 614/444-4028 Kelly Funk 614/212-3468 Jen Stallings 614/330-1220 Margie Price 614/441-6481 Marge Hauer 614/313-5050 Andrea Morgan 614-257-9781 Faculty on Call to back Intern/Resident Tom Burgett 614/875-8318 Beth – First shift Dave – Second shift 26 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 Function ICU –Equine/LA ICU – Small Animal E/CC LA Vet Assistants Microbiology Pharmacy Radiology Radiation Oncology Small Animal Vet Assistants Theriogenology Cardiology Comm. Practice Dermatology Internal Med Neurology Oncology Essential Alternate Notes ALL FACULTY, RESIDENTS, INTERNS and STAFF are essential and should report as scheduled Olivia Holt* 440/670-2433 ALL FACULTY, RESIDENTS, INTERNS and STAFF are essential and should report as scheduled Renee Cahill* (ICU) 614/205-1413 Courtney Beiter* (ER) 740/503-0227 Ryan Lentz Isaac Asore Other vet assistants contact 740/857-1192 614-209-7901 the team lead for 740-506-4359 instructions Nancy Martin Josh Daniels 208/964-2913 614/556-1740 Andy Whicker Mary Widders 614/876-8775 614/890-4624 Julie Morris* Standby staff: 614/309-5776 Denise Bailey Jenny Bolon Kelly Winn 614/266-7120 Nicole Pastorek Charles Smith Dr. Eric Green Nicole Pastorek 614/506-5832 (Standby) 330/205-2915 Cathy Leuszler Marcella Kimmick Other vet assistants contact 614/477-4068 614/888-6158 the team lead for instructions Dr. Elizabeth Coffman Chelsey Messerschmidt 865/387-3381 614/572-4721 Patti Mueller* (Standby) Tammy Muse 614/772-6561 614/312-4796 Dawn Eblin* (Standby) Michelle Dumond 614/202-2657 Cell: 740/398-1297 Deb Crosier* (Standby) Annie Jones 614/778-5508 614/205-3851 Joy Quang (Standby) Robin Richardson 614/353-9433 (Standby) 614/987-5285 Amanda Waln* (Standby) Heather Myers 937/875-7108 419/460-1535 Stacey Gallant* Ashley DeFelice 614/308-0682 614/205-7719 27 Veterinary Medical Center Emergency Closing Procedures/Designations 2.23.12 Function Ophthalmology Rehabilitation Small Animal Surgery ER Laboratory Essential Kelley Norris* (Standby) 614/216-1045 Tracy Marsh* (Standby) 614/313-7494 Kim Penrod 614/582-8576 Mary Ross 614/361-7637 Alternate Notes Chris Basham 419/295-6149 Standby Staff: Kristi Brush Amy Weatherall Mat Kerzee Michelle Gilliam EMERGENCY SUPPORT REPORT AS SCHEDULED MARY BOYD-BROWN, NICOLE TEBBE 614-447-1608 (H) 937-875-0622 614-678-2252 (Cell) *Denotes Service Coordinator. All service coordinators are essential unless otherwise designated for Weather or Short Term closures. Please contact your supervisor or the Hospital Administration office staff if you have questions or concerns about this list. All service coordinators should contact AD Patient Care in the event of closure and follow plan outlined in the VMC Technical Staff Short Term Closure Plan. 28 Food Storage and Consumption in the VMC The storage and consumption of food and beverages in animal handling and treatment areas of the VMC is prohibited, and signs indicating such are posted throughout the hospital. Food and beverage storage and consumption also are prohibited in clinical laboratories (e.g. microbiology, hematology, chemistry). The Environment Health and Safety Committee strongly recommends that persons working in the VMC eat lunch in the cafeteria. The EHS suggests that, whenever possible, everyone should arrange their schedules to allow a break for lunch. When it is not possible to use the cafeteria, food and drink may be consumed ONLY in the following areas: • • • • • • • • • • • • • • • • Conference rooms The corridor adjacent to the small animal wards The corridors connecting the small animal side of the hospital with the large animal corridor. This does NOT include the large animal red-floored corridor or the connector between the original hospital and the Galbreath Equine Center. The corridor in front of the pharmacy and central supply on the large animal side of the hospital Small animal reception The food animal office Equine reception The small animal waiting room Faculty offices The Galbreath Center observation deck The basement storage area and dock The student lounge/computer lab in the basement of the VMC Biomedical media Educational Resources Operative practices corridor Radiology corridor The EHS realizes that shared meals are an important social activity for personnel in the VTH, and the EHS wants to encourage the tradition of shared meals. Food for such affairs can be stored in the refrigerator in the access hallway near the locker rooms in the Galbreath Center, in the refrigerator in the closet across from the women’s restroom in the hallway outside the Food Animal Office, and in the refrigerators in the lounge/computer lab area. NO FOOD CAN BE STORED IN REFRIGERATORS DEDICATED FOR STORAGE OF MEDICATIONS AND PATIENT SAMPLES. Refrigerators throughout the hospital will be labeled according to whether or not food for human consumption is permitted. Those reserved for patient medications and samples will be monitored, and food or beverages intended for human consumption will be removed and discarded as necessary. Microwave ovens currently used to prepare food and beverages for human consumption and located in prohibited areas will need to be removed or relocated to areas where food preparation and consumption is permitted. Cookouts: Grills should be placed in the vicinity of the picnic tables near the Coffey Road entrance to the hospital. Grills may not be placed near the south exit of the large animal hospital, the Galbreath Equine Center, the sand exercise area, or the grassy space south of the treadmill facility. We appreciate your cooperation in this very important matter of biosafety. 29 Gift /Conflict of Interest Policy V02-2010 Policy Statement: The Veterinary Medical Center (VMC) operates with the highest level of professionalism, medical standards and ethical practices. In order to prevent or mitigate any potential conflicts of interest and to comply with Ohio Ethics laws, VMC faculty and staff and students as defined below, may not accept benefits or gifts except in accordance with this policy. Definitions 1) “Gift” - any bestowal of money, any item of value, service, loan, thing or promise, discount or rebate for which something of equal or greater value is not exchanged. Payments for travel, entertainment and food are gifts. 2) “Industry” – includes those businesses, corporations, or entities that supply or wish to supply equipment, goods, services, or other medical related products to physicians, technicians, administrators, or the VMC. 3) “Representative” – includes any individual who is employed by or who represents any entity defined under “Industry” above. 4) “Faculty Member” – includes regular and auxiliary, tenure-track, clinical track or research faculty members. 5.) “Staff Member” – includes all administrative, technical and support staff. 6.) “Student” – includes all graduate associates, residents, interns, fellows and student employees. General Principles: 1) The VMC is committed to transparency in all dealings with industry and the public. 2) Faculty and staff are encouraged to cultivate appropriate development opportunities to enhance the mission of the VMC. 3) Research must be free of any potential bias, real or perceived. 4) When considering any therapy, the clinicians’ and students’ primary responsibility is to the animal and the owner. 30 5) The goal of this policy is to be sure all individuals are aware of their responsibilities with regard to industry relations. 6) The institution and individuals are accountable for their actions. 7) Appropriate interactions between industry and faculty/residents/students/staff do exist, but the boundaries of that interaction need continuous monitoring and all such relationships must meet University policies and guidelines. Policy Details: Gifts from Clients: While gifts or tokens of appreciation from clients offered in gratitude for patient care should always be met with appropriate expressions of gratitude, clients are still considered as persons doing business with the VMC. Therefore, a gift from a client should also be limited as defined below. 1) A "Gift" of value shall not be accepted by a faculty, staff or students. The “Gift” should not be accepted if this influences or is perceived to influence a deviation from the normal course of care or cost for the client and patient. 2) The solicitation of personal gifts is prohibited. If a client insists on gift-giving the following alternatives are acceptable: A. A “gift to the VMC or faculty department/service" in the form of something that is needed in the VMC or department/service (for example, clinical or diagnostic tools that may enhance the patient, client, and/or teaching experience) or; B. A donation to the VMC, faculty department development funds, or some other recognized charity also made in the faculty or staff member's name (provided that the honoree does not take the charitable tax deduction) or; C. A gift of flowers, a fruit basket, or other consumables that is given to or shared with an entire staffing unit and not just for an individual. The item(s) should be shared among the unit in a timely and open manner. If a client sends a gift via mail or courier, without the option for refusal, and/or it is outside the range of acceptable as stated above, the gift shall be given to the VMC Director’s Office for department-condoned fund raising or employee recognition activities. 31 Gifts from Industry Representatives: Vendors are discouraged from offering personal gifts to faculty and staff. Faculty and staff may not accept any personal gifts which may have the effect of or appearance of influencing purchasing decisions or other actions of that employee. Faculty and staff may receive an item of nominal value if the item primarily benefits patient care at the VMC. If a faculty or staff member has any concern about whether or not a gift should be accepted, they should not accept the gift. 1) Drug, pet food or device samples All donations of free pharmaceuticals (prescription and non-prescription drugs) to the VMC shall be approved by the Pharmacy. Similarly, all donations of pet food or medical devices to the VMC and distributed through the VMC or by student representatives of the major manufacturers shall be approved by the related VMC administering unit manager such as pharmacy or central supply. Donated pharmaceuticals and pet food are an important source of revenue to the College through appropriate and legal sale to clients of the VMC; therefore, only those products without restrictions for resale shall be accepted, unless they are donated for a specific approved purpose. 2) Educational Activities: From time to time, a vendor representative may offer to support educational activities for the improvement of patient care or professional development. The VMC Director or the Chair of the sponsoring Department must approve such programs in advance. Any vendor educational support must be coordinated with the Continuing Education or Veterinary Clinical Sciences department. No financial support for an educational program may be contingent on or otherwise linked to any decision regarding the purchase or use of a product in the VMC. 3) Contributions A. The University’s development program receives and processes gifts and contributions from a number of sources including corporations and corporate foundations. B. Vendors should separate their grant making functions from their sales and marketing functions. Accordingly, if a vendor or patient service representative or other corporate representative wishes to discuss a corporate contribution of cash, equipment, supplies, or services, the faculty or staff member should immediately notify the VMC Director’s Office and/or the faculty department office. The Development Office should then be contacted so these Offices become the principal points of contact with the vendor. 32 4) Promotional and Informational Material A. Vendors are not permitted to post any type of printed or handwritten material, advertisements, signs or other such promotional materials anywhere on the VMCs premises without the VMC Director’s prior consent. B. Vendors’ promotional material may not be displayed in public areas, technician stations, cafeterias or lounges without the VMC Director’s prior consent. Faculty and staff attire should not normally include industry logos. C. If a vendor wishes to supply educational material, it must be reviewed and approved before any distribution may occur. 5) Compliance A. Vendors who fail to comply with the VMC requirements are subject to losing their business privileges at the VMC. B. Repeated non-adherence to our policy by Vendor Representatives will result in the restrictions on the representative and, possibly, a request to the company to replace its representative. 6) Training The VMC will provide training information annually for faculty, staff and students. As part of this training the VMC will provide a template with language that may be used to help vendors, clients and potential donors understand gift limitations, and the appropriate way to thank faculty, staff and students for their outstanding medical care. The VMC will consider signage, brochures and other opportunities for client awareness. Responsibilities: Position or office: List of responsibilities: 1. VMC Director’s Office Administration of training, inquiries, program updates. Resources: 1. Ohio Ethics Commission, Information sheet #7; http://www.ethics.ohio.gov/EducationandPublicInfo_IS7_Gifts.html 2. Financial conflict of interest policy for faculty; Revised by the Board of Trustees 3/2/07, Resolution No. 2007-100 33 34 35 36 37 38 39 40 41 42 43 44 VMC Policy for Handling “Good Sam” Medications (Submitted January 26, 2011, approved by VMC Board March 25, 2011) Use of medications for clients who have financial need or special circumstances is an issue that should be addressed in a manner that client needs and safety are taken into account while not bringing in liability to the VMC. The proposal would be as follows: 1. Storage of “Good Sam” medications would remain with the services but will only be those that were dispensed from our pharmacy and are within the expiration date. Each service will be expected to monitor and manage their respective “Good Sam” medications. 2. “Good Sam” medications will be re-labeled for client use at no charge. ONLY medications dispensed from OSU VMC pharmacy will be re-labeled. 3. No outdated medications can be used as “Good Sam” medication. Those products must be returned to pharmacy for proper disposal. Please refer to the following link from the USDA for the official policy on using expired products in veterinary medicine: http://www.aphis.usda.gov/animal_welfare/downloads/policy/policy3.pdf 4. Due to liability and safety, no medications from outside sources, i.e. not dispensed by our pharmacy or have been removed from the premises, will be re-labeled. Pharmacy will accept medications from outside sources for proper disposal only according to government regulations. (Re: Drug Laws of Ohio Code 4729-9-04 Returned Drugs) 45 CVM Human Resources Policies Social Networking Website & Photography Revised: January 2012 Applies to: Faculty, Staff, Students, Visitors Overview Social networking Web sites or on-line communities, such as My Space, Facebook, and Flickr are being used increasingly by faculty, staff, and students to communicate with each other, and by universities to post events and profiles to reach a variety of audiences. As part of the College of Veterinary Medicine’s commitment to building a community in which all persons can work together in an atmosphere free of all forms of harassment, exploitation, or intimidation, when using College electronic resources and on-line social networks, faculty, staff, and students are expected to act with confidentiality, integrity, and respect for the rights, privileges, privacy, and property of others. By doing so, individuals will be abiding by applicable laws, including copyright laws, University and College policies, and the College of Veterinary Medicine’s Code of Conduct. In addition, as members of the veterinary medical profession, there is an expectation to adhere to a set of values that reflect their commitment to excellence. The College of Veterinary Medicine considers faculty, staff, and students to be members of the profession whose actions reflect on the profession and the College. It is important to remember that public sites, no matter what the security settings, may be viewable by clients, future employers, referring veterinarians, potential students, and co-workers. Your postings may impact the impression these individuals have of you, your veterinary college, and the veterinary profession. Social Networking Posting College Business Use Only designated College representatives are authorized to conduct College business online. If authorized, an employee may post on a social network profile: the College name, a College email address or College telephone number for contact purposes, or post official department information, resources, calendars, and events. Unauthorized use of College information or use not in keeping with College and University policy, will be subject to corrective action. Personal Use Consistent with University policies on personal use of electronic resources, access to social networking sites is to limited and must not interfere with an individual’s performance of his/her assigned job responsibilities or someone else’s job performance or compromise the functionality and security of the department or campus network. Faculty, staff, and students are not permitted to present personal opinions in ways that imply endorsement by the University. If posted material may reasonably be construed as implying support, endorsement, or opposition of the University with regard to any personal statements, including opinions or views on any issue, the material shall be accompanied by a disclaimer: an explicit statement that the CVM Human Resources Policies/Social Networking Usage Revised: August 2010 Page 1 46 individual is speaking for himself or herself and not as a representative of the University, College or any of its departments or units. Monitoring The College of Veterinary Medicine does not routinely monitor social networking sites, however, as with other electronic resources, College systems’ administrators may perform activities necessary to ensure the integrity, functionality, and security of the College’s electronic resources. However, other employees, students, organizations and individuals do monitor and share information they find on social networking Web sites. Posted information is public information. Risks – Spam, Spyware, and Viruses Many social networking sites collect profile information for advertising (SPAM) targeted at individuals with particular affiliations and interests. Use of the sites may increase SPAM to your email account. In addition, from social networking sites or links on social networking sites, your machine or network may be exposed to spyware and viruses that may damage your operating system, capture data, or otherwise compromise your privacy, your computer and the College network, as well as affect others with whom you communicate. Investigations In response to concerns or complaints or information provided by individuals, College administrators may access profiles on social networking sites. In addition, the College has no control over how other employers, organizations, or individuals may use information they find on social networking Web sites. Proper Usage The use of social networks such as Facebook and My Space have provided an increased opportunity for faculty, staff, students, and alumni to connect and get to know each other, share information and experiences and stay in touch. In many cases, the use of such communications can increase our ability to interact with each other in positive ways. They also allow inappropriate behavior to be perpetuated. Persons choosing to use social networking sites should understand that such sites claim a license to ownership of all material posted by participants. This license allows them to keep and disseminate content even after you have removed such content from your page. Below is a list of behavior considered inappropriate and should be avoided: 1. Breaches of patient/client confidentiality which include sharing or releasing patient/procedures pictures, case information and recorded images or audio without the specific written approval from the client/owner; 2. Posting of any University-owned or teaching animals in any form to any public site. 3. Posting of any material related to protected or copyrighted University-owned property. 4. Posting pictures of University facilities, especially those that are secured or teaching/research facilities. 5. Faculty and staff should be aware of their behaviors while in the capacity of officially representing the College at public functions. 6. Lack of control in encounters with patients, faculty, staff, fellow students, and other health professionals. 7. Criminal activity. CVM Human Resources Policies/Social Networking Usage Revised: August 2010 Page 2 47 8. Violence intended to inflict harm, physically or mentally on self or others. 9. Distribution of defamatory comments about faculty, staff, fellow students, clients or vendors/contractors or other representatives of the College. 10. Invasion of another’s privacy by any means. 11. Misrepresentation of credentials, abilities, or position. Faculty, staff, and students in the College of Veterinary Medicine should remember the following guidelines: 1. Steps should be taken to ensure social networking sites have the appropriate privacy settings to avoid inadvertent public dissemination of material to audiences beyond their intended audience and beyond their control. Be sure to set your profiles on social networking sites so that only those individuals whom you have provided access see your personal information. 2. Do not write about patients/clients in a manner that could in any way convey the patient’s identity, even accidentally. You are cautioned that patients with rare diagnosis, physical appearances and specific locations within the hospital may be easily identifiable even in the absence of names and medical record information. Comments on social networking sites should be considered the same as if they were made in a public place. Simply removing the name does not make patient/client information anonymous. The best advice is to not post any such information or pictures of patients or clients. 3. Avoid libelous comments. Comments made regarding care of patients or a colleague portrayed in an unprofessional manner can be used in court or a disciplinary hearing. 4. Do not post someone else’s work (even from Internet sites) without permissions and attribution. 5. Avoid posting confidential or proprietary information owned by the University or College (e.g. Podcasts or other on-line teaching materials, research materials, etc or materials intended for use by OSU CVM students) 6 Computers in clinical areas are not to be used for social networking sites unless they are sanctioned by the College for the purpose of professional work or education. We also ask students to use discretion regarding using such sites during lectures as this is discourteous and may distract others around you. 7. Individuals should be aware of policies on discrimination, harassment, and sexual harassment. Activities on-line could be subject to these policies. Photography The College of Veterinary Medicine prohibits any employee, visitors, students and/or the public from utilizing any cameras or other recording devices, including cell-phones with cameras, to take pictures of any client or university owned animal while on university property without consent from the owner and only then with a university provided camera and for the purpose of official academic publication/presentation. Principal investigators wishing to photograph their own animals may do so, but strictly for the purpose of scientific presentation. Photos are not to be displayed on personal social networking websites. Any exceptions to this policy must be specifically approved by the specific department chair and/or the Veterinary Medical Center Director. Students are prohibited from taking photographs of client-owned CVM Human Resources Policies/Social Networking Usage Revised: August 2010 Page 3 48 animals in the Veterinary Medical Center. Student organizations must consult with the Associate Dean of Student Affairs before utilizing photographs for any reason. Resources Cloud Computing Guidelines for Teaching, Administrative Support, and Research – Office of the CIO – http://cio.osu.edu/policies/ccg_V62.pdf University Policy on Disclosure of Personal Information - http://cio.osu.edu/policies/disclosure.html Institutional Data Policy - http://cio.osu.edu/policies/institutional_data/ Responsible Use of Computing and Network Resources -http://cio.osu.edu/policies/responsible_use.html Web Policy and Guidelines - http://www.osu.edu/resources/71.html CVM Human Resources Policies/Social Networking Usage Revised: August 2010 Page 4 49 Written Estimate, Charge Capture & Adjustment Policy Approved: 05-28-10 Written Estimates: Written estimates are a required form of client communication at the OSU Veterinary Medical Center. These communications serve several purposes: 1) making clients aware of the possible range of cost and care at a specific point in time; 2) providing proper written documentation of our client communication; and 3) insuring the required deposit is received prior to admission. All clients should receive a preliminary estimate in advance of surgical or medical procedures. If the animal is transferred to another service within the Veterinary Medical Center, the client should receive an updated total estimate for care under this new receiving service that incorporates the initial estimate. The estimate may be revised if results of diagnostic testing alter the plan for treatment or if medical or surgical complications arise. The approved estimate form should be submitted to the client services staff member who will request payment from the client prior to admission. Copies should be maintained in both the medical record and in the Accounting department. Charge Capture (Refers to billing for all services performed): This policy provides the framework for the Veterinary Medical Center to bill clients in a consistent, timely, and fair manner. Charge capture allows us to pay our staff and vendors and to value our expertise appropriately. The policy also demonstrates to our students one of the fundamental business principles of successful veterinary practice. 1 50 It is the responsibility of all Veterinary Medical Center faculty and staff to ensure that all fees/charges should be submitted at the time services are rendered. If the fee related to a medical procedure or supply is not included in the present fee book, new fee requests can be processed through the Accounting department. All client bills are subject to audit, and missing charges are added and billed to the client. Timely entry of charges prevents a client from receiving a bill for added charges in the mail. Charge Adjustments: It may be appropriate in special circumstances to adjust (“write-off”) from a client’s bill. Adjustments are not a means for the client and the clinician to “price haggle,” as the Veterinary Medical Center has an approved fee schedule in place. Policy: All adjustment requests must be authorized by the Section Head using the Veterinary Medical Center’s authorized form. The Section Head’s can approve adjustment amounts totaling to $200 for a given client’s visit. The service is responsible for maintaining the level of adjustments below 1% of annual service revenue. Adjustment requests greater than $200 must be pre-approved by the Veterinary Medical Center Director on the Veterinary Medical Center authorized form. Clinicians should NOT promise an adjustment to the client in advance of proper authorizations. Accounting may only process adjustment requests if all fields are completed on the Veterinary Medical Center authorized form. Customer bills cannot be withheld from the normal billing cycle while awaiting the completed form. “Capping” of bills (the process of limiting the total amount of the bill) is NOT an authorized method of bill adjustment. Therefore, Accounting and the cashiers will not “cap” a bill. Adjustments granted by individual clinicians without the appropriate authorization can be charged to that individual clinician’s or service’s development or earnings funds. 2 51 To reduce customer service issues related to adjustments, the authorized and completed form must be submitted to Accounting in a timely manner. Approved Adjustment Types: ● Teaching – A faculty member determines that an additional medical procedure or test is of significant teaching value or was performed in error due to student teaching. These adjustments are not used to adjust “medically indicated/required” procedures/tests or as an incentive for enrollment in a research or grant project. ● Administrative – These are adjustments related to a communication, billing, or a procedural issue. The Veterinary Medical Center Director or an approved and designated person must initiate any administrative adjustment and this should be approved by the Director or an appropriate designee. ● Research – These adjustments are billed (transferred) to the appropriate grant/project. The proper billing account number is required on the authorized form prior to the adjustment. ● Good Samaritan – This adjustment is used exclusively to treat animals in need of veterinary care and lacking appropriate financial support that have a reasonable prognosis for good long-term recovery (along with a temperament that does not prevent future adoption). Funds to allow these adjustments are very limited and monitored by the Small Animal Emergency Faculty. Animals owned by individuals or other agencies are not eligible for Good Sam funds. 3 52 Client Services I. General Information • Client Services staffs the Reception Desk in the Companion Animal lobby 24 hours a day, 365 days a year. o Monday through Friday between 7:00 a.m. and 4:30 p.m. the staff register arriving canines and felines, notify departments when the registration is complete, notify departments when a client has returned from leaving the building, pick up discharge medications from the Pharmacy, collect deposits for companion animals that are being admitted, cashier when all charges have been entered into Vetstar and notify the appropriate department when the patient is ready for release. • Client Services staffs the Farm Animal Reception Desk Monday through Friday between 7:30 a.m. and 5:00 p.m. The staff member answers incoming telephone calls, makes Farm Animal appointments and registers patients. When all charges have been entered into Vetstar for a Farm Animal visit, the payments will be taken at the Companion Animal Reception Desk. • Client Services staffs the Equine Reception Office Monday through Friday between 8:00 a.m. and 6:00 p.m. Monday through Friday. The staff members answer incoming telephone calls; make Equine and Equine Ambulatory Field Service appointments, register patients and cashier at time of patient discharge. • Emergency Hours - Between 4:30 p.m. and 7:00 a.m. Monday through Friday and all day on Saturdays, Sundays and holidays the VMC is on emergency hours and the Client Services staff at the Companion Animal Desk handle the following for ALL THREE HOSPITALS (Companion Animal, Farm Animal and Equine): o o o o o o o • II. receive and direct all incoming telephone calls register animals collect emergency fees retrieve medical records collect deposits for animals that are being admitted pick up discharge medications when the Pharmacy is open cashier when all charges have been entered into Vetstar The Companion Animal Call Center makes canine and feline appointments Monday through Friday between 8:00 a.m. and 5:00 p.m. and is located in the area behind the Companion Animal Reception Desk. Messages (Interns & Residents only) • • You will be assigned a mobile phone and messages will be put into your voice mail. If you cannot be reached on your portable phone or are experiencing technical difficulties please notify the front desk so other arrangements can be made to contact you. 53 III. Appointments • • • • • IV. All appointments (including those for College of Veterinary Medicine and Veterinary Medical Center faculty staff and students owned animals, over-books, drop-offs) must be scheduled in Vetsatar. An animal cannot be registered until there is an appointment for that animal in Vetstar. Appointments can be entered into Vetstar by Client Services staff members, the Surgery and Community Practice Clerical Associates (for their respective departments) and Registered Vet Techs. If a client presents at any of the three Reception Desks without an appointment in the Vetstar system the patient will be registered for the appropriate service based on the information the client provides. ALL animals must be registered upon arrival. No diagnostic testing, procedures or results can be entered into Vetstar or VADDS without an open registration. Patient Discharge Summary and Medical Record • A Patient Discharge Summary (PDS) must be turned in with the Medical Record before a patient is released. o The PDS must be signed by the clinician. o Please check to be sure that the accurate medical record number and the patient name is on the PDS. Please assure that the information is consistent throughout the PDS. Since students often engage in the cut and paste technique of creating a PDS it is important to check for consistency of name and gender throughout the document. o The Medical Record must include the folder (all consent forms, communications, and paperwork from any previous visits) and the current visit record. o Please sign out of the patient Vetstar record. o The Medical Record and PDS should be turned in at the side counter as soon as completed and signed by the clinician. o You should tell the Client Services staff member who accepts the medical record and PDS if there are any discharge medications for the patient. o When the client is checked out by the cashier the service will be paged that the client is ready for release. (“The owner of ‘Fluffy’ Smith is ready for release.”) • If the Medical Record and PDS have not been turned in before the client arrives the technician and clinician will be contacted that the client is back in the lobby. o Once the Medical Record and PDS are brought to the Reception Desk side counter the client will be checked out and the service will be called/paged that the patient is ready for release. *Note: It is important that we collect the payment before you bring the patient out. The clients usually prefer this because it is easier for them, at the counter, to not have to hold a leash or the pet itself, while they are trying to make their payment. Also, once the owner has their pet and instructions, it is easy for them to leave without paying and harder for us to collect by billing. 54 • V. For outpatients that are being admitted to the hospital: o An Estimate Form must be submitted if a patient is staying in the hospital overnight. o The Estimate Form must be signed by the clinician and the owner. o Please sign out of the patient Vetstar record. o All three copies of the Estimate Form should be turned in to the Reception Desk side counter. o You may keep the current visit information and any paperwork essential to that day’s treatment of the patient. Equine and Farm Animal Emergency Hours Communication • All Farm Animal and Equine communication regarding “expectations” of what can or may happen during Emergency Hours should be placed in the "Extern Book". The Extern Book is a large black binder that will be delivered to the Client Services Companion Animal office from the Farm Animal and Equine offices at the close of their business hours. • The communication expected to be put in the Book includes any activity (authorization for releases, visits, on-call changes, etc.) taking place after 500pm Monday-Friday and/or on Saturday or Sunday. • Information entries should be logged under the date they are expected to happen. • Equine and Farm Animal patient status reports are not provided to owners during Emergency Hours unless you tell your client they can call at a specific time and you will be here to provide the update. 55 The Hospital Phone System To make a call to a number on campus: Dial the last five digits To make a local call to a number OFF campus: Dial “9” Enter the phone number Call back phone numbers: Equine: 4-3704 / 4-3701 Food Animal: 4-6666/ 4-4441 Small Animal, see following documentation Personal Long Distance Calls The University has issued a strict policy regarding using university phone services for personal long distance calls. Absolutely no personal long distance phone calls should be made using a university phone or a hospitalassigned UNITS long distance code. There are several alternatives if you must make a personal long distance phone call from work. Use your personal cell phone Obtain a UNITS Long distance Access code for personal use. Visit http://www.units.osu.edu/long_distance/traditional.php for details. You will be billed directly for any calls you make using this access code. Use a calling card You should be using your Veterinary Hospital-assigned UNITS long distance access code for any business related long distance calls. Phone bills will reviewed on a monthly basis to look for patterns indicating personal calls. If you suspect someone else is using your phone or your business long distance code, please report it to Alicia Palmer at 8-5404 or Alicia.palmer@cvm.osu.edu. If Alicia is not available, please contact Jennifer Holman at 23756 or email her at Jennifer.holman@cvm.osu.edu immediately and we will cancel your code and obtain a new one for you. We appreciate your honesty in this matter. 56 Incident Report Form Background and Purpose: Numerous individuals (students, interns, residents, technicians, staff, and faculty) can be involved with patient care in the Veterinary Teaching Hospital. Unanticipated incidents that relate to patient care and client service can occur. When they do, a clear understanding by all involved as well as timely communication to the hospital administration is essential. A cogent written description of the given incident and subsequent review will expedite the most satisfactory resolution. Additionally, formal incident reporting can eliminate or minimize future incidents of a like nature. An additional purpose to formally report such incidents is that the written documentation might serve to reveal chronic patterns or issues that need attention. When an incident occurs that warrants reporting, a standardized “Incident Report Form” will be filled out by the individual who has the most knowledge of the incident. Incidents that require reporting are not clearly defined. However, any injury or accident that involves a hospital patient should be reported. In general, any incident that has an adverse effect on the patient or significantly influences our ability to manage the patient or communicate with the owner should be reported. Procedure: Whenever an incident involving a hospital patient or client occurs, the clinician in charge of the case is to be informed. An incident report form is available in the hospital administration office and should be completed and returned to that office as soon as possible after the incident occurs, generally within 24 hours. The person with the most complete knowledge of the incident should initiate the report. Questions as to whether an incident report should be completed are to be directed to the Veterinary Hospital Administration. Incident reports should not be filed with the patient medical record; however, any pertinent medical information that pertains to the animal should be recorded in the medical record. When an incident report is received, the hospital director will review the report and determine which individuals should meet to discuss the incident. This will generally be the hospital director, the clinician in charge of the patient, the person completing the form, and any other hospital personnel relevant to the incident. The purpose of the meeting is not to place blame but rather to determine what action should be taken to minimize the risk of a similar incident occurring in the future. Incident reports will be kept on file indefinitely. NOTE: Separate forms are available in the hospital administration office for reporting accidents, injuries, or bites involving people; e.g. employees, students, clients and visitors. 57 Hospital Related Injuries and/or Illnesses Veterinary Students, Columbus State Students, Volunteers Students with OSU Student Health Insurance 1. Between the hours of 8:00 a.m. and 4:30 p.m. Monday through Friday, and 9:00 a.m. – 12;30 p.m. on Saturday, students should go to the Student Health Center for treatment at no charge. Phone: 292-4321 2. After 4:30 p.m. Monday through Friday and on weekends and holidays, students with health insurance should go to any Network Urgent Care facility for treatment of ACUTE medical conditions. (i.e. America’s Urgent Care Facilities, including Urgent Care of Upper Arlington, 4661 Sawmill Rd., 614-583-1183). Prior illnesses and injuries that have not been previously treated are not considered acute. 3. Students may go to the EMERGENCY ROOM (check plan to see which ER’s are in the Network) for treatment after 4:30 p.m. Monday through Friday and on weekends and holidays. Students with non-OSU health insurance Students who do not have OSU Student Health Insurance should contact their individual insurance providers for instructions. Injury/Illness Reports • All students injured while performing duties as part of their curriculum or while volunteering at the Veterinary Medical Center should complete a "Student/Volunteer Accident Report" form (available in hall wall pocket next to the Veterinary Hospital Administration Office, room 1102) and return it to the VMC Administration Office. Animal Bites • An “Animal Bite” report form (available in hall wall pocket next to room 1102 Veterinary Medical Center) must be completed and returned to room 1102 anytime someone is bitten in the hospital. If a student has any questions or concerns about an injury or illness that was a result of something that happened at the Veterinary Medical Center, he/she should contact the Veterinary Medical Center Administration Office (rm. 1102 Veterinary Hospital, 614/292-7158). 58 STUDENT/VOLUNTEER ACCIDENT REPORT INSTRUCTIONS This form is to be completed by the individual or a person with knowledge of the accident and submitted to the VMC Administration office (VMC 1102) within 24 hours of the occurrence. STUDENT/VOLUNTEER INFORMATION Name: OSU ID #________________________________ Home Address: City: Zip Code: Sex ☐Male ☐Female Date of Birth: Age: Home Phone: Supervisor’s Name_______________________________________________Supervisor’s Phone__________________________ ACCIDENT INFORMATION Accident Location (room, stall, ward, etc.): Accident Date: What was being done before the accident occurred: Time: ☐a.m. ☐p.m. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ What happened: ________________________________________________________________________________________________________ Was this part of your normal duties: ☐Yes ☐No Body Part(s) affected or injured:___________________________________ Type of Injury or illness:___________________________What object harmed the individual:____________________________ Did the student/volunteer seek medical attention: ☐Yes ☐No Witness (name and phone number): Report prepared by (if other than accident victim): Student/Volunteer Signature: Date: SUPERVISOR/CHARGE PERSON This accident was reported to me on: Date: Supervisor/Charge person signature: __ Time: _ ☐a.m. ☐p.m. Date: HEALTH CARE/TREATMENT Student/Volunteers with OSU Health Insurance procedure: • Between the hours of 8:00 a.m. and 4:30 p.m. Monday through Friday, and 9:00 a.m. and 12:30 p.m. on Saturday, students should go the Student Health Center for treatment (phone number 292-4321) • After 4:30 p.m. Monday through Friday and on weekends and holidays, student with health insurance should go to any Network Urgent Care facility for treatment of ACUTE medical conditions, (i.e. America’s Urgent Care Facilities, including Urgent Care of Upper Arlington, 4661 Sawmill Rd., 614-583-1183). Prior illnesses and injuries that have not been previously treated are not considered acute. • Students may go to the EMERGENCY ROOM (check plan to see which ER’s are in the Network) for treatment after 4:30 p.m. Monday through Friday and on weekends and holidays. Student/Volunteers with non-OSU Health Insurance: • Students who do not have OSU Student Health Insurance should contact their individual insurance providers for care and instructions. 59 ANIMAL BITE REPORT INSTRUCTIONS • This form is to be completed by the person who was bitten or someone who witnessed the incident. This form must be turned into the VMC Administration Office (VMC 1102) within 24 hours of the occurrence. VICTIM’S INFORMATION Name ________ Address_________________________________________________________________________ Age_____________________________________________________________________________ Phone number____________________________________________________________________ BITE INFORMATION Date of bite Area affected by the bite Severity of the bite Area of VMC where bite occurred_____________________________________________________ Brief explanation of how the bite occurred _____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Did the victim receive medical treatment? ☐Yes, if yes describe treatment including where treatment was given ☐No Name of person who reported the incident to the owner (must be completed) ________________________________________ OWNER’S INFORMATION Owners Name Owners Address (including city and state) ANIMAL’S INFORMATION Description of animal (species, breed, color, size) Rabies tag number Expiration date ________________________________________________________________________________ Signature of Person Submitting Report Date 60 REPORT OF AN INCIDENT INVOLVING AN ANIMAL IN THE VMC INSTRUCTIONS • • • This form is to be completed by a person with knowledge of an accident or incident and submitted to the VMC Director within 24 hours of the occurrence. DO NOT file this report with the Medical Record. Multiple blocks under each category below may be applicable, if so check them all DATE OF INCIDENT FACULTY VETERINARIAN IN CHARGE OF THE CASE TIME OF INCIDENT ☐a.m. ☐p.m. LOCATION OF INCIDENT ☐Ward ☐Stall ☐ICU ☐Prep room ☐LA unloading area ☐Recovery ☐Radiology ☐SA Lobby ☐Exam room ☐Surgery suite ☐Parking lot SEVERITY OF INCIDENT ☐No apparent injury ☐Minor ☐Moderate ☐Severe ☐Death ☐Not applicable TYPE OF INCIDENT __ ☐Anesthesia ☐Diagnosis challenged ☐Diagnostic procedure (i.e.x-ray, lab test) ☐Discharge of patient against medical advice ☐Equipment misuse/malfunction ☐INJURY ☐Self-caused ☐Slip and fall of animal resulting in injury ☐Struck by an object ☐Other ☐MEDICATION ☐IV or injection ☐Other ☐Patient property lost/damaged ☐Remarks by owner ☐Treatment procedure ☐Other________________________________ _______________________________________ _______________________________________ _______________________________________ SHORT DESCRIPTION OF INCIDENT (Include only facts about what occurred. Avoid speculation and assignment of blame. Attach additional documentation if necessary.) If injury, state type of injury and body part involved. TREATMENT GIVEN OR ACTIONS TAKEN FOLLOWING INCIDENT _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 61 (Provide names) Personnel on Duty at time of incident ☐Faculty Member ☐Resident ☐Intern ________________________ ☐Technician ________________________ ☐Student ☐Other OWNER NOTIFIED ☐Yes Date Time By whom Owner response Notified at time of incident Examined animal at time of incident ________________________ ________________________ ________________________ ________________________ ☐a.m. ☐p.m. ☐No Reason why owner was not notified What, if any, changes in procedure would you recommend to avoid the recurrence of the type of indident? (Signature of person completing incident report) (Date) STATEMENT OF VETERINARIAN IN CHARGE OF CASE – Below or on an attached sheet, include facts about patient’s condition and treatment needed following incident, if sufficient information is not included elsewhere on this form. (Signature of Veterinarian in charge) (Date) 62 CLIENT ACCIDENT REPORT INSTRUCTIONS This form is to be completed by the individual or a person with knowledge of the accident and submitted to the VMC Administration office (VMC 1102) within 24 hours of the occurrence. CLIENT INFORMATION Name: Home Address: Sex ☐Male ☐Female Date of Birth: ACCIDENT INFORMATION Accident Location (parking lot, lobby, etc.): Accident Date: What was being done before the accident occurred: _______________________________________ Zip Code: Home Phone: City: Age: Time: ☐a.m. ☐p.m. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ What happened: ________________________________________________________________________________________________________ Is there something that could have been done to prevent this accident______________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Type of Injury or illness:____________________________________________________________________________________ ________________________________________________________________________________________________________ Body Part(s) affected or injured: ________________________________________ ________________________________________________________________________________________________________ What object harmed the individual:__________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Did the client seek medical attention :☐Yes ☐No Witness (name and phone number): Report prepared by (if other than accident victim): Client Signature: SUPERVISOR/CHARGE PERSON OF AREA ACCIDENT OCCURRED This accident was reported to me on: Date: Supervisor/Charge person signature: Date: Time: ☐a.m. ☐p.m. Date: 63 Student Orientation - Medical Records General Information: A medical record can be retrieved 24 hours a day, 365 days a year by a member of the Client Services staff. The Medical Records department is only staffed between 8:00 a.m. and 5:00 p.m. Monday through Friday. Who does the medical record belong to? ♦ ♦ The record, according to the State Practice Act law, is the property of the Veterinary Hospital. The record must be maintained in the Veterinary Medical Center proper and never leave this building or college campus unless under court order or subpoena. Records are the legal documents outlining the agreed upon care and treatment received by the patient and must be accessible at all times. Who needs to have a medical record? ♦ ♦ All animals that come to the hospital or need lab tests performed must be registered and have a visit record created each time they come to the hospital. This includes animals of veterinary students who are coming in for examination, testing and/or treatment. Never throw away a visit record or other documents that comprise the record. If you think an error has been made please come to the Reception Desk or Medical Records for assistance in how to correct the problem. Patient Records for Clinic Appointments: Where do I obtain a record for a patient for clinic appointments? ♦ ♦ The Reception Desks will provide you with the visit record, record folder and other documents for the current appointment. Do not remove the documents in these folders with previous visits. Patient Records for Discharged Patients: Where do I put a record when the patient is discharged or expires? ♦ ♦ ♦ The entire completed medical record, including both the old chart and the current visit, must be turned into the Reception Desk prior to release of the animal. A completed chart contains the medical record folder, paperwork from previous visits the current visit records, and an accurate, completed and signed Diagnosis Sheet and Patient Discharge Summary. In the case of animals that have expired, the entire complete record needs to be turned into Medical Records by the following morning. Patient Discharge Summaries are required for all patient visits including expired, adopted or Technician appointment cases. 64 Loose Lab work or reports: Where do I place miscellaneous reports or documents for the medical record? ♦ Lab reports, communications sheets, RDVM records, etc. should be placed in either the Red Baskets or the Loose Lab Work bin located in Medical Records for incorporation in the medical record. Requesting Records for other purposes: Where do I request a record be signed out for phone calls, prescription refills, case presentations, studies, etc.? ♦ ♦ ♦ ♦ ♦ Complete a chart request slip in the Medical Records department. These types of requests are pulled every few hours, so plan accordingly. For studies and research requests, give a list of the charts you are requesting directly to a member of the Medical Records staff. These requests take a minimum of 5 business days to complete. All charts need to be signed out to the person who will be responsible for the chart. Charts need to be signed out in a clinician’s name with your name added. Return charts to “The Box” in the Medical Records department once you are through with them. Do not leave them lying around. Emergency Cases: Where do I obtain a medical record for emergency cases when the department is closed? ♦ ♦ The Emergency Hours Reception Desk staff will pull charts for you for Emergency Cases only when the Medical Records department is closed. NO Self Serve. They do not pull charts for case presentations and non-emergency situations. Requests for these charts should be done during normal departmental business hours. Release of Information or Record Copies: What do I do if someone requests copies of the record? ♦ Because of the legal ramifications regarding the improper release of information, any requests for copies of patient records must be referred to the Medical Records department for processing. ♦ Either inform a Medical Records staff member of the copy request or have the person requesting the records call the Medical Records department. We charge $1.00 per page for all copies, except Patient Releases, Referral letters and Vaccination Certificates. These are provided free. ♦ Verbal information can only be released to the Owner of the animal listed at the time of the visit or the RDVM listed on the record. 65 Rev. June 3, 2008 Ohio Administrative Code Ohio Veterinary Medical Licensing Board 4741-1-21 Record keeping. (A) Every veterinarian performing any act requiring a license pursuant to the provisions of Revised Code Chapter 4741. shall prepare, or cause to be prepared, a record documenting the health status of the animal(s) treated and any necessary data such that another veterinarian may follow the rationale and continue therapy if necessary. The record shall be dated and shall include all pertinent medical data such as vaccination, drugs types and doses and all relevant medical and surgical procedures performed. The records shall identify the owner of the animal(s) and provide an address and telephone number of other means of contact. (B) Records for companion animals shall include identifying information such as age, sex, species and breed or description of the animal’s name, if known. Animals used for economic purposes that are treated on an individual basis shall be similarly identified. Animals used for economic purposes that are treated on a herd basis may be identified collectively, provided the treatment information is reflective of accepted medical practice for the species and lists doses of all drugs dispensed. (C) All regulated substances shall be recorded and required by federal and/or state regulations. (D) Records, including imagery, diagnostic tests, laboratory data, surgery reports, progression of the disease process and all of the pertinent information, are the sole property of the treating veterinarian. Records shall be released upon request from a subsequent treating veterinarian and must be returned to the original veterinarian within a reasonable time. Copies of records must be available upon request from the owner of the animal at a reasonable cost to the owner. (E) Records shall be kept for a period of three years following discharge of the animals(s) from veterinary care. Eff 1-22-03 Note: The OVMB permits the recording of such information by veterinary students. However, attending clinicians are obligated to review the students’ recording of such information and assure it is complete. 66 Documentation Guidelines for the Record: ♦ ♦ ♦ ♦ ♦ ♦ All entries must be made in permanent blue or black ink. (No pencil or colored gel pens which are water soluble. Patient name and medical record number must be included on every page. Either write this information legibly on each page or affix a patient sticker to each page. Put the Date (including year) and Signature on each entry. Legible!!! (Imagine being on the witness stand and being asked to read your hand-written entries) Be Consistent and Accurate (Right vs. Left?). Corrections - Place a single line through the change. Write “Error” next to it and date and initial the correction. The correct information can now be documented. (Never use liquid paper or white-out information. Never black out or obliterate information) Form specific guidelines: Patient Discharge Summary (PDS) – Make sure the Patient name, Admission date and Discharge date are correct. The PDS must be signed by the clinician. Multiple patients must not be listed on the same discharge summary. SOAP note – Not required for Outpatient cases. Must document daily SOAP notes for all Inpatient (hospitalized) cases. ** In legal terms – If it’s not written in the medical record, it didn’t happen** (This is how clients and others will see your records and in turn judge the quality of care you provide.) Chart Completion and Delinquency (For Interns and Residents only) ♦ ♦ ♦ ♦ ♦ ♦ All medical records not in active use for a visit or special need such as a prescription refill, phone call or research should be returned to the Medical Records office. A record is considered complete when it has been diagnosed AND signed by the contact Intern, Resident or Faculty member. Records must be diagnosed and signed within 30 days of discharge. Records without a diagnosis, signature and signed discharge summary are considered incomplete. Each month, Interns, Residents and Faculty members receive a listing of all the records they have signed out in their name and an indication which are considered incomplete records. Incomplete records are stored by clinician last name in a distinct location of the Medical Records office for easy access. Incomplete records will not be signed out for research studies until they are complete. 67 PARKING • Senior students are expected to have a parking permit or use the Pay-N-Display if they plan to bring a vehicle on campus. Parking permits are available for purchase through Campus Parc which is located in Bevis Hall. It is likely that most students purchase a C permit and would be expected to park in spaces designated for C parking. The Coffey Road parking lot offers the only C spots close to the Veterinary Medical Center. • Owners of any type of permit (A,B,C) are allowed to park in any A, B or C designated parking spaces between the hours of 4 p.m. and 3 a.m. Monday through Friday mornings and 4 p.m. Friday through 3 a.m. Monday mornings. • The Large Animal parking lot may be used by any permit owner between 6:00 p.m. and 8:00 a.m. Mondays – Fridays and 6 p.m. Fridays through 8:00 a.m. Monday mornings. Please park in a space facing the isolation doors. The last three spaces in that row on the West side (closest to Galbreath Equine entrance) must be left available at all times for Equine Ambulatory Field Service vehicles. • The parking lot immediately in front of the Companion Animal entrance and nine parking spaces in the front row of parking across Vernon Tharp Street that are marked with Reserved (R) signs are for VETERINARY MEDICAL CENTER CLIENTS ONLY. Even if you have brought your animal in for medical care that day these parking spaces are not for use by VMC personnel. • Home Football Saturdays change all the usual weekend rules. Our client parking lot will still be reserved for CLIENTS ONLY. It has been the practice in prior years to reserve the Goss Parking lot for use by College and Veterinary Medical Center personnel who must work on a home football Saturday. If you are scheduled to work one of these days, you will need to pick up a SPECIAL PARKING PASS from Room 102 on the days just proceeding that Saturday and return the pass the Monday after. This special pass should be placed clearly visible in the windshield of your vehicle so officers directing traffic for the event can see you have a special permit to get to the VMC and left displayed while you park in the Goss parking lot. If the location of the reserved parking for personnel changes we will communicate that throughout the VMC. • Except in emergency, unloading and loading situations, it is against Fire code and Medical Center regulations for vehicles to be parked inside any part of the Medical Center. In emergency, unloading and/or loading situations where the vehicle owner walks away from the vehicle, keys MUST be left in the ignition. The inside of the Medical Center is not to be used for washing, repairing, or performing maintenance on vehicles. If for any reason you are asked to drive a vehicle that is owned by the University and has state license plates, you must first complete a Registration Form so you are insured while driving. State owned vehicles are continually under close scrutiny by the public, both as to its use being for strictly official business and the adherence to traffic laws regarding their operation. BICYCLES Bicycles are to be parked and secured in designated bike racks around the Medical Center. It is against the OSU parking regulations to attach bikes to anything except the parking racks provided for that purpose. Violators will be ticketed. It is against fire regulations for bicycles to be parked in and/or housed inside the Veterinary Medical Center. 68 PATIENT VISITATION While we encourage clients to visit their hospitalized animal, it is important that the visit be arranged in advance and approved by the assigned clinician(s). Visits must be pre-approved to ensure that the visit does not interfere with treatment. There may be times when the clinician advises against a visit for a specified period of time or puts strict limits on the visit. These restrictions must be followed in order not to jeopardize the animal’s recovery. Clients should be given the name of the contact person who will be coordinating the visit and asked to check in at the appropriate Reception Desk to announce their arrival. During Emergency Hours the Reception Desk in the Companion Animal lobby serves the needs of ALL clients. Each Service is responsible for managing its own patient visits and releases. Companion Animal patient visits will be coordinated by senior students. Visits (other than those in ICU) are typically held in a Visitation Room or one of the examining rooms if both Visitation Rooms are occupied. SECURITY • • • • Everyone in the Veterinary Medical Center is required to wear their photo I.D. badge at all times. There is a security guard on duty from 11:00 p.m. every night until 7:00 a.m. Entrance doors to the Veterinary Medical Center are locked daily at 11:00 pm. with the exception of the main entrance to the Companion Animal hospital which is locked at 1:00 a.m. There is an intercom system at the main entrance door for people to use to call if they want to gain entrance after 1:00 a.m. Entrance doors should never be propped open during times of expected lock-down. 69 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Vetstar Instructions These instructions are intended for those who have completed the Vetstar training on Carmen. They are not a replacement for the electronic training modules; they are intended to supplement them. Note: The most up-to-date copy of these instructions will be posted in the Vetstar 9.0 Online Training course on Carmen (http://carmen.osu.edu). Overview • • Vetstar is the name of the hospital information system (HIS) software used throughout the OSU Veterinary Medical Center. Vetstar is used for several important reasons: 1. to order all radiology procedures (e.g. radiographs, ultrasounds, etc.) and laboratory tests (e.g. profiles, CBCs, cultures, etc.) required for your patients. When procedures are ordered through Vetstar, requisitions are automatically printed in the appropriate departments. 2. to view or print the results of all radiology procedures and laboratory test procedures performed for your patients; 3. to review the electronic medical record of the procedures, lab tests, treatments and medications for your patients; and 4. to bill clients for the services and supplies provided to your patients. Hints and Tips • • • • • • Be sure the CAP LOCK and NUM LOCK keys are on before using Vetstar. Use the Enter key to move from field to field. User the Tab key to select from a list. Check to see you are in the appropriate “mode” – Add or Change. After you are finished using Vetstar, be sure to LOG OUT of the system by clicking the small gray box in the lower left corner, or pressing ESC to the Main Menu, and selecting option 9-Log Out. Call VIS Support 2-4146 if you have any problems. DO NOT turn off the terminal, press Ctrl-Alt-Delete, or go to another terminal and repeat the same process if your session is frozen or has a red lightning bolt in the lower right. If the ESC key does not work to exit a frozen screen, please call VIS. VIS Support • VIS Support is located at VMC room 0086. They may be called at 614-292-4146 on weekdays between 8 AM to 5 PM. Page 71 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Function Keys • Each Vetstar screen must be in the correct “mode” to function properly. • The modes (Change, Lookup, Add, etc.) are displayed in the lower right-hand corner of each screen. • Any time you want to back out of what you have done, press ESC <Escape>. • Typically, the screens are in the correct mode by default. However, if you are not able to change, lookup, add or delete as expected, you may need to change the mode. You may change the mode using right-click on your mouse, using buttons on the screen (if available), or using the following function keys: o F3 <Save> o F4 <Window> o F5 <Add> o F6 <Change> o F7 <Delete> o F9 <Expand> Quick Commands • Several Quick commands are available to students to access chosen screens directly rather than using the menus. These are entered in the Command prompt on the Client / Patient Processing screen and will be described throughout this document: o LL – Lab Labels o LR – Lab Results o RR – Radiology Report (Print Imaging Request) o SR – Surgery Report (View on Screen) Search for Client/Patient In the COMMAND field on the Client/Patient processing screen, search for the client/patient by one of the following options: Medical record/chart/patient number 1. 2. Type M and the patient 9-digit number. For example: M000310293 Press the Enter key. Page 72 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Client’s last name/patient’s name 1. Type in the client’s last name (or partial), slash /, and then the patient’s name (or partial). Press the Enter key. For example: DOE/SASSY or DOE/SAS. Avoid using partial names unless absolutely necessary as these searches will be much slower. Page 73 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 2. If more than one client/patient matches the search criteria, a window will display with all the matching results. Page 74 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 3. 4. Press the Expand button or F9 key to see additional client/patient information. Click the correct client/patient with the mouse. You may also arrow up and down and press the Tab key to select. Page 75 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Client name 1. Type in the client’s complete last name, followed by a comma, space, and then the client’s first name (or partial of first name). Press the Enter key. For example: DOE, JOHN 2. If more than one client/patient matches the search criteria, a window will display with all the matching results. Press the Expand button or F9 to see additional client/patient information. Click the correct client/patient with the mouse. You may also arrow up and down and press the Tab key to select. 3. Page 76 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Ordering Lab Tests 1. 2. 3. 4. Select the client/patient on the Client/Patient Processing screen. Choose the Charges tab listed on the left side of the screen. Press the Enter key to the PROC CODE field. Type in the name of the lab test to order, and press Enter. 5. Select the correct lab test with the mouse, if more than one lab test appears. Page 77 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 6. 7. Enter through the remaining fields on the charge screen until the Laboratory Request window appears or you are prompted with a template. Depending on the type of lab test you order, either a template or the Laboratory Request window will appear. If you are prompted with the Laboratory Request window, double click on the HISTORY bar to add history. Type in the reason for the lab test, and Enter through to the next line. Note: failure to complete the requested information may cause delays in receiving the test results! Page 78 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Press the SAVE button or F3 until you return to the Laboratory Request screen. 8. If you are prompted with a Template (similar to the Comments screen, but pre-populated with a form to fill out), click on the Word icon in the lower left hand corner of the screen. Page 79 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 9. After clicking on the Word icon, you will be put into a text editor called TextPad. TextPad will word-wrap for you, but does not bold, underline, or italicize. Complete all fields/information on the template. Note: failure to complete the requested information when ordering lab tests may cause delays in receiving the test results! 10. 11. 12. 13 Once all information has been completed, click on the middle X in the upper right hand corner of the screen, or you can go the FILE and select EXIT. Either way you will be prompted if you want to save the changes; click on YES. You will then see the screen flash. The information just typed will be imported into Vetstar. Press the Save button (or F3 key) until you return the charge screen. Note: After saving with a template you may also be prompted to complete the HISTORY (i.e., why the lab test is being ordered). Complete the HISTORY information as previously described. If you have additional lab tests to order, begin at step 3. Otherwise, slowly Save until you come to the REPORT DESTINATION screen. Page 80 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 14. 15. The cursor is in the Destination field. Type in the label printer code (example: LL165). Then press Enter and two labels will print out for each lab test you ordered. Place one label on your specimen, and bring the specimen to the lab along with the extra label. If you are finished using Vetstar, LOG OUT of the system. Reprinting a Lab Label ***Do NOT RE-ENTER the lab test if Vetstar failed to print a label for any reason.*** 1. 2. 3. 4. 5. Select the client/patient on the Client/Patient Processing screen. In the COMMAND field, type in the quick command LL (lab label), and press Enter. Bring the cursor into the L field for the correct test line. Right-click and select Window (or press F4). Type the label printer code in the Destination Field on the Report Destination screen, and press Enter. Page 81 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Printing a Lab Report (except culture results) ***Note: You cannot print lab results for a single test. However, you can print lab results for a group of tests (e.g., all Chemistry tests). Culture results are available through the Infectious Disease Database. 1. 2. 3. Select the client/patient. In the COMMAND field, type in the quick command LR (lab report). Bring the cursor to the R column for the report you want to print. Page 82 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 4. 5. 6. Right-click and select Window (or press F4) to open the Case Results Report window. Enter the Case Report Format using one of the following options: LR = all lab results CLR = chemistry results only HLR = hematology results only CYLR = cytology results only PLR = parasitology results only SLR = serology results only PALR = histopathology/necropsy results only Type Y in the OK field. Page 83 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 7. On the Report Destination screen, type in the printer identification in the Destination field and press Enter. View Lab Results On Screen 1. 2. 3. Select the client/patient. In the COMMAND field, type in the quick command LR. Bring the cursor to the RESULTS column for the results you want to see, right-click and select Window (or press F4). Page 84 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Ordering a Radiograph/Ultrasound/MRI/CT Scan 1. 2. 3. 4. 5. 6. Select the client/patient on the Client/Patient Processing screen. Choose the Charges tab listed on the left side of the screen. Press the Enter key to the CODE field. Type in the area of the procedure, and press Enter. Do not just type in the word ‘radiograph, ultrasound, etc.;’ be specific to the location (e.g., tibia). All procedures associated with radiology/ultrasound/MRI/CT Scan will begin with the word RADIOLOGY. Highlight and use Tab to select the procedure desired. Enter through the remaining fields on the charge screen until the Imaging Request Screen appears. Using the Enter key complete the following fields: • Location – where the patient is located in the hospital. • Imaging Comments/History – The window will automatically open. Type in the reason for the request. After completing the information, Enter through to the next line. Save (F3) – the information & return the Imaging Request screen. • Examination Area – a window will open at this field. In the Examination Area field, type in the first few letters of the area to be examined (e.g., TIBIA = TIB), and press Enter. • When applicable, complete: R/L field with R=right, L=left, B=both F/H field with F=fore, H=hind, B=both. Page 85 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Once you have completed the Examination Area and R/L and F/H fields (when applicable), Save (or press F3) until you return to the Imaging Request screen. Note: failure to complete the requested information may cause delays in receiving the radiograph results! 7. Enter through to the OK field, type in Y, and press Enter. Page 86 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 8. 9. You are then returned to the charge screen. If you have additional radiographs to order, begin with Step 3. Otherwise, Save (or press F3) until you return to the Client/Patient Portal screen. If you are finished using Vetstar, LOG OUT of the system. Page 87 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Printing a Radiology/Ultrasound/MRI/CT Scan Report 1. 2. 3. 4. Select the client/patient on the Client/Patient Processing screen. Enter the quick command RR (radiology report) in the COMMAND field, and press Enter. Patient with one radiograph procedure: You will be immediately brought to the Imaging Report screen. If so, then type in Y in the OK field on the Imaging Report screen, and press Enter. Type in the printer identification in the Destination field and press Enter. Patient with more than one radiograph procedure: Highlight and use Tab to select the radiograph procedure. Then type in Y in the OK field on the Imaging Report screen, and press Enter. Type in the printer identification in the Destination field and press Enter. Page 88 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Surgery Report Instructions Hints and Tips * * * * * * BE PATIENT when starting and exiting TextPad as Vetstar must export and import your text. If you encounter problems, DO NOT turn off the terminal, press Ctrl-AltDelete, or go to another terminal and repeat the same process. You will be at risk for losing all the information you typed into the computer. Do not attempt to bold, highlight, italicize, or underline. Only plain text will be retained. You can spell check your text by clicking the ABC√ icon on the toolbar. If the screen goes white, the word processor screen disappears, or the keyboard is unresponsive, press the ALT ESC keys to bring the word processor program to the foreground. You should then be able to continue your work. Call VIS Support 2-4146 if you have any problems. Creating a NEW Surgery Report 1. 2. Select the client/patient on the Client/Patient Processing screen. Double click on the Pad & Pencil (comments) icon. Page 89 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 3. 4. 5. 6. If the patient has multiple visits, highlight and select the visit to which the surgery report is applicable. Click Surgery Reports with your mouse, or scroll down to highlight this and press Tab. With the first line of the Comments window selected, press the Window (F4) key. If the page is blank: In the Enter Document Code field type SR (for surgery report). [Note: if the Enter Document Code window does not appear, press the Add (F5) key, then the Window (F4) key.] Page 90 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 7. 8. Press Enter three times; wait, and the Surgery Report template will appear. Double click on the Word icon in the left hand corner of the screen to start the text editor. Page 91 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 9. Type your report in accordance with the template. TextPad will word-wrap for you, but does not bold, underline, or italicize. You can spell check your report by clicking the ABC√ icon on the toolbar. Page 92 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 10. 11. 12. Once all information has been completed, click on the middle X in the upper right hand corner of the screen, or you can go FILE and select EXIT. Either way you will be prompted if you want to save the changes; click on YES. You will then see the screen flash. The surgery report you just typed in was imported into Vetstar. Press the Save button (or F3 key) twice to return to the Client/Patient Portal screen. Log out of Vetstar if you are finished, or continue working in Vetstar. Edit an Existing Surgery Report 1. 2. 3. 4. 5. 6. 7. 8. 9. Select the client/patient. Double click on the Comments icon. If the patient has multiple visits, select the visit to which the surgery report is applicable. Double click on the Surgery Reports line. Click on the Word icon in the left hand corner of the screen to start the text editor. Edit your report as needed. You can spell check your report by clicking the ABC√ icon on the toolbar. After revising the report, go FILE and select EXIT. You will be prompted if you want to save the changes; click on YES. You will then see the screen flash. The revisions to the surgery report are imported into Vetstar. Press the Save button (or F3 key) twice to return to the Client/Patient Portal screen. Log out of Vetstar if you are finished. Printing a Surgery Report for an OPEN Visit If your patient has an OPEN visit, you will see visit information listed in the Visit Information section on the Client/Patient Portal screen. 1. 2. Select the correct client/patient. Type in the quick command SR (surgery report) in the Command field and press Enter. Page 93 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 3. Type in the printer identification in the Destination field and press Enter. Page 94 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Adding Another Surgery Report to an Existing Surgery Report 1. 2. 3. 4. 5. 6 7. 8. 9. 10. 11. Select the client/patient on the Client/Patient Portal screen. Double click on the Pad & Pencil (comments) icon. If the patient has multiple visits, highlight and select the visit to which the surgery report is applicable. Highlight Surgery Reports and press the Tab key or double click on the Surgery Reports line. Press the Add (F5) key, then the Window (F4) key. Press Enter three times and wait. The Surgery Report template will append to the end of the first surgery report. Double click on the Word icon in the left hand corner of the screen to start the text editor. Type your report in accordance with the template. The text editor will word-wrap for you, but does not bold, underline, or italicize. You can spell check your report by clicking the ABC√ icon on the toolbar. Once all information has been completed, click on the middle X in the upper right hand corner of the screen, or you can go the FILE and select EXIT. Either way you will be prompted if you want to save the changes; click on YES. You will then see the screen flash. The additional surgery report you just typed has been imported into Vetstar. Press the Save (F3) key twice to return to the Client/Patient Portal screen. Log out of Vetstar if you are finished, or continue working in Vetstar. Page 95 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Printing a Surgery Report for a CLOSED Visit 1. 2. 3. 4. Select the correct client/patient. Left click on the VISIT SUMMARY tab on the left side of the screen. Enter sr for Custom Report. Check the Closed Visit Report box and press Enter. 5. In the Patient Visit Inquiry window, use the arrow keys to select the visit. Press Tab. Type in the printer identification in the Destination field on the Report Destination screen and press Enter. 6. Page 96 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Discharge Summary Instructions Overview • • The purpose of the Discharge Summary application is to create, print, search and retrieve patient release forms and referral letters for patients seen in the hospital. This document is also referred to as the “Go Home”. Creating a NEW Discharge Summary Document 1. 2. 3. 4. 5. Double click on the Discharge Summary icon. Once the application has started, you may be prompted for your CVM Domain account and password. Click on the Create NEW Discharge Summary icon. You will then be prompted with the option of using a Discharge Summary with a template (e.g., Cat Declaw, Canine Vaccines, Dermatology) or creating a document without a template (i.e., Blank – no template). Click on either Template or Blank. If you select Template, a list of templates will appear. Click on the green COPY TO NEW button of the template you would like to use. Page 97 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 6. 7. 8. 9. 10. 11. Your cursor will then go the OSU Case No: field. Type in the patient’s medical record number (do not use the M as you do in Vetstar). Then click on Lookup Patient Data icon. The client/patient/RDVM information will populate the screen. The fields in blue are required fields for the Discharge Summary document. Complete the following fields: Type (LA, SA, EQ) Clinician #1: The doctors will be listed in alphabetical order by last name. Date Admitted & Discharged Patient Status: Select the appropriate patient status. To the left are gold-colored section tabs (Diagnosis, History, Findings, etc.). The tab you are working in will be highlighted yellow. To move to another tab, simply click on the desired tab. In the DIAGNOSIS tab section, indicate whether the Diagnosis Status is either Final or Pending, and indicate any lab tests or cultures that are outstanding. Type the information into each tab section as indicated by the tab heading. Page 98 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 12. 13. 14. 15. 16. To Spell Check each tab/section, click on the Spell Check icon in each section. To the right of section box is a green-colored Notes to RDVM tab. This is for the user to type additional information for the RDVM. If you are typing Notes to RDVM, the area will be highlighted a light green. The additional RDVM information will append to the Discharge Summary Report. To Print a DRAFT of the Discharge Summary document click on DRAFT under the Patient Discharge or Referral Letter to the right of the screen. Then click on the green PRINT icon. You will then be prompted to print either the RDVM or Patient Discharge Summary. Click on the appropriate selection. A copy of what the DRAFT Discharge Summary document will look like will appear on the screen. At the top of the document, you will Page 99 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 see Press Enter to continue. Once you press Enter, you will be prompted with the Print window. You must select the correct name of the printer. There are times the system will put a default printer in the NAME field, and your document will print elsewhere in the hospital. Select the correct printer & print your DRAFT copy of the Discharge Summary document. 17. 18. After you print your DRAFT Discharge Summary document, you are prompted as to whether or not you want to make this your FINAL record. Click NO. (You will probably need to edit the document later.) You are then returned to the Discharge Summary screen with the tabs and client/patient information. To exit the Discharge Summary application, click on red Quit button. Edit/Revise an Existing Discharge Summary Document 1. 2. 3. Double click on the Discharge Summary icon. Type in the password when prompted and press Enter or click on OK. Click on the Find Current Discharge Summary to Edit/Print icon. Page 100 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 4. 5. 6. The cursor is in the Med Rec # field. Type in the patient’s nine-digit medical record number, and then click on the blue Find icon. If there is more than one current Discharge Summary document, all will appear on the screen. Click on the yellow Edit icon of the Discharge Summary document that is to be edited. Edit/revise your Discharge Summary document as needed, Spell Check (if needed), and print. Note: In order to print a FINAL Discharge Summary document with the OSU Veterinary Medical Center information, click on the Final button for either the Patient Discharge or Referral Letter. Page 101 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 Infectious Disease Database Instructions Overview • • The purpose of the Infectious Disease Database application is to provide the microbiology results for patients with cultures submitted in the hospital. Students are not able to enter or modify information in this database. Printing Culture Results 1. 2. 3. Click on the Infectious Disease DB icon. If prompted, type in your CVM Domain account name and password (password is case sensitive). Click on the Student Menu tab. Page 102 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 4. Click on Search/View Microbiology Results. 5. Type in nine-digit patient medical record number, and then click on Find. To print, click on the Print button. 6. Page 103 Vetstar, Discharge Summary, and Infectious Disease Database: A Mini-Manual Last revised: April 2013 You also have other options to retrieve results, such as clicking on View List of Most Recent Microbiology Results. From there, you will have different resulting options to choose from (e.g., Today, Yesterday, Last 7 days, Last 14 days). You can also click on any of the table headings (e.g, Patient Name, Medical Record No., etc.) to sort and then select. Page 104 ANESTHESIA PROTOCOLS Revised 4-13 SMALL ANIMAL REQUEST FORMS A paper anesthesia request form must be completed for all cases requiring anesthesia. These and other hospital request forms are located in the yellow boxes on the shelves outside of the small animal surgery office door, in the CP-ICU treatment room, and on the shelves across from wards D and E. Requests must be completely filled out with all appropriate boxes checked and the animals weight noted in kg. A procedure time or case order as well as the requesting clinician’s signature are required. Any special requests: i.e. Arterial catheters, central lines should be noted as well as current medical problems seizure history, cardiac murmurs, azotemia etc. Please indicate on the form if the animal is aggressive, cage protective, etc. REQUESTS MUST BE TURNED IN BY 4:00 the day before the procedure! If this is not possible, please handdeliver the sign-up to an anesthesia technician as soon as you are aware of the need for anesthesia. Requests that are received after this cut-off time or that are incomplete will be prioritized by the anesthesia service in consultation with the requesting service. Every attempt will be made to inform you as soon as possible if a request is incomplete. The request form has 3 copies. The white and yellow copies are to be placed in the appropriate labeled box outside the door to the surgery office (room1058). The pink copy is to be used as a no food sign for the animal’s cage or run. PRE ANESTHETIC REQUIREMENTS Healthy animals up to 5 yrs. of age: PCV & TP. Healthy” animals older than 5 years of age: CBC and Profile within 30 days of the requested procedure and a PCV &TP within 24 hours. Compromised Patients or repeat anesthetics might require additional lab work. Check with the anesthesiologist on duty if you have any doubts. The name of the anesthesiologist on duty is located to the left of the door to the small animal surgery office. Please make sure that all anesthetic candidates are as stable as possible for anesthesia. For example if an animal is dehydrated, hypotensive, hypoprotienemic please take the appropriate measures to correct the instability. DO NOT RELY ON THE ANESTHESIA DEPARTMENT TO STABILIZE YOUR PATIENT PRIOR TO IT BEING ANESTHETIZED!! If any case is going to the ICU post-anesthesia we ask that you have the ICU orders written ahead of time whenever possible. 105 LATE CASES AND EMERGENCIES The “Last Call” for patients scheduled for anesthesia should be made by 2:30pm to ensure table times of 3:30. The Anesthesia Department will only induce Emergency procedures after 3:30. Please be aware that this might result in an extra day’s board charged to the client if the case is delayed until the following day. There is an anesthesia student assigned for cases needing after hours Small Animal Anesthesia. The name of the anesthesia student on call for that particular night or weekend day is located on the inside of the prep room door and in the ER book at the front desk. For “HIGH RISK” patients or if there are any questions concerning protocol there are anesthesia technicians or residents on call. The call list for these anesthesia personnel is in the ER book as well as in the SAS office. All cases after hours will receive appropriate anesthesia emergency fees. DO NOT call the anesthesia technicians or residents to warn us of pending cases. Do Not call us before the surgeon has evaluated the patient, you have owner permission and all financial obligations have been taken care of. Phone protocol: Call the number listed on the ER call list for the anesthesia technician. If there is no answer and an alternate number is listed please try the alternate number otherwise leave a detailed message including a number that is available by an outside line. If you do not get a call back in an appropriate amount of time please try your call again. Once you have spoken to the on-call technician please also call the on call anesthesia student (phone list locations are above). LARGE ANIMAL / EQUINE/ FOOD and FIBER (LAA) REQUEST FORMS All Equine and Food and Fiber cases need to be signed up by 4:00 p.m. the day before surgery. A completed anesthesia request form for each patient must be completed and submitted. Place the white and yellow copies of the request in the black basket hanging on the Anesthesia door in the red hallway. Blank forms are located at that location and in other designated area for forms. Hang the pink copy on the patient’s clipboard on the stall door. In the event of “to arrive” cases we would prefer the case to be signed up for anesthesia, even if the Clinician won’t know until it arrives if it needs our service. If a case needs to be added first thing in the morning, let the Surgery Technician know in morning rounds by 10:00 a.m., so they can sign it up. Complete all pertinent information on the request form. • The form should have a patient-identifying label affixed. If a label is unavailable include at the minimum the owner’s name and the case number. • Date of the procedure on the form. • Include the time of the procedure or the order in the event of multiple procedures. • Write the exact procedure(s) being performed (example: CT Scan then EEG). 106 • • • • Note positioning of the patient (examples: LSD or dorsal then LSD). Include the procedure location (example: radiology, room B). Have the Clinician and or Resident sign the bottom of the form. Add any information that might be helpful for us to know about the case in the “special request” area (example pre-op drugs, the prep standing or down, or any critical patient information). Please contact us as soon as possible if a scheduled time needs to be changed or cancelled. Notification of such a cancellation or delay can allow us to assign an earlier time to case scheduled for a later time. The time requested may need to be changed slightly in the event that multiple cases are signed-up for the same time (example; three cases for 10:00 a.m. – we would need to stagger them to 10:00, 10:15, 10:30 etc.). We will communicate the changes as needed to the Clinician in charge of each case. The Resident or Faculty member from the requesting service assigned to the case and one senior student must stay with the case from induction through recovery. NO EXCEPTIONS Please direct any questions about the anesthesia request forms or scheduling changes to the Large Animal Anesthesia Supervisor phone #. 2-9587, if no answer call 7-7954 Cases received after 4:00 will be prioritized by the anesthesia service in consultation with the requesting service and will be fit into the schedule at the discretion of the Anesthesiologist on duty. All scheduling conflicts should be discussed with the Anesthesiologist on duty. Pre anesthetic requirements Young Healthy patients: PCV and TP. Compromised patients: CBC, Profile, and other pertinent laboratory data. Please check with a member of the anesthesia team when in doubt. Please make sure that all anesthesia candidates are as stable as possible for anesthesia. For example if an animal is dehydrated, hypotensive, hypoprotienemic please take the appropriate measures to correct the instability. DO NOT EXPECT THE ANESTHESIA DEPARTMENT TO STABILIZE YOUR PATIENT! EMERGENCY PROCEDURES For after hours Large Animal Anesthesia (LAA) Only Anesthesia Personnel are on Duty. The schedule is posted at the front desk as well as in the Equine, Equine ICU, and Large Animal offices. DO NOT call the anesthesia technicians or residents to warn us of pending cases. Do Not call us before the surgeon has evaluated the patient, you have owner permission and all financial obligations have been taken care of. 107 108 Standard Practices for Management of Small Animal Infectious Disease By Dr Dennis Chew and Dr Shane Bateman 1. Classification of Infectious Disease High Risk Moderate Risk Canine Parvovirus Infectious Canine Hepatitis (CAV-1) Canine Distemper Leptospirosis Canine Infectious Tracheobronchitis Feline Infectious Peritonitis Feline Calicivirus Salmonellosis Feline Rhinotracheitis Campylobacteriosis Feline Panleukopenia Hospital Diarrhea Chlamydiosis Cheyletiella Mange Q-Fever Sarcoptic Mange Exotic Newcastle Disease Giardiasis Plague* Chlamydiosis Canine Brucellosis Tularemia Avian Influenza* Cryptosporidiosis Zoonotic Potential Rabies* Leptospirosis Canine Brucellosis Sporotrichosis Dermatophytosis Giardiasis Round/Hook Worm Salmonellosis Campylobacteriosis Q-Fever Tularemia Plague* Cat Scratch Disease (Bartonella) Cheyletiella Mange Sarcoptic Mange Toxoplasmosis Cryptocococosis - birds Cryptosporidiosis Monkey Pox * Tuberculosis Mycobacterium bovis* Avian Influenza* *Reportable Disease Priorities for Students, Clinicians, Technicians and Hospital Staff Diligent attention to the potential for spread of infectious disease to other areas of the hospital is paramount. Persons who are participating in the care of a patient suspected to have a high-risk infectious disease, should minimize contact with other patients that are believed to be immunosuppressed or insufficiently vaccinated. One student or technician in a ward will be designated to manage patients in Small Animal Isolation. 2. Admission of Patients Suspected of HIGH RISK Infectious Disease a. Suspicion of High Risk Infectious Disease Present Prior to Patient Entering Hospital: If suspicion of high-risk infectious disease (dangerously contagious disease) is present prior to the client/patient entering the hospital admission area, clients should be cautioned to enter the building only as necessary. Clinicians and students having contact with the patient must wear protective gowns, gloves, and plastic boots. Patients should be examined outside the building when possible. Alternatively, animals may be examined in a room close to the entry door that is designated for cases suspected to be infectious (the “garage” room with lobby access). Dogs suspected to have parvovirus infection will remain in this designated room on a gurney with the 109 client while awaiting results of ELISA testing for parvo status and for results of WBC count. This process usually takes between 30 and 45 minutes. Those dogs that have ELISA + reaction or neutropenia will be admitted to the isolation ward. If there is suspicion of another high-risk infectious disease, then the patient should be admitted immediately to the isolation unit until this can be confirmed. Except for patients <5kg who can be carried, all other patients must be placed onto a gurney. To minimize the potential for spillage of infectious material (feces, urine, and vomit) during transport, the gurney must contain adequate absorptive material to prevent spillage (i.e.: plastic garbage bags, cage pads). The gurney must be transported through the client waiting area and through the double doors into the hallway in front of Wards 1-3. The gurney should be transported through Ward 2, then down the hallway behind Wards 1-8 directly into the isolation unit anteroom. The gurney should not enter the isolation room. The patient should be lifted from the gurney in the anteroom to the cage. Someone must be designated to immediately mop the floor along this route with an effective disinfectant solution, which shall be available in the examination room hallway. The gurney must be thoroughly cleansed while in the anteroom. After cleaning, the gurney is moved just outside the anteroom door, where it must be thoroughly wiped/sprayed with disinfectant (10% bleach) on all surfaces including the wheels. b. Suspicion of High Risk Infectious Disease Not Identified until after Patient Entry to Hospital: If the patient has already entered the hospital, before the potential for a high-risk infectious disease has been identified, every effort must be made to identify possible areas of contamination. The examination room, client waiting area and all other areas where potential contamination with infectious material may have occurred must be cleansed thoroughly with an effective disinfectant solution (See Chapter 1). All students and clinicians handling the patient must wear gloves, gowns and protective boots as soon as the potential for high-risk infectious disease has been identified. All other clients present in the waiting area whose patients may have been exposed to the infectious disease should be informed of the risk and the symptoms of the disease in question. Vaccination status should be determined and updated vaccination recommended for diseases to which the animal has been exposed and for which there is a vaccine available (especially for parvovirus, canine distemper, panleukopenia, infectious tracheobronchitis). The owner is responsible for keeping his/her animal’s vaccination status up to date. The patient that is suspected of high risk infectious disease should be transported to the isolation unit as outlined in 2 (a) above. c. Contamination of Persons in Contact with Patient Suspected of High Risk Infectious Disease: • Owners of high-risk infectious disease patients should be encouraged to enter the hospital only when necessary, and should wear clean uncontaminated clothing. Clients who must have contact with front desk staff and who are wearing potentially contaminated clothing must be provided with a protective gown and thoroughly wash their hands prior to any contact with front desk staff. Clients must be instructed regarding the policy for entry and exit from the isolation unit identified in III (a) below if visitation of their pet is to be allowed in the isolation unit. The practice of allowing clients to visit patients in Isolation should not be encouraged. • Any person (student, clinician, technician, staff member) who has unprotected contact with a patient suspected of high risk infectious disease must immediately be provided with a clean uncontaminated set of surgical scrubs or change into other clean uncontaminated clothing. The contaminated clothing should be placed in a plastic bag and transported for laundering. After placement of the clothing in the bag, the person must thoroughly wash his/her hands prior to any further contact with other patients or clients. In addition, any person who experiences contamination of their personal clothing during protected contact with a patient suspected of high risk infectious disease must immediately change clothing as outlined above. d. Admission of dog or cat suspected to have Rabies. • All rabies suspects will be kept in the ICU and so noted with a sign on the cage “Rabies Suspect”. Only faculty, residents, interns, students, and staff presumed to have a protective titer to rabies will care for the patient. 110 3. Isolation Unit Entrance and Exit Procedures a. Personnel: Upon entry into the anteroom, patient supplies should be gathered and prepared prior to entry into the isolation room. Once these preparations are complete, then protective footwear, gown and gloves must be put on prior to entry into the isolation room. All patient treatments and diagnostic procedures should be performed in the isolation room when possible. After completion of necessary patient contact, all personnel should clean the area as well as possible. All infective material should be cleaned from the floor using a mop and appropriate freshly prepared disinfectant solution (1:10 dilution bleach). ALL soiled cage material should be placed in the trash. Upon completion of necessary procedures, gloves, gowns, and protective footwear should be removed and placed in the trash at the door to the anteroom. ALL PERSONNEL LEAVING THE ISOLATION ROOM MUST IMMEDIATELY WASH THEIR HANDS THOROUGHLY AT THE SINK IN THE ANTEROOM PRIOR TO EXITING FROM THE ANTEROOM. If any article of personal clothing becomes soiled with infective material or comes into close contact with the patient, procedures in 2(c) above must be followed. b. Patient: When the patient is required to leave the isolation room for diagnostic procedures or is being discharged from the hospital it should be carried from the cage to the anteroom and placed on a gurney. To minimize the potential for spillage of infectious material (feces, urine, and vomit) during transport, the gurney must contain adequate absorptive material to prevent spillage (i.e.: plastic garbage bags, cage pads). Any hospital personnel having contact with the patient during transport or during diagnostic procedures must be provided with protective gowns and gloves. After contact is complete, all hospital equipment that the patient has come into contact with must be cleansed thoroughly with an effective disinfectant solution (1:10 dilution bleach). All gowns and gloves should be transported to the isolation unit and disposed of in the trash in the isolation unit. ALL PERSONNEL WHO HAVE PARTICIPATED IN THE PROCEDURE MUST IMMEDIATELY THOROUGHLY WASH THEIR HANDS AFTER REMOVING THEIR GOWNS AND GLOVES AND PRIOR TO ANY OTHER PATIENT CONTACT. If any article of personal clothing becomes soiled with infective material or comes into close contact with the patient, procedures in 2(c) above must be followed. The gurney should not enter the isolation room. The patient should be lifted from the gurney in the anteroom to the cage. The gurney must also be cleaned completely, including the wheels and allowed to dry prior to being used again (see above). c. Trash and Cleaning Procedures: Trash should be double bagged and clearly labeled as: BIOHAZARDOUS MATERIAL-POTENTIALLY INFECTIOUS, and left in the hallway outside the anteroom. Ward attendants will place these bags into red biohazard bags and transport to the holding area for biohazard waste removal on the dock. The route to reach the Dock should be through the corridor behind the Wards to the elevator behind Ward 1. Any supplies or equipment which enter the isolation unit (anteroom or isolation room) must not be removed unless in the trash, or following a thorough cleansing with an appropriate disinfectant solution (1:10 dilution bleach). The floor of the anteroom must be mopped once daily, or more often if necessary, with an appropriate disinfectant solution (1:10 dilution bleach). The entire isolation unit must be thoroughly cleaned after departure of any patient, which was housed there with an appropriate disinfectant solution (1:10 dilution bleach). Special attention must be paid to cleaning any infective material from walls, and equipment. d. Maintenance of Disinfectant Wash Buckets 111 • Fresh buckets of disinfectant (1:10 dilution bleach) are maintained in the isolation area by the small animal critical care unit technicians at least once daily. Disinfectant buckets are prepared and maintained in the general receiving areas and the wards by the small animal grooms and by the small animal technicians. Methods of preparing the disinfectant buckets and proper sanitation of the ward areas and equipment are taught during groom and technician orientation to the job. 4. Admission of Patients Suspected of MODERATE RISK Infectious Disease a. All patients, who are suspected of moderate risk infectious disease, may be admitted to the critical care unit. At the discretion of the admitting clinician, and preferably in consultation with the director of the critical care unit, the patient may be admitted to the isolation unit and treated as a high risk infectious disease case and procedures outlined in 2 and 3 above must be followed. This should be necessary only if there are immunosuppressed patients who are at risk for the infectious disease in question, that are present in the critical care unit. b. Hospital personnel and/or clients, who are required to have contact with a patient suspected of a moderate risk infectious disease, must wear a protective gown and gloves. A special trash receptacle labeled as BIOHAZARDOUS MATERIALPOTENTIALLY INFECTIOUS must be located nearby and all gowns, gloves, and soiled cage materials must be placed in this receptacle. This trash will be disposed of as in 3(c) above. ALL PERSONNEL WHO HAVE CONTACT WITH THE PATIENT MUST IMMEDIATELY AND THOROUGHLY WASH THEIR HANDS AFTER REMOVING THEIR GOWNS AND GLOVES, AND PRIOR TO ANY OTHER PATIENT CONTACT. If any article of personal clothing becomes soiled with infective material or comes into close contact with the patient, procedures in 2(c) above must be followed. If the patient must leave the critical care unit for diagnostic testing, relevant procedures in 2 (b) above should be followed. Any equipment, which has become soiled by infective material, should be immediately and thoroughly cleansed with an effective disinfectant solution (1:10 dilution bleach) prior to being utilized for any other patient. 5. Admission of Patients Suspected of ZOONOTIC POTENTIAL Infectious Disease a. All patients, who are suspected of zoonotic potential infectious disease, may be admitted to the critical care unit. At the discretion of the admitting clinician, and preferably in consultation with the director of the critical care unit, the patient may be admitted to the isolation unit and treated as a high risk infectious disease case and procedures outlined in 2 and 3 above must be followed. This should only be necessary if there are immunosuppressed patients, that are at risk for the infectious disease in question, present in the critical care unit. Alternatively, if the zoonotic potential is very high or special precautions must be taken to prevent human transmission. b. Hospital personnel and/or clients, who are required to have contact with a patient suspected of having a zoonotic infectious disease, must wear a protective gown and gloves. A special trash receptacle labeled as BIOHAZARDOUS MATERIALPOTENTIALLY INFECTIOUS, must be located nearby and all gowns, gloves, and soiled cage materials must be placed in this receptacle. This trash will be disposed of as in 3(c) above. ALL PERSONNEL WHO HAVE CONTACT WITH THE PATIENT MUST IMMEDIATELY AND THOROUGHLY WASH THEIR HANDS AFTER REMOVING THEIR GOWNS AND GLOVES, AND PRIOR TO ANY OTHER PATIENT CONTACT. If any article of personal clothing becomes soiled with infective material or comes into close contact with the patient, procedures in 2(c) above must be followed. If the patient must leave the critical care unit for diagnostic testing, relevant procedures in 2(b) above should be followed. Any equipment that has become soiled by infective material should be 112 immediately and thoroughly cleansed with an effective disinfectant solution (1:10 dilution bleach) prior to being utilized for any other patient. c. Hospital personnel and/or clients, who have had contact with a patient suspected of having a zoonotic infectious disease known to be transmitted by fomites must not enter into areas of food preparation or distribution designed for human consumption wearing the same clothing and shoes as during the potential exposure. The use of disposable barrier clothing is encouraged. Clothing and shoes must be changed before leaving the building in these circumstances. Clothing should be bagged and laundered, and shoe bottoms and sides disinfected. d. Clients should be informed of the zoonotic potential of their pet’s disease as soon as a reasonable suspicion or confirmation of a zoonotic disease is established. The client should be encouraged to contact their local physician for further advice following exposure to a zoonotic disease. See Table at beginning. e. Immunocompromised people (clients, students, staff, faculty, technicians) may be exposed to zoonotic diseases in our hospital or from animals at home. Special precautions to lower the risk for acquisition of an infectious agent from animals may be appropriate in these circumstances. It is important that confidentiality be maintained if that is the wish of the individual. Resources for more information on these issues are : Healthy Pets, Healthy People at www.cdc.gov and PAWS (Pets Are Wonderful Support) [Pets and the Immunocompromised Patient] at www.pawssf.org/library_immunocompromised.htm. These sources provide helpful material for attending veterinarians and the immunocomproimsed community. Excerpted from: INFECTIOUS DISEASE CONTROL: BIOSECURITY POLICIES AT THE OHIO STATE UNIVERSITY COLLEGE OF VETERINARY MEDICINE, March 2004 Infectious disease control in the Veterinary Teaching Hospital By Dr Richard Bednarski Introduction Infectious disease control within the Veterinary Teaching Hospital implies that infectious diseases, which by definition are regularly introduced to the hospital by its patients, are prevented from contacting and infecting other patients and hospital personnel. Infectious disease control measures should be designed to prevent transmission of infectious microorganisms from recognized and unrecognized sources of infection. To this end, facility design including ventilation, patient housing and stratification must be appropriate. Additionally, all patient contact personnel must be trained in appropriate personal hygiene practices including hand washing and the use of barrier clothing. Personnel should be familiar with basic principles of cleaning and disinfection as well as proper disposal of contaminated waste. Hospital personnel including students, staff, and faculty have a duty to take all reasonable steps to safeguard patients, staff and the general public form infection. It is essential that hospital personnel be familiar with the clinical signs and epidemiology of infectious disease that may pose a threat to hospital patients and animals in our community. It is the duty of all to follow written and unwritten guidelines pertaining to the containment and control of infectious disease. Objectives 1. Protect the hospital staff, patients, and facility from exposure to extremely contagious and dangerous diseases by not admitting animals involved in a herd outbreak (epizootic) of disease and/or those with a disease that is reportable to state or federal authorities. 113 2. Provide care for animals with contagious diseases while protecting hospital staff and patients from exposure to these diseases by enforcing strict isolation policies (Refer to respective large and small animal isolation documents). 3. Identify patients with zoonotic disease (see attached list), particularly those diseases that pose a risk for immunocompromised humans. Reduce exposure of students and staff to these patients while continuing to provide excellent care, by adhering to appropriate personal hygiene and recommending against exposure for immunocompromised persons. 4. Reduce the likelihood of the introduction of infectious diseases into the VMTH by way of recently acquired teaching and research animals and protect research and teaching animals from infectious diseases that may be present in the hospital. Minimize hospitalization of horses and cows from the teaching herd. It is especially important to minimize contact with the cull cows purchased for Large Animal Techniques and Palpation classes. The committee recommends that teaching of LA and Equine techniques occur at the College’s Finley Farm or in a separate facility near the Columbus campus, such as the Waterman Farm. This will eliminate teaching animals as a source of disease introduction. Teaching animals brought to the hospital must have undergone appropriate quarantine at Finley Farm or another College-approved facility. Monitoring research animals in the hospital Require a 2-week quarantine at Finley Farm or other approved quarantine facility before hospitalization. Donated horses coming directly from an individual’s home may not be required to undergo quarantine before admission to the hospital. House research and teaching animals in designated parts of the hospital (See below). Minimize contact with hospital patients by using specified traffic flow patterns, and restricting as much as possible, contact of research technicians with hospital patients. 5. Reduce the likelihood of outbreaks of nosocomial disease by adhering to stringent policies for hospital hygiene. (Isolation of animals with infectious diseases, periodic depopulation and disinfection of all parts of the hospital; monitoring of the environment.) Refer to the section describing yearly depopulation, cleaning, and disinfection, below. 6. Prevent nosocomial infection by facilitating a strict code of personal hygiene. Hand washing is the single most important procedure for preventing nosocomial infection. Personnel must have easy access to hand washing facilities. Preferably these facilities will provide a source of hot and cold running water, a liquid soap dispenser, and disposable paper towel dispenser. The design must minimize contamination of the hand washing station (e.g. Foot pump style soap dispenser, foot or arm control faucet handles). When clean running water is inaccessible nonwater antiseptic cleaners can be used as an alternative. Non-water antiseptic cleaners may be used as an alternative when hands are not visibly soiled and repeated hand washing inflames the skin. Hands must be cleaned immediately before and after patient contact. Hands must be cleaned before and after patient contact even when disposable protective gloves are worn. Clean clothing and suitable protective clothing must be worn during patient contact, typically a white coat in small animal clinics and coveralls in large animal clinics... Visibly soiled clothes must be removed as soon as possible and before contact with another patient. Footwear worn in the large animal hospital must be capable of being cleaned and disinfected. Suitable materials for this footwear are rubber, latex, plastic, leather, or other moisture impervious material. As an alternative, disposable plastic footwear shall be worn over non-protective footwear. Hospital personnel should remove protective clothing (white coats, coveralls) and remove protective footwear before leaving the hospital. Hospital personnel should adhere to these guidelines when visiting areas of the Veterinary College outside the hospital. 7. Protect hospital staff and students by requiring immunization against rabies. Require periodic checks of Rabies titers (through Occupational Health). Cleaning Isolation Stalls (See Isolation stall floor plan, Appendix 1) 114 1. Routine daily cleaning of occupied stalls. a. Whenever possible, it is advisable to have one Ward Attendant in charge of the Isolation area. This person should be very familiar with all Isolation protocols. b. Isolation stalls are cleaned in the afternoon; after all other hospital stalls have been cleaned. c. Two people are required to clean these stalls. One person stays on the apron outside the stalls to move the forklift and attached red ISOLATION bucket. This person should be wearing barrier clothing [boots, gloves and a gown, obtained from the isolation storage room]. Large isolation gowns are available to fit over winter clothing. This person also hands straw and hay to the person inside the stall. A second person who is inside the stall and is wearing prescribed barrier clothing, removes soiled bedding into the red bucket that is parked in the open doorway on the parking lot side of the stall. This person exits through the anteroom opening onto Ward 1 and must follow the protocol for using barrier clothing in isolation. Put on plastic boots and gloves in Room A. Look into room B to see if trash container is full. If so, take a new red Biohazard trash bag into room B. All trash from Isolation should be treated as Biohazard waste. Put on a new isolation gown in Room A. Empty the trash into the bag you brought in and tie shut. Enter the stall, taking any tools needed and the full trash bag(s). Shut the stall door. Give trash bags to the person outside on the apron. The trash bags should be placed in the Isolation Trash Cart. All soiled bedding and hay is placed in the red bucket. The stall is re-bedded and fresh hay is placed in the stalls, unless there are special instructions for feeding. Make sure the automatic waterer is on (unless special instructions have been posted that the waterer should be off), and is clean. Empty, clean and refill auxiliary water bucket(s). Note quantity and quality of feces (formed, watery, voluminous scant etc.). Record these observations on the ICU flow sheet in Room A as you leave. Be sure to note time and to initial your comments. Replace tools in room B. Remove and discard Isolation gown. Do not lean on anything. Open the door to room A and prop open with hip. Do not touch the room A side of the door with gloves or boots. Remove boots as you step out, being careful not to step in room B without boots or to touch anything in room A with dirty gloves. Gloves should be removed by turning inside out from the cuff, and should be discarded in the wastebasket in room B. d. Wash hands with Betadine or Nolvasan soap. e. All soiled bedding and manure goes directly into the compacter. This includes tanbark. The forklift should be driven around the outside of the Galbreath Equine Center to the compacter and should never be driven through the hospital or the connector between the old hospital and the Galbreath Equine Center. The red bucket should not be set down anywhere except immediately adjacent to the compacter or on the isolation apron. f. Any material from an Isolation stall is considered contaminated. Spillage must be immediately cleaned up and every effort must be made to minimize scatter of organic material on the concrete apron in the Isolation enclosure. g. All feed and bedding should be taken into the stall through the parking lot side, never through rooms A and B. 2. Feeding Horses in Isolation a. Ward attendants will feed in the afternoon after cleaning the stalls. Special feeding instructions should be posted in room A. b. Ward attendants will leave hay and grain rations outside the parking lot door to the stall, weather permitting. An ICU technician will feed horses in the morning. 115 c. Hay is transported on a cart that is parked in the Supply Room near the Northeast exterior door of the Galbreath Center connector. When the weather is inclement, hay for horses in Isolation is left on this cart. 3. Cleaning and Disinfecting a Vacated Stall a. Room A should be cleaned first or at a different time than cleaning of rooms B and C. b. Room A Students and ICU Technicians will remove all medications. Unopened vials and boxes can be returned to the pharmacy and credited to the client. Partly used medications are not returnable and are placed in the “Good Sam” medication box in the Isolation Supply Room. All paperwork should be returned to the Equine or Food Animal Office. An ICU Technician will designate someone to remove all items from the counter and shelves. The large box containing new gowns can be used to collect all these items. The box will be left on the counter in room A. The Ward Attendant will remove the box and put it on a clean cart in the Ward 1 hallway during cleaning of room A. Wet down all surfaces, walls, floor and doors in the room using a hose from the Ward 1 hallway. Do not soak shelves. Counter, sink, doors, shelves, walls, floor, coat hooks, and trash container should be scrubbed using Profoam. The seals around doors and edges of door to Room B should be carefully cleaned. Clean counter top and scrub any stains. Rinse well. Spray phenol on all surfaces. An ICU technician will designate someone to replace shelf and counter contents when room A dries. c. Rooms B and C Be sure that the exterior door of the stall is open, and that the Phenol sprayer is just outside the stall on the concrete apron. Put on gloves, boots and an Isolation gown before entering Room B. Do so whether entering Room B from Room C or from Room A. Gather all trash. Blue towels, gowns, fluid bags, bandage material, extra supplies, and tape on equipment, should all be discarded. Sharps should be placed in the sharps container. Discard the thermometer and the stethescope. All trash should be placed in a Biohazard Bag. Nasogatric tubes, buckets, muzzle, lead shank, and hoof pick should be thoroughly scrubbed and rinsed in Room B. Nasogastric tubes should be double bagged and returned to Central Supply. Place muzzle, lead shank and hoof pick in a bucket while completing stall cleaning. To double bag equipment. first place in a garbage bag and tie shut. Then, have a person outside the stall open a red bag into which the contaminated garbage bag can be carefully inserted, taking care to keep the outside of the red bag uncontaminated. Label bag with contents. The use of the red bag alerts the Technicians in Central Supply that the equipment is contaminated. Be careful not to discard biohazard bags containing reusable equipment! An ICU or Medicine Technician will clean clippers, stomach pump, oral dose syringe, oxygen reduction valve and bubbler, and CRI pump that may be in the stall. CRI pumps and oxygen reduction valve and bubbler should be wiped with alcohol and placed in room A. Flush stomach pump and dose syringe with water and phenol. Place in bucket with muzzle etc. Wipe clippers with alcohol and remove and clean blades. Clipper body is placed in room A. Double bag blades for return to Central Supply where they will be gas autoclaved. Medicine or ICU technicians will make sure that stomach pumps and dose syringes in Isolation are intermittently taken apart and gas autoclaved. This can be done when contamination is perceived to be heavy or after approximately 3 months of service. Check with Rick Teasley in Central Supply to make arrangements to have the pumps and syringes autoclaved. This will probably be done on a Saturday. Clean the pumps and flush with water and phenol. Double bag and take to Central Supply. 116 4. 5. 6. 7. Use hot water and completely rinse all surfaces of the rooms B and C, including lights, vents, pipes and doors. Flush all drains. Scrub with all surfaces with Profoam, starting in Room B, including the top of the short wall, the air exchanger and the hose rack. Wash and scrub all stall surfaces. Pay particular attention to the outside door and pipe divider if there is one. Rinse thoroughly, staring in Room B. Rinse all surfaces and floors into drains. When Room B is rinsed, replace resident equipment. Using the bleach sprayer, spray bleach (undiluted) on all floor and wall stains. Some are permanent, but most are not. Let stand about 10 minutes then rinse thoroughly into drains. Spray disinfectant (phenol) in a fine mist for best contact. Uses the 3 gallon pump sprayer kept in the ICU storage room. Disinfection should start in Room B and move to the door in the parking lot side of the stall. Spray inside waterer, and feed bowl, buckets, muzzle, lead shank and hoof pick and the grate of the air exchanger. Spray all surfaces in each room, including door seals and steps of both doors. Thoroughly rinse waterer, buckets, muzzle and feed tub after 30 minutes. Clean and disinfect the concrete apron in front of the stall. Stall Culturing Protocol a. Stalls should be cultured 24 hours after cleaning. The culture result log sheet (Appendix 2) for the stall is obtained from the logbook in the Isolation Supply Room, and hung on the clip on the outside of the door to the Ward 1 hallway. The Ward attendant writes in the date the stall was cleaned, the date the disinfection process was completed, the date the cultures were obtained and where in the stall the cultures were obtained. b. Samples for culture should be obtained by swabbing the stall drain, under the feed tub, in the drain in Room B, and any defect in the stall floor or walls where organic material may be sequestered. Pool the swabs and submit to the VMTH Microbiology Laboratory. The cost of stall surveillance is defrayed by the hospital. c. The Ward Attendant checks for results of the culture. When results are obtained, he/she notes on the log sheet the date and the culture results. If the culture is positive, the stall must be cleaned and sanitized again. A new entry on the log sheet should appear for the second cleaning process. The stall will not be used until the culture is negative. Records of Stall Use and Disinfection a. Stall Culture log sheets are kept in the log book in the Isolation Supply Room. These important hospital records form a data base that allows us to track the history of stall use. b. Census sheets are kept in a logbook in the Isolation Supply Room. One census sheet is used per stall. The Ward Attendant enters the case number and owner’s name for each horse in each stall. The census book allows us to determine which horse was in a stall on a given date. This information is especially useful when there is great pressure on the isolation facility; occasionally, a horse must be placed in a stall for which the disinfection process has not been completed. The Biosecurity Officer should be consulted before using a stall that has not been properly sanitized. Trash Removal a. All non-organic debris is placed in biohazard trash bags that are tightly tied. Place the bags on the apron just outside the stall while the stall is being cleaned. Bags are then placed in the trash cart kept outside the Isolation Storage Room. Do not open bags or set them down elsewhere. b. When the cart is full, it is wheeled to the dumpster for biological waste that is located on the loading dock, taking a route outside the hospital. Do not enter the Connector with this cart. c. Biohazard and sharps containers should be removed when the container is close to full. Remove through the stall door on the parking lot side. Concrete apron outside Isolation Stalls. a. The apron should be kept clean of debris at all times. The area just in front of each stall should be carefully cleaned after the stall is cleaned each day. 117 8. 9. 10. 11. b. The apron should be swept, scrubbed with profoam, rinsed and disinfected weekly, weather permitting. Ancillary Equipment a. Mats are often used for foals in Isolation. Mats should be cleaned and disinfected after every use. b. Mats are usually stored on the concrete apron. Mats should be placed in a clean, vacant, isolation stall if one is available. Mats must be cleaned and disinfected before being placed in such a stall. If no stalls are available, we recommend that the mats be stored on the apron, covered with a tarp. Guidelines for Stall Reuse a. All stalls should be subjected to the cleaning, disinfection, and culturing. Culture results must be negative before the stall can be reused. b. Exceptions should be authorized by the Biosafety Officer for Equine or Food Animal and Medicine and Surgery. Supply Room a. Sweep out daily to keep free of organic debris and as clean as possible. b. Keep supply cabinets closed. c. Clean all surfaces with foam cleaner weekly. Handling contaminated equipment a. CRI pumps, should be kept in ROOM A if possible, with lines attached that lead to the patient, and should be externally cleaned by an ICU technician. b. One pair of clippers should be designated for use in isolation and should be kept in the Isolation Store Room. Clippers used in Isolation should receive preliminary cleaning by an ICU technician in Room B. The external surfaces including the cord, should be wiped with alcohol. The blades should be removed, scrubbed, double bagged, and returned to Central Supply for autoclaving. The rest of the clipper should be removed from the stall via the parking lot door, and replaced in the Isolation Storage room. c. Other equipment should be cleaned as well as possible by an ICU technician in Room B, double bagged and returned to Central Supply. 118 Appendix 1 LARGE ANIMAL ISOLATION STALL WARD 1 B A TREATMENT ROOM ANTEROOM SINK C STALL TRASH PARKING LOT 119 Stall Cleaning Record Appendix 2 STALL # _______________________________ Date Cleaned ____________________ Date Cultured ____________________ Results: Date Date Sanitized__________ Where Cultured_____________ _____________________________________ ____________________________________ _____ Date Sanitized_______________ Where Cultured_____________ Date Cleaned ____________________ Date Cultured ____________________ Results: Date ________________________________________________________________________ Date Cleaned____________________ Date Sanitized_____________ Date Cultured ____________________ Where Cultured_____________ Results: Date ________________________________________________________________________ Date Cleaned____________________ Date Sanitized_____________ Date Cultured ____________________ Where Cultured_____________ Results: Date ______________________________________________________________________Date Cleaned________________ Date Sanitized_______________ Date Cultured ____________________ Where Cultured ___________ Results: Date Date Cleaned____________________ Date Sanitized_____________________ Date Cultured ____________________ Where Culture______________ Results: Date ________________________________________________________________________Date Cultured ____________________ Date Sanitized________________ Date Cultured____________________________ Where Cultured _____________ Results: Date Date Cleaned____________________ Date Sanitized_______________ Date Cultured ____________________ Where Cultured_______________ Results: Date ______________________________________________________________________Date Cleaned ____________________ Date Sanitized______________ Date Cultured ____________________ Where Cultured ___________ Results: Date 120 Chapter 5 Biosecurity in Food Animal Medicine and Surgery By Dr Michael Rings General Rules and Considerations All students, staff and faculty of the food animal section will dress appropriately for the work within the section (Coveralls or surgery scrubs). Personnel in the Food Animal area should be clean at the beginning of each day and wear footwear that can be disinfected (rubber boot preferred) A second set of clean coveralls or scrubs should be available in the event that the original set becomes contaminated by feces or blood during the course of the day. All equipment used in the examination or treatment of a patient should be thoroughly cleaned prior to storage within the Food Animal section or before being returned to Central Supply. Any equipment used in the treatment of a suspected zoonotic or contagious disease should be placed in a biohazard bag prior to returning to Central Supply. Transporters and tilt tables will be thoroughly cleaned between animal use and disinfected with a 10% bleach solution or other satisfactory disinfectants. Non-Foreign Diseases that require special attention Diarrhea Diseases Johne’s Disease / Paratuberculosis (Reportable* if culture positive) Cryptosporidiosis Bovine Virus Diarrhea Salmonellosis Respiratory Diseases Infectious Bovine Rhinotracheitis BVD Mycobacterium bovis*, Mycobacterium avium Abortion Diseases Q-fever (Coxiella burnetti) Brucella abortus*, Brucella melitensis*, and Brucella suis* Leptospirosis Central Nervous System Diseases Rabies* Scrapie* Transmissible spongiform encephalitis* Miscellaneous Diseases Contagious Ecthyma Mycosporum gypseum (Club Lamb Fungus) There is considerable interest in this disease and it creates large problems for exhibition livestock. This disease may be zoonotic. Bluetongue (In sheep*) *Reportable Disease For cattle, sheep, goats and camelids presenting with a primary complaint of diarrhea, assessment of the most likely differential diagnoses needs to be made by the receiving clinician before the animal is 121 hospitalized. If there is a strong possibility for any of the above-listed problems, the animal should be housed in an isolation stall (ward 1) and the area in the hospital where the animal examined should be disinfected. Attempts to confirm the diagnosis should be made as soon as possible. Students, technicians and faculty having contact with any of these animals prior to hospitalization in isolation must disinfect their footwear and any clothing contaminated by feces must be changed before contact with any other patient. The use of disposable barrier clothing is strongly encouraged. Thorough hand washing with a disinfectant soap (betadine scrub, chlorhexidine, etc.) should take place before handling other patients. Contaminated areas should be thoroughly cleaned. Disinfection of premises and equipment contaminated during examination will be done using a phenol-based compound such as One Stroke Environ, Osyl or Amphyl (known to show activity against M. avium subsp. paratuberculosis). Respiratory Diseases Ruminants presented with a primary complaint of respiratory disease should be examined closely for evidence of highly contagious viral pathogens (Herpesvirus, Bovine Virus Diarrhea Virus). Any evidence of necrotic nasal plaques or oral ulcers is justification for placing the animal in Isolation. Animal with histories suggesting an outbreak of respiratory disease involving more than 10% of the herd will be considered to be infected with a contagious disease and hospitalized in isolation stalls until an accurate cause of the condition can be determined. Mastitis and Udder Evaluation All lactating dairy cattle being examined should be evaluated with respect to mastitis by both the black plate and California Mastitis Test and the results entered into the record. Evidence of clinical mastitis should be brought to the owner’s attention, especially in animals to be hospitalized. Evaluation of the severity of the mastitis will be used to decide the order of milking during hospitalization, with non-mastitic cows being milked first, followed by less severe cases and ending with the most severe cases. All teats will be dipped in an appropriate sanitizing solution (usually chlorhexidine teat dip) following evaluation of the milk. Where appropriate (animal off antibiotics or not infused locally), cultures will be submitted to determine whether contagious agents such as Mycobacteria, Mycoplasma spp, or yeasts are present. Lactating dairy cows to be hospitalized shall be listed by the stall number on the white board at the end of Ward 2. The stall number of cattle with mastitis will be circled on this board so that the milkers are aware of the mastitis. The “claw” of the milking machine must be rinsed in fresh betadine solution (diluted to a 3% solution) after milking each cow. All milking equipment must be rinsed with dilute betadine solution. Contagious ecthyma (ovine contagious pustular dermatitis), while not a contagious problem to cattle, represents a problem both as a contagious disease for sheep, goats and camelids and as a zoonotic problem for humans. Indications from prior research suggest that scabs remain as infective agents for years. Sheep and goats entering the OSU VTH should be examined closely for signs of CE, i.e. proliferative lesions at the lateral commissures of the lips, proliferative lesions on the muzzle. Owners should be questioned about exposure to CE/soremouth/orf so that animals in the recovery phase will be identified and appropriate safety measures taken (students must wear appropriate barrier clothing, especially gloves) when handling suspect animals. Animals with contagious ecthyma don’t necessarily need to be in isolation but should be clearly identified and access to the stall limited to personnel needed to treat the animal. Personnel handling suspicious animals should wear disposable gloves that can be discarded in biohazard bags following examination or treatment. 122 Biosecurity in Equine Medicine and Surgery By Catherine W Kohn 1. Biosecurity Risk of Diseases of Equids: Clinicians should be vigilant in identifying patients that may be affected with these diseases. a. Very High Risk Diseases: Diseases of such a highly contagious nature or potential for catastrophic disease that quarantine of affected animals on the home farm is desirable. EHV-1: Transmission of virulent EHV-1 from horses with neurologic disease has been documented at the OSU VTH. Affected horses originated from a large outbreak of virulent disease at a boarding stable. Horses from an outbreak of EHV-1 should not be transported to the hospital because of the danger of spreading the virus in nasal secretions via aerosol or fomite contact. When discussing potential referral of horses with respiratory, neurologic or reproductive signs consistent with EHV-1 infection, hospital staff are directed to determine whether a serious outbreak of EHV-1 disease has occurred. If so, the local veterinarian should be directed to quarantine the affected horses. OSU staff may arrange to visit the premises to help in diagnosis or management of affected horses, but must observe strict biosecurity measures while on the farm and before returning to the OSU-VMTH (see Chapter 8). b. High Risk Diseases: Contagious diseases or those with significant zoonotic potential for serious human disease. Horses suspected of having one of these diseases must be strictly isolated. c. Salmonellosis West Nile Virus* Rabies* EHV-1 (not associated with a serious outbreak) Mycobacterium avium (GI) Cryptosporidia especially foals. Campylobacter Cryptococcosis Methicillin resistant staphylococci Moderate Risk Diseases: Transmission to horses or other large animals in the hospital is possible. Strict isolation is required. Streptococcus equi var equi Influenza Diarrhea (any patient) Horses with fever and leucopenia EIA* Piroplasmosis* Blastomycosis Histoplasmosis d. Potentially Zoonotic and Contagious Diseases with a low risk of horse to horse transmission. Use disposable barrier clothing. Rhodococcus equi Lawsonia intracellularis *Reportable Diseases 123 2. Admitting an Equine Patient with an Infectious Disease that Poses a Biosecurity Risk a. Identify high risk patients based on history and results of initial physical examination. It is crucial that all faculty, staff and students become familiar with the diseases listed above, to facilitate identification of affected horses. b. Horses should NOT be admitted to the wards, hallways, or surgery and examination rooms. Walk immediately into a clean Isolation stall. c. Hospital staff should then put on appropriate barrier clothing as described below (Isolation Protocol) before examining the horse in the isolation stall. d. The owner/handler should be instructed not to enter the VMTH. The owner should be advised of the seriousness of the risk of transmission of contagious or zoonotic disease and should be given advice on washing/disinfecting clothing and shoes. 3. Hospitalized Patients that Develop Potentially Infectious Disease while in the Hospital a. Identify patients quickly and move them to Isolation immediately. It is preferable to be conservative, and move a patient to Isolation when not necessary than to have a breech of biosecurity. Any horse with diarrhea must be moved to an Isolation Stall. Horses with fever and leucopenia (with or without diarrhea) should be moved to Isolation. b. A red “DO NOT USE” sign should be placed on the door of the vacated stall in the main hospital. This sign alerts the Ward Attendants that the horse that vacated the stall may have an infectious disease. The stall cannot be used until it has been cleaned, disinfected, and cultured. See Stall Cleaning. 4. Isolation Protocol a. Meticulous attention to isolation protocol is crucially important for the welfare of all animals that enter our hospital. The Isolation stalls are used to isolate potentially infectious horses from the rest of the hospital and to isolate potentially infectious horses from each other. See Appendix 1 Chapter 3 for a diagram of an isolation stall. b. How to Enter and Leave Isolation: The Anteroom (A) is a clean “safe” area. This room is stocked with plastic boots, plastic gloves, plastic rectal sleeves, syringes, needles, and scrub. Red contamination bags are provided for transport of biohazardous material. Use the anteroom for storing drugs and materials for use on the case, but not for materials that have been in contact with the case. Enter A from the Ward I aisle. Put on clean plastic boots, disposable gloves, and an isolation gown. Enter the Treatment Room (B). A lead shank, stethoscope, stomach tube, pump, buckets, a contaminated waste container and a sharps container are kept in the Treatment Room. Contaminated equipment, such as a thermometer, IV fluid sets etc. are kept in the Treatment Room. Medications are not stocked in the treatment room because unused medications must be discarded. Non-disposable equipment needed for the patient is double bagged, and returned to Central Supply for cleaning (See Chapter 3). . Buckets will be cleaned and disinfected in the stall by the Ward Attendant when a horse is discharged. After working on the patient, the stall door should be latched securely. Remove coveralls and discard. Open anteroom door and prop open with one hip. Remove one boot and step on ledge between Treatment Room and Anteroom. Remove other boot and gloves and throw in basket provided in the Treatment Room, then step into Anteroom. Wash hands with disinfectant soap (Betadine or Nolvasan). c. Supplies in Isolation: A thermometer is checked out of the pharmacy for each patient in Isolation. The thermometer is kept on the shelf in the Treatment Room. A new disposable stethoscope will be provided for each patient. Keep all drugs, syringes, rectal sleeves, etc. in the Anteroom only. Take individual drug doses, or materials needed for one procedure into the treatment room and stall. Never store drugs or materials in treatment room. Items that are not used and are not autoclavable/gasable must be thrown away. The Ward Attendants stock the Anteroom and additional supplies are kept in the Isolation Supply Room, located next to Isolation stall #9. d. A Medicine Cart is kept in the Isolation Storeroom. The cart is stocked with supplies and a limited number of drugs (carbocaine, xylazine, acepromazine etc.). To perform routine procedures on horses in isolation (such as a catheter change), the outside door (towards the Parking Lot) can be opened by someone not dressed in barrier clothing. This assistant can pass the necessary equipment etc. to those working on the horse in the stall. e. Special Procedures for Horses in Isolation 124 Endoscopy: The endoscope that is not attached to a video unit should be used. The horse should be restrained in the open doorway on the parking lot side of the stall, held by suitably attired persons. The scope is operated by a person on the outside of the stall, who handles the controls only; the scope is passed by someone in the stall. The endoscope light source should not be taken into the stall. Radiographs. A suitably attired person moves the horse to the parking lot door way. The portable x-ray machine is outside the stall. If necessary, the horse can be moved partially out of the stall to facilitate the procedure. Clean and disinfect the area in front of the stall after such procedures. Portable spray canisters containing Wexcide are available for spot disinfection. The appropriate dilution for Wexcide should be used (See Chapter 1). Occasionally a horse in Isolation must be moved to Radiology for a diagnostic procedure. Consult the Biosecurity Officer for Equine Medicine and Surgery before moving the horse. Such procedures should be scheduled at the end of the day. The horse must be walked all the way around the hospital, and should enter the red corridor at the south end and proceed directly into the large animal radiology room. All manure must be cleaned up and the spill area must be thoroughly cleaned and disinfected with a phenolic disinfectant (Wexcide). Persons handling the horse should wear barrier garments. The radiology room will be cleaned and disinfected after the procedure is completed. Ultrasonography: The ultrasound machine is placed outside the open parking lot side door of the stall. The probe is placed in a rectal sleeve, and handed to the suitably attired person performing the ultrasound examination, in the isolation stall. The ultrasound machine should never be taken into the stall. When the procedure is complete, the probe is taken out of the stall as the operator removes the rectal sleeve. The probe should then be thoroughly cleaned and disinfected. Bandage Changes: Should be performed in the stall, or, if there is a compelling reason, on the concrete apron in front of the stall. Clean and disinfect this area after the procedure is completed. Other procedures: It is sometimes necessary to perform hydrotherapy on a horse in isolation. A second, clean and unbedded isolation stall can be used for this purpose, if one is available. The treatment stall should be cleaned and disinfected after every use. f. Moving horses in Isolation: it is occasionally necessary to perform procedures that are unsafe or impossible in the isolation stall. For example, a rectal examination, joint flush etc. Joint flushes in foals can be managed on a mat on the concrete apron in front of the isolation stall, weather permitting. It may occasionally be necessary to use the third bay, nearest the main entrance, in Triage to perform a procedure on a horse from isolation. Horses with diarrhea or strangles should not be moved out of isolation. Consult the Biosecurity Officer for Equine Medicine and Surgery before using the triage area for a horse in isolation. Such procedures should occur only at the end of the day, the activity should be confined to the third bay, appropriate barrier clothing should be warn by all who have contact with the horse, and triage should be cleaned and disinfected after such use. g. Horses in isolation because of enteric disease should be cultured for salmonella a minimum of 3 times (once daily for 3 days). If all 3 initial cultures are negative, 2 more cultures should be submitted before declaring the horse salmonella negative. A form to record when cultures are taken should be taped to the Anteroom side of the treatment door. (Appendix 1). All salmonella isolates should be serotyped. When a salmonella organism is isolated, obtain a Serotyping Request Form from Microbiology (Appendix 2). Fill out the form and return it to the Microbiology Laboratory. The sample will be sent the NADL in Ames Iowa for serotyping. A log of all isolates that are serotyped should be kept electronically in Microbiology. This data base should be readily available. h. Horses in isolation should be discharged from isolation and should not reenter the Barn except in extenuating circumstances (long stay in the hospital is anticipated, draft horse too big for the stall, etc.). Check with the Biosecurity Officer for Equine Medicine and Surgery before moving a horse into the Barn from isolation. 125 i. Availability of Isolation Stalls: Occasionally, all isolation stalls may be in use or awaiting negative culture results. If this is the case and a client wants to send a horse requiring an isolation stall, the case should not be admitted or the client should be told the following: “Currently, our isolation facility is full. We have a strict infectious disease control protocol that requires that we culture each stall after it has been cleaned and disinfected subsequent to discharge of the previous case. We do have open stalls that are awaiting results of cultures. We can put your horse in one of these stalls or you can take the horse to another referral facility.” If asked about the risk of putting a horse in such a stall, the clinician should say that we cannot guarantee that disease transmission will not occur, but the stall has been thoroughly cleaned and disinfected. Do not use stalls that have yet to be cleaned and disinfected. A record of patients that have been housed in each isolation stall is kept in the Isolation Storage Room. Using this record, clinicians can determine the diagnosis for the last animal in the stall. For example, a horse with diarrhea and 5 negative cultures might have been the last occupant. If stall cultures are not yet available, this stall would be safer for a new admission than a stall occupied by a horse with salmonellosis or Srep equi var equi, j. Taking Laboratory Specimens out of Isolation: Lab specimens from Isolation patients should be bagged to avoid contamination. After the sample is collected, it should be left on the floor just inside the Treatment Room. Remove coveralls, boots and gloves and enter the Anteroom as usual. Use a clear plastic bag as a glove. Put your hand in the bag; reach into the Treatment Room (B) to pick up the specimen. Pull the bag over your hand to invert the bag around the specimen. Tie off the bag. Plastic bags are stored in the Anteroom. THERE SHOULD BE NO FECAL CONTAMINATION OF THE OUTSIDE OF CONTAINERS SUBMITTED FOR ANY LABORATORY EXAMINATION. k. When a Horse Leaves Isolation: Dispose of all items in Treatment Room that cannot be autoclaved/gased. Put these items in the trash container provided. Items that can be cleaned, such as nasogastric tubes will be managed by the Ward Attendant or a Medicine or ICU technician. Items in the Anteroom can be returned to the hospital. l. Daily Cleaning of Isolation Stalls: Isolation stalls are cleaned in the afternoon, after other stalls have been cleaned. Ward Attendants entering the stall wear barrier clothing. The stall is cleaned through the open door on the parking lot side, using a large container on the forklift. A second Ward Attendant moves the forklift from stall to stall. Waste is placed in the compacter. (See Chapter 3). 5. Cleaning of Stalls that Housed a Horse with an Infectious Disease (in the Barn or in Isolation) a. A Stall Cleaning Record (Appendix 2, Chapter 3) should be placed on the clipboard on the stall door. A red “DO NOT USE” sign should have been placed on the stall door (in the Aisle of Ward 1 for isolation stalls) by the clinician when the occupant was moved to isolation or was discharge from an Isolation Stall. Each stall has a cleaning record and these should be reused until the sheet is full. All stall cleaning records (except those for Isolation) are kept by the Ward Attendants in a loose leaf notebook in Equine ICU. A similar notebook containing records from isolation stalls is maintained in the Isolation Supply Room. These “libraries” of stall histories are available if needed for investigating biosecurity issues. b. The Ward Attendant records the dates the stall is cleaned and disinfected. All stalls are thoroughly cleaned of organic material and disinfected (See VMTH Barn Cleaning Procedures, Chapter 3). c. A composite culture sample is then taken from 3 or more areas of the stall including the drain (isolation) or area near the grate at the back of stalls in the barn, and any defect in the stall mats or the walls where organic material may be sequestered (see page 16 4 b). d. The composite sample is submitted to the Microbiology Laboratory in the VMTH. We routinely culture for Salmonella. Culture for Strep equi var equi and Rhodococcus equi is also important. Three to 5 days are required to obtain culture results. Culture results are not available on Sundays or Holidays. e. The Ward Attendant will mark the Stall Cleaning Record with the date on which the cultures were negative. f. When the stall culture is declared negative, the Stall Cleaning Record is completed and then returned to the notebook in the Isolation Supply Room, and the red sign is removed from the stall, indicating that the stall may be used. 126 g. If the stall cultures positive, the red sign is left in place. The stall should then be inspected by the Barn Manager, (currently Mr. John KIndall) to determine if there are problem areas such as space under the mat, defects in the wall etc. Repairs should be made and a second cycle of cleaning and disinfection will then be initiated. The Equine and Food Animal Biosecurity Officers should be informed. 6. Stall Allocations and Management of Cases in the Hospital a. The Galbreath Equine Center Surgery Ward This area should be reserved for orthopedic patients hospitalized for treatment of elective, clean surgical conditions. In general the end of the Ward nearest the Surgery suites should be used for surgical preparations and should not be used for procedures such as bandage changes or wound management. The ward should be “cleanest” at the surgery suite end. The initial surgical preparation should take place in the Ward, so that only a final prep is required in the OR anteroom. Outpatients should not be placed in this surgical ward. b. Room B surgical suite should be used for dirty surgeries including exploratory ceiliotomies, standing urogenital surgery, airway procedures (with the exception of laryngeal prostheses that can be managed in the Galbreath Surgery Suites), and joint flushes. Every effort should be made to contain dirty procedures to this room. c. Room C may also be used for surgery on contaminated or obviously infected lesions. However, this room is used primarily for surgery on Food Animals and camelids. d. Triage may be used for dirty procedures such as flushing joints. Use the third bay. Occasionally, standing flank laparotomy, or laparoscopy may be performed in the stocks in the first bay of triage. If room B is unavailable or there is a crisis in the old hospital (no vacuum etc.) Triage may be used for abdominal surgical procedures. e. Ward 3: should house research horses. A maximum of 6 stalls at the red hallway end of the ward may be occupied by camelids, when appropriate stalls are not available in Wards 1 or 2. f. Ward 4: Equine Medicine patients should be housed in Ward 4, along with overflow surgical patients g. Ward 5 will be used to house teaching animals during Autumn and Winter Quarters. The ward will be functionally isolated from the rest of the hospital during these quarters so that teaching animals, particularly cull cattle, are isolated from hospital patients. (See Recommendations 4 and 5 in the Introduction). The only exception will be horses that are used for force-plate studies. These horses may temporarily be taken into Ward 5 for force plate studies. 7. Foals a. Mares and foals that need intensive care should be housed in the large stalls on the west side of Equine ICU. b. Persons entering foal stalls should wear plastic foot covers and gloves. Protective footwear and gloves should be removed when leaving the stall, and placed in a trash can. c. Any foal with diarrhea should be in an Isolation Stall. 8. Horses with Colic Horses with colic are housed in ICU or may be moved to Ward 4 when they no longer require intensive monitoring. Because colic patients are more likely to shed salmonella, these horses should not be routinely walked around the hospital or grounds. 9. Outpatients a. Outpatients should be housed temporarily in the west end of Ward 4. b. Contact with other hospital patients and research horses should be minimized. 10. Research Horses in the Hospital a. All horses must undergo a two week quarantine at Finley Farm, or at a facility approved by the Biosecurity Officer for Equine Medicine and Surgery and Dr Bednarski, before entering the hospital. b. All horses should be housed in Ward 3 or Ward 5 (Spring and Summer Quarters). If restraint is required to work on these horses, the stocks at the red hall way end of Ward 3 should be used. 127 c. Movement through the hospital should be absolutely minimized. Technicians and faculty working with research horses should avoid contact with other horses in the hospital. 11. Teaching Horses a. In principle, there should be little or no contact between teaching horses and clinical patients. This can be best accomplished by reducing the number of teaching labs performed in the hospital or preferably moving all teaching laboratories to another location outside the VMTH. See Recommendations 4 and 5 in the Introduction. b. Teaching horses should be housed in Ward 3 or Ward 5 (Spring and Summer Quarters). 12. Blood Donor Horses The hospital maintains a small group of blood donor horses at Finley Farm. One or two horses are always in the hospital and should be housed in Ward 3 or 5 (Spring and Summer Quarters). Blood collection procedures should be performed using the stocks at the red hall way end of Ward 3. 128 Appendix 1 Fecal Culture Collection and Results Culture Collection and Results Date Entered Isolation: _______________ From Stall # _______________ Doctor _______________ Culture #: Date: Result: __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ __________ _______________ __________ 129 Appendix 2 Serotyping Request Form Date ____________________ Dear Clinician/Pathologist: Should you want this Salmonella/Arizona serotyped, please complete the following form and return to the microbiology lab within one week of the date reported. This information is required by the National Veterinary Services Labs before they will serotype these isolates. Your assistance is appreciated. Clinic/Path. # ____________________ Micro Lab # ____________________ Owner Name ________________________________________ Address ________________________________________ ________________________________________ ________________________________________ Source Animal ____________________ Clinical Role Herd/Flock Size ____________________ Primary # of Herd Affected ____________________ Secondary _______________ # of Herd Dead ____________________ Other Age of Animal ___________________ _______________ _______________ Return to the Veterinary Microbiology Laboratory OSU VMC 130 Prices are as follows: Blood Bank Packed red blood cells canine 200 ml per unit Packed red blood cells canine small (120 ml) Packed red blood cells feline 20-25 ml per unit $134.50 $103.50 $ 138.75 Fresh Frozen Plasma canine 100 ml, or feline) per unit Fresh Frozen Plasma feline 25 to30 ml $113.75 Cryoprecipitate (canine) per unit $140.75 Cryoprecipitate Poor Plasma (canine) (150 to 200 ml’s) per unit $124.25 Blood typing kits (Alvedia) The typing kits are in the ICU cabinet and the instructions are inside each kit. Our stock of PRBC’S FOR DOGS is mainly UNIVERSAL BLOOD TYPE, and is in the refrigerator on the first shelf. DEA 1.1-POSITIVE DOG SHOULD RECEIVE DEA 1.1-POSITIVE RED BLOOD CELLS. Positive PRBC’S, if available, are stored in the BOTTOM SHELF of the refrigerator. IF THE RECIPIENT IS DEA 1.1-NEGATIVE, HE/SHE MUST RECEIVE UNIVERSAL BLOOD TYPE. Any dog that has been previous transfused should be BLOOD TYPED and CROSS-MATCHED. Our stock of PRBC’S FOR CATS is TYPE A. THERE IS NOT UNIVERSAL BLOOD TYPE FOR CATS. TYPE-A RECIPIENTS MUST RECEIVE TYPE-A BLOOD OR PRBCs. TYPE-B RECIPIENTS MUST RECEIVE TYPE B-BLOOD OR PRBCs. ALL CATS MUST BE BLOOD TYPED AND CROSS-MATCHED; INCOMPATIBLE BLOOD TRANSFUSIONS IN CATS IS TYPICALLY FATAL. FRESH FROZEN PLASMAS for dogs and cats are in the FREEZER. Canine FFP is identified with orange color, and Feline FFP is identified with blue color. Cryoprecipitate for dogs is identified with green color, and Cryoprecipitate-poor plasma is identified with yellow color. Each blood product (PRBC’S, FFP, Cryoprecipitate, and Cryoprecipitate-poor plasma) has a charge slip attached. Please complete the charge slip and place it in the box attached to the BLOOD BANK Refrigerator. 131 Central Supply Policy and Procedures 1. What is Central Supply? Central Supply is the area where surgical packs, surgical instruments, buckets, etc. are cleaned and sterilized. All non-pharmaceutical items are purchased here, such as sutures, feeding tubes, i.v. catheters, bandage material, syringes, needles, etc. We dispense bulk supplies to the Hospital Sections where you can obtain single syringes, needles, sponges, etc. There are supply stations located in all sections of the hospital. Some catheters are stocked in Central Supply that require client charge tickets to obtain. There are also dispensing machines (Pyxis) where these products can be checked out after hours. The list of the se items is too large to list here- please ask for assistance. We have high vacuum steam autoclaves for items that can tolerate high temperatures (stainless steel instruments, silicone catheters, cloth drapes). We also have two Ethylene Oxide (gas) Low temperature sterilizers for items that cannot endure steam sterilization such as cautery handles, feeding tubes, etc. Items returned to Central Supply for processing are first cleaned either manually or in the Sonic cleaner or instrument washers. The items are rinsed, dried, arranged into packs, and wrapped before sterilizing. Steam autoclave processing takes about one hour where gas sterilization takes sixteen to twenty hours. 2. Access to Central Supply • Central Supply is open Monday through Friday, 7:00 a.m. to 2:00am. Please ring the doorbell located next to the doors on both the Small Animal door and the Large Animal Door. • Central Supply is located on the main floor next to Pharmacy, our room number is 1143. • The personnel in Central Supply will assist you with your requests. 3. Obtaining items from Central Supply Please bring the client’s charge tag or the clients account number with you when you need an item from us. Some items do not require a charge (surgical instruments, re-wrapped items, catheters, buckets, nasogastric tubes, etc.) but other idem do require a charge (single use catheters, casting material, staple removers, etc.) This is basically trial and error, so pleas seek assistance until you become familiar with the system. 4. Isolation and Biohazard Procedure If an animal is in Isolation or is suspect of having a contagious disease, the re-usable item returned to Central Supply for cleaning and sterilization must be double-bagged in plastic bags and labeled as contaminated. Items that are disposable like needles, syringes, bandages, etc., must be discarded in an approved biohazard container. These can be identified by the red color with the international symbol for BioHazard. All sharps (disposable hypodermic needles, scalpel blades, trocars and catheters with needles) must be discarded in a Sharps bucket. These buckets are in 2 gallon and 7 gallon sizes and are identified with the International BioHazard sign. Do not allow sharps to be disposed of in the trash or laundry. Any drapes, bandages or towels containing blood or body fluids must be discarded in an approved BioHazard container as described above. 132 5. Returning items to Central Supply During regular hours of operation, please ask for assistance. After hour, put items next to the sink nearest to the large animal hallway. Do not let surgical instrument soak in water and make sure that all sharps (scalpel blades, needles) are removed and discarded property. If possible, please rinse buckets and tubes and discard disposable materials. 6. Surgical scrubs and Uniforms Students are NOT permitted to use scrubs or other uniforms owned by the Veterinary Hospital. NO EXCEPTIONS! Always have your scrubs with you even if you do not anticipate needing them. 7. Use of University-owned equipment Students are NOT permitted to use University-owned equipment for personal use. 8. Obtaining Assistance after-hours or on weekends Please ask the technicians on duty to obtain necessary items from Central Supply if not found in the treatment or ward areas. If an emergency situation cannot be resolved please have a technician contact Rick Teasley. Rick Teasley: Central Supply phone 614-292-6975/Cell 614-557-5938 133 GUIDE TO THE CLINICAL LABORATORY The Clinical Pathology Laboratories include the clinical chemistry, cytology and hematology laboratories. These laboratories provide diagnostic service and professional laboratory expertise to the Veterinary Medical Center and other departments/research laboratories within the college and university. The Clinical Labs are staffed by 3 Clinical Pathologists, 4 full time and 3 part time medical laboratory technicians. Routine laboratory hours are Monday-Friday 7:00 a.m. to 5 p.m. and Saturday 8 a.m. to 12:00 p.m. Following routine hours, a technician is available to process STAT samples 7 days a week, with the final submission cutoff time being @11:30 p.m. Please call the evening technician if you anticipate a submission after 11:30 but prior to midnight. For ER/Critical care patients that require laboratory work after midnight, there are bench top analyzers available for electrolytes, blood gases, and baseline CBC parameters. A laboratory technician is on call for those patients that may need additional special procedures, in which case an emergency call back fee will be charged to the client. ROUTINE SPECIMEN REQUIREMENTS • • • • • • • • CBC, platelet count, Coombs, Cortisol Profile, T4, digoxin, phenobarb, ELISA heartworm Ammonia level OSPT or APTT, fibrinogen, AT III Foal IgG TIA Urinalysis Crossmatch NOVA samples purple top red top green top / on ice blue top small red top syringe or French square red or purple top heparinized syringe SUBMISSION PROCEDURES All lab work must be ordered in VETSTAR which will give you sample requirements, price, and if the test is done “in house” or is available through a send out lab. Upon completion of the lab order entry, the system will generate two labels, one of which goes on the sample tube, the other one dropped off at the lab along the specimen. ***ANY UNLABELED SAMPLES WILL NOT BE PROCESSED AND WILL BE DISCARDED*** There is @ a 2 hour turnaround time for routine samples after which the results will be available in VETSTAR to view and/or print. Samples may be ordered STAT if needed for an additional cost. Please inform the lab staff when dropping off those samples. 134 ADDITIONAL INFORMATION IF YOU HAVE ANY QUESTIONS OR PROBLEMS WITH TEST RESULTS – PLEASE MAKE THE LABORATORY STAFF AWARE OF IT AS SOON AS POSSIBLE. WE WILL RECHECK THE RESULTS - IN SOME CASES YOU MAY BE ASKED TO REDRAW THE SAMPLE FOR FURTHER ANALYSIS. • Alert technicians of all potentially biohazardous samples. • Label cytology slides with PENCIL only. • Alert chemistry lab ½ hour before submitting an ammonia sample. • Hematology samples are kept for 24 hours, chemistry samples are kept for one week. (Spin and save samples are kept longer) • If a test you have ordered has been processed /completed and you need to cancel it – you have to “write it off” • Any research samples that need to processed are to be scheduled with the lab as soon as you know your protocol. An erequest will be required to process charges. Contact Numbers: Hematology/Cytology Lab Chemistry Lab 2-7955 2-7952 Evening technician Weekend technician 2-7951 2-7944 135 Test (Chemistry) Submission Requirements Status Lab ACTH PT/Spin Cold/Freeze Send Out MSU Adrenal Panel (pre and post) RT - 3 ml Send Out Tennessee Albumin RT - 3 ml Routine/Stat In House Aldosterone PT Send Out MSU Alpha 1 (Fecal Proteinase Inhibitor) Special tubes in Chemistry Send Out Texas ALT - Alanine Amino Trans RT - 3 ml Routine/Stat In House Amikacin RT - 3 ml Send Out URL Ammonia GT/On Ice/Spin Cold Routine/Stat In House Amylase RT - 3 ml Routine/Stat In House AP - Alkaline Phosphatase RT - 3 ml Routine/Stat In House APCAP - (CIALP) RT - 3 ml Routine/Stat In House AST - Aspartate Amino Trans RT - 3 ml Routine/Stat In House BHBA (Beta-Hydroxybutyrate) RT - 3 ml Routine Oregon Bartonella PCR PT - 2 ml Send Out NCSU Bicarbonate - Total RT - 3 ml Routine/Stat In House Bile Acids - Pre/Post RT - 3 ml Routine/Stat In House Bilirubin - Direct RT - 3 ml Routine/Stat In House Bilirubin - Total RT - 3 ml Routine/Stat In House Blood Gas Whole Bld/Hep. Syringe Routine In House Blood Donor Feline <10 PT - 2 tubes Send Out NCSU/Illinois Bromide Large RT - 6 ml (min.) Routine/Stat In House BUN RT - 3 ml Routine/Stat In House Calcidiol-25 HD - (VIT. D) RT - 3 ml Send Out MSU Miscchg (+) add SO fee $15.00 Calcitriol - 1.25 HD RT - 3 ml Send Out Hollis Calcium - Total RT - 3 ml Routine/Stat In House Calcium/Mag Panel - Ion & Tot RT - 3 ml Routine/Stat In House Calcium/Mag Panel - Ion Hep syringe/RT - 3 ml Routine/Stat In House Calculi - Stone Analysis Urinary stone in clean contai Send Out Biliary stone in clean contain Send Out UCD Texas Urolith Lab Carnitine GT - 3 ml Send Out UCSD Catecholamines GT - 10 ml *KEEP COLD* Send Out ARUP Lab Chloramphenicol RT - 3 ml Send Out URL Chloride RT - 3 ml Routine/Stat In House Cholestrol RT - 3 ml Routine/Stat In House Cholinesterase PT - 5 ml *DO NOT SPIN* Send Out URL CK - Creatine Kinase RT - 3 ml Routine/Stat In House Clot Fact Assays BT - 3 ml Send Out Cornell Clot Fact Assays - ADT'L BT - 3 ml Send Out Cornell COP RT/PT - 3 ml Routine In House Copper - Tissue 10 mg/Dry Wt. Send Out MSU Cortisol -Pre/Post 1/Post 2 PT - 3 ml Routine In House Creatinine RT - 3 ml Routine/Stat In House Cyclosporin PT - 3 ml Send Out URL Digoxin Level RT - 3 ml Routine In House Dilantin RT - 3 ml Send Out URL DM testing PT - 3 ml Send Out Missouri Drug screen RT - 3 ml/Urine - 10 ml Send Out URL Electrophoresis (SPE) RT - 2 ml Wednesdays In House Estradiol RT - 3 ml Send Out UCD Estrone Sulfate RT - 3 ml Send Out UCD $163.00+ $50.00 $130.00 Ethylene Glycol Testing RT - 5 ml Send Out URL Felbamate RT - 3 ml Send Out URL Ferritin RT - 3 ml Send Out KSU Folate & B12 RT - 3 ml Send Out Texas Fructosamine RT - 3 ml Send Out Idexx FSH & LH RT - 3 ml Send Out BET Labs Gastrin RT - 3 ml Send Out MSU Gentamicin RT - 3 ml Send Out URL GFR (Iohexol Clearance) RT - 5 ml/2,3,4 hr. Send Out MSU GGT RT - 3 ml Routine/Stat In House Glucose RT - 3 ml Routine/Stat In House Gluthathione Perox GT/PT - 3 ml - whole blood Send Out MSU Granulosa Cell Tumor RT - 3 ml Send Out UCD Heartworm Ser - Ant K-9 RT - 3 ml Routine/Stat In House Herpes-PCR RT - 3 ml Send Out Univ. Missouri Immunoelectrophoresis RT - 3 ml Send Out Arrange w/lab Immunoglobulins RT - 3 ml Send Out CSU Inhibin RT - 3 ml Send Out UCD Insulin RT - 3 ml Send Out MSU Insulin Like Growth Factor (Somatom RT - 3 ml Send Out MSU Iron & Total Binding Capacity RT - 10 ml Send Out Kansas St. Keppra Leval RT - 3 ml Send Out NMS Labs Lactate Hep syringe/RT - 3 ml Routine In House LDH RT - 3 ml Send Out Idexx Lead GT - 5 ml or Urine 10 ml/whoSend Out Idexx Magnesium RT - 3 ml In House Routine/Stat $84.00 $35.00+ $85.00+ $85.00+ Masticatory Muscle Myocitis RT - 3 ml Send Out UCSD Muscle Profile .5x.5x1.0cm biopsy (saline moistened) Send Out UCSD Mineral Analysis RT - 3 ml/tissue Send Out MSU Myasthenia Gravis RT - 3 ml Send Out UCSD Mycoplasma PCR PT - 3 ml Send Out Illinois Neospora Titer RT - 3 ml Send Out Auburn Nerve Profile 1" biopsy Send Out UCSD NEFA(Non-Estar. Fatty Acids) RT - 3 ml Send Out Oregon NOVA Blood Gas Hep syringe (includes pH, pCO2, pO2, Hct, SO2, BE, HCO) Routine In House NOVA BUN/Creat Hep syringe/RT - 3 ml Routine In House NOVA iCa/iMg Panel (includes pH, iCa, iMg) Hep syringe/RT - 3 ml Routine In House NOVA Co-oximetry Hep syringe (includes tHb, SO2, O2Hb, MetHb, HHb, O2Ct, O2Cap) Routine In House NOVA Electrolytes Hep syringe/RT - 3 ml (includes Na, K, iCa, Cl, iMg, Ca/Mg) Routine In House NOVA Metabolic Panel Hep syringe (includes pH, Na, K, iCa, Cl, iMg, Ca/Mg, BUN, Creat Routine In House NOVA Panel (full w BG) Hep syringe (includes Metabolic panel tests plus Blood gas) Routine In House Osmolality RT - 3ml or CSF 1ml or UrineRoutine In House PARR PCR Clonality PT - 3 ml Send Out Colorado Phenobarbital RT - 3 ml Routine/Stat In House Phosphorus RT - 3 ml Routine/Stat In House PLI RT - 3 ml Send Out Idexx/Texas PLI snap RT - 3 ml Routine In House NOVA tests (Chem): Postassium/Sodium RT - 3 ml Routine/Stat In House Pre Purchase Drug Screen RT - 25 ml Send Out Arizona Large Animal RT - 3 ml (includes 19 tests with GGT, Mg, SDH, no ALT) Routine/Stat In House Small Animal RT - 3 ml (includes 17 tests with ALPLEV on canine samples) Routine/Stat In House Camelid RT - 3 ml (includes same tests as large animal profile plus Cortisol) Routine/Stat In House Equine RT - 3 ml Routine/Stat (includes 20 tests with D.Bili, GGT, Mg, SDH, Trig, no ALT or Cholesterol) In House CSF RT - csf (includes same tests as serum profile, less T.P. and Albumin) Routine In House Geriatric RT - 4 ml (includes same tests as Small Animal profile plus T4) Routine In House Liver RT - 3 ml (Includes: ALT, ALP, GGT, T. Bili, Albumin & Bile Acid) Routine/Stat In House Renal RT - 3 ml (Includes Alb, BUN, Ca, Bicarb, Creat, Cl, K, Na, Phos) Routine/Stat In House $100.00+ Profiles: Submammilian RT - 3 ml Routine In House (includes same tests as Small Animal profile (less osmo) plus Bile Acids and Uric Acid) Exotic Mammal RT - 3ml Routine/Stat (includes same tests as Small Animal profile (less osmo) plus Bile Acids) In House Urine Urine - 15 ml (fresh) Routine In House (includes: Na, Cl, K, B.U.N., Creatinine, Calcium, Phosphorus, Osmo - freezing point) Progesterone RT - 3 ml Routine In House Protein Electrophoresis RT - 3 ml/ CSF 5 ml or Urine Routine/Stat In House (Wed) Protein (total) (T.P.) RT - 3 ml Routine In House Parathormone (PTH) RT - 3 ml Send Out MSU PTHRP PT - 3 ml Send Out MSU Quinidine RT - 3 ml Send Out URL Rheumatoid Factor RT - 3 ml Send Out Idexx Rodenticide Testing (Toxicology scre PT - 3 ml Send Out MSU Selenium RT/PT - 3 ml Send Out MSU 17-Hydroxyprogesterone (pre & post) RT/PT - 3 ml Send Out Tennessee SDH RT - 3 ml Routine In House Sodium/Potassium RT - 3 ml Routine/Stat In House Taurine GT - 3 ml on ice Send Out UCD Testosterone RT - 3 ml Send Out UCD Theophylline RT - 3 ml Send Out URL Thyroid Screen RT - 5 ml Send Out MSU T3 RT - 3 ml Send Out MSU T4 RT - 3 ml Routine In House Free T4 (by dialysis) RT - 4 ml Send Out Idexx TLI, B12, Folate RT - 5 ml Send Out Texas Toxo/Neospora RT - 4 ml Send Out Auburn Triglyceride RT - 3 ml Routine In House Troponin I RT - 3 ml Send Out URL TSH RT - 3 ml Send Out MSU Uric Acid RT - 3 ml Routine In House Urine Protein/Creatinine Ratio Urine - 3 ml Routine In House Urine Cortisol/Creatinine Ratio Urine - 3 ml Routine In House Viral Panel (Llama) RT - 3 ml Send Out Oregon Vitamin A, E, D RT - 3 ml Send Out MSU $85.00 + Vitamin B12 RT - 3 ml Send Out Texas Volitile Panel RT - 3 ml Send Out URL Zinc (avian) RT - 3 ml Send Out MSU updated 10/2011 $145.00 SMALL-ANIMAL EUTHANASIA PROTOCOL The Ohio State University Veterinary Medical Center (updated March 2013) Honoring the Bond Support Services are available to clients, at no cost, before, during and after the euthanasia process. While it is especially important to consult with the HTB Program Coordinator for clients with specific needs*, the service is available for ANY client that is considering or has decided to euthanize their companion animal. *Examples of clients with specific needs include families with children, single and/or senior clients, clients with their own medical concerns, clients of service companions, and/or those with intense emotional responses (including ones expressing great guilt, intense attachment, suicidal ideation, signs of depression, significant changes in sleeping, eating, work habits, social involvement etc.) When the HTB Program Coordinator is unavailable, please make an effort to distribute resources to any client coping with the terminal diagnoses, euthanasia or death of their companion-animal. The resources are located in the brochure organizer hanging on the wall in the area between the pharmacy window and the door to the business office, as well as in the comfort rooms. Brochure titles include, but are not limited to: Difficult Decision-Making Choices after the Death of a Companion Animal (necropsy and body care options) Coping with the Loss or Death of a Companion-Animal Helping Children Cope with the Death of a Pet How Do I Know When it’s Time? Assessing Quality of Life for your Companion Animal and Making End-of-Life Decisions Do Companion-Animals Grieve? Before Euthanasia In non-emergency situations, plan ahead. Schedule euthanasia for when you have adequate time to answer questions and address owner concerns. Encourage client to bring someone for support and/or transportation. Reserve Visitation/Comfort Room or identify appropriate outdoor location. Prepare room/location for euthanasia (Exam table folded away, supply of tissues, comfort mat or padding on floor.) Inform pet's caregivers in advance (including technical staff) that pet will be euthanized. Notify reception staff of client's appointment or greet client in lobby at a specified time and escort them to quiet room. (Avoid requiring the client to wait in the lobby surrounded by healthy animals and happy pet owners). Do not discuss patient’s condition or other case related issues in the lobby. Provide client with brochure titled Choices after the Death of a Companion Animal, which explains the necropsy process, as well as choices of cremation and burial options. Discuss postmortem examination options (full necropsy, cosmetic necropsy, no necropsy). * Discuss body care options (owner takes pet; hospital disposition/communal cremation; cremation or pet cemetery-separate arrangements must be made by family with funeral home/cemetery). * Every effort should be made to have the client check out PRIOR to the euthanasia. You may ask the cashier to enter the room to avoid the client standing in the public lobby. Please ensure all charges have been entered prior to asking cashier to enter room. *See addendum for suggested language for these discussions. 143 Client-Present Euthanasia Confirm/clarify client's necropsy/body care decisions. Complete necessary legal paperwork (Euthanasia Disposition/Request Form). Inform client that accounting representative can come into the room to collect final payment. Once all the charges are entered and prior to euthanasia, notify accounting representative that client is in the Visitation/Comfort room; when appropriate, ask accounting representative to meet with client to review account and collect final payment. Offer to/ask client if they would like to clip fur, remove collars, or carry through with any activity that might be symbolic or meaningful to them. Ask owner’s permission to make a clay paw print impression. (Some owners do not want one, and may be upset or offended upon receiving one, unexpectedly.) Phone Authorized Euthanasia Provide same education and support as for client-present euthanasia. Ask for a second witness over the phone, as client is not present to sign paperwork. Ask client if there is anything that they want you to say to their pet before euthanasia. Determine if a caregiver would like to be your client/patient advocate (someone who will remain with the pet throughout the entire euthanasia process). If feasible, provide pet a special snack, allow special playtime, and/or offer one last walk outside. Inform them that will be notified by mail regarding any remaining balance related to the patient’s care. (Some clients prefer to pay at that time, in order to get all the affairs resolved and avoid receiving a bill, later. If this is the case, please assist owner in contacting accounting.) Educate Client About Euthanasia Process Ask if client has ever euthanized a companion-animal before (this information may provide you valuable insight into the important do's and don'ts for this particular client). Educate about euthanasia drugs and their actions. Educate that process is quick; 10-30 seconds on average. Discuss agonal breathing. "After Bo has died, it may still appear that he is breathing…" Educate that after death, pet may urinate and defecate, eyes will remain open, and muscle movement may occur. Remind client that it is and individual choice whether to be present or not and that you support either choice. 144 Prepare Pet Before pet is transported to quiet room, an IV catheter should be placed to decrease the stress involved with euthanasia. Preferred placement for the IV catheter is in a rear limb vein to allow client easier access to the patient’s head and face. Let other health care providers say good-bye. It is especially important to inform any technical staff who may have cared for your pet for several days, weeks, or crucial hours, that a pet is now being euthanized. If the pet has wounds or fecal/urinary staining, clean-up, bandage, or cover with towel. If transporting pet on a gurney, use cage pads, blankets, or towels to soften the feel and appearance of the metal surface. Once in the room or outside location where the euthanasia is to occur, place the pet on padding or blankets, or utilize a padded gurney. Do not place pet directly on ground, floor, or exam table. If the pet is not agitated, ask client if he/she would like to spend some time alone with their pet before proceeding. Allow client private time with pet before administering sedation. Advise client you will check back with them at a designated time (10…15…20 minutes). If client requests additional time, check back with client as needed. Encourage client to hold or talk to pet. If feasible, encourage client to provide pet a special snack, allow special playtime, and/or offer one last walk outside. The Euthanasia Procedure Talk to client and pet in gentle tone of voice. Administer sedation; allow appropriate time to peak affect. Suggested doses of sedation would include any of the following: Acepromazine 0.05-0.1 mg/kg IV-allow 10-20 minutes to peak effect (avoid in patients with poor perfusion or seizure history). Propofol 1-4 mg/kg IV-immediately prior to euthanasia solution. Offer client one last opportunity to say good-bye before proceeding. Remind the client that you will be flushing the catheter, administering the drugs, and flushing the solution again after the drugs have been administered. Remind the client that the process takes approximately 10-30 seconds on average. (Even though this information will already have been discussed, many clients report not being “quite ready” for how quickly death comes after the drugs have been administered—help eliminate surprises by quickly reviewing the process prior to administration). You may even choose to let the client know that the heart may stop beating even before the injection is finished. Support pet's head if possible. Once breathing has stopped, auscult pet. Gently inform client that pet has died (She’s died. Her heart has stopped beating. Etc.) Role model for client that it is o.k. to touch or talk to companion-animal after it has died. 145 After Euthanasia When/if appropriate, it may be helpful to encourage client to share favorite stories or memories. Encourage client to spend additional time with pet if desired. If client is not taking pet's body home, assure client that their companion-animal is not being left alone. (Either take body, or have someone stay with body as client leaves). If the Honoring the Bond Social Worker is not present, inform client of the possibility of a follow-up phone call. Also provide any appropriate written material/brochures to the client. To every extent possible, do not have client walk through the lobby. If client exits at this time, escort them via the department chair/hospital director hallways (i.e. turn right out of the comfort rooms). Preparing Body Body to be taken by owners or hold/undecided: Use white, cardboard casket/coffin or blue tarp (Coffins are located in the loading dock and tarps are located in cabinet in treatment room or on the loading dock). o Clean body o Express bladder o Line casket with disposable cage pads o Brush/groom pet o Position pet to give appearance that animal is sleeping o Cover body, not head o At client’s request, place familiar objects with pet o Tape casket closed Body to Funeral Home or Hospital Disposal/Communal Cremation: Use plastic bag Client Taking or Picking Up Deceased Pet DO NOT TRANSPORT THE PET'S BODY THROUGH THE MAIN LOBBY. IT IS ALSO NOT ACCEPTABLE TO TRANSPORT A BODY THROUGH THE CLIENT SERVICES AREA. When delivering a pet's body to a client, USE A PRIVATE EXIT (north door into the large animal breezeway or main entrance via the department chair/hospital director hallways). Do not “hand-off” a body to a client in the lobby. Client After Care Sympathy card: Encourage care team members to sign and share sentiments; relevant poetry or stories may be included. If cards are not signed within 5 days of the death, pawprints and/or other items will be mailed to the owner with a general sympathy card from the VTH. Pawprint and/or hair clippings: If an owner has consented to making and/or painting of pawprint, please complete in a timely manner. If collars have been removed, please mail or offer to clients. Do not throw away lost collars and/or leashes. Place them in appropriate lost and found bins, either in ICU or near the paw print station. 146 SMALL ANIMAL EUTHANASIA CHECKLIST Reserve quiet room (tissues available, mat on floor) Inform reception staff Notify staff/medical team that may want to say goodbye Consult the Honoring the Bond Program or provide brochures to owner Review/sign Euthanasia Request/Disposition form o Discuss postmortem/necropsy examination options * o Discuss body care options * o Only check box about “approved protocols” if the client signs additional consent forms for IACUC approved research (tissue bank, research, etc.) o Provide brochure titled “Choices After the Death…” (explains necropsy and body care options) Educate about euthanasia process o drugs, their actions, timing o agonal breathing, muscle fasciculation o involuntary urination/defecation Return collars, leashes, carriers to owner Ask owner if they would like clay pawprint, hair clipping, etc. Ask owner if they would like cashier to collect payment in room o After all charges are entered and prior to euthanasia, ask cashier to collect payment in room Place IV catheter (preferably) in rear limb vein Euthanize (talk owner through steps, as you go) Use a private exit (via the department chair/hospital director hallways or meet owner outside with pet via Large Animal breezeway) Enter client/patient information in Deceased Database and label appropriately Sympathy Card Pawprint made Pawprint wrapped, owner address on envelope and placed in “to be mailed box” Collars/leashes mailed and/or placed in lost and found, if not sent with owner *See addendum for suggested language for these discussions. 147 Discussing Necropsy Examination Many families may be reluctant to consent to necropsy examination, which may be important in answering many questions for the veterinary team. In such situations, the following may be useful ways of initiating a discussion with the family. Ensure the client initials the appropriate spot on the Euthanasia Request form, or that their choice is clearly recorded in the medical record (witness who confirmed client’s directives should also sign the record if possible). It is also important to let owners know that there is a possibility that a necropsy will not give us answers. “This is a hard decision to make. I’d like you to know that there are several methods of performing a necropsy examination, which may help us shed some light on Ralph’s problems. Would you like me to explain them? • A complete necropsy allows us to examine all the body cavities visually to detect problems that might be visible to the naked eye. We also take tissue samples from various organs that are then prepared in a special way to allow us to examine them under a microscope and detect very small problems. This option allows for the collection of the most information. • Choosing a cosmetic necropsy might be your choice if you are considering burial. With this option only the chest and abdominal cavities are opened for examination and tissue sampling. Afterwards, the cavities are closed again so that you may view the body if you wish. With a cosmetic necropsy, it is less likely to find results. • A final option for you to consider would be to consent to allowing us to obtain tissue biopsies using a needle through the skin instead of opening a body cavity. Although we might not obtain complete information with this method there is still a reasonable chance that we can learn something important. “This must be very difficult for you. Would it be helpful to offer you a different perspective on this decision? • I know how much you loved Ralph and how much joy he brought to those who knew him in life. Other families in this situation have taken some comfort in the thought that even after death, and by consenting to necropsy examination, you might let Ralph be able to contribute to our knowledge and training so that we might help another animal and family in the future. I know this might sound selfish, but the information that we obtain from a necropsy examination might really help us and other patients like Ralph in the future. Please know that I’ll support whatever decision you make.” • Some families have found comfort in the thought that Ralph’s final contribution might be the gift of information or education. They have also found comfort in consenting to a necropsy examination as an educational memorial for their beloved companion. I don’t want you to feel pressured into any decision and just know that I’ll support whatever decision you make, but I wanted you to know that by consenting to a necropsy examination you would be able to contribute to my understanding of problems like Ralph’s and thus it might help other families and future veterinarians. Discussing Body Care Choices Clients are often uneducated regarding the choices available to them for the care of their companion’s body following death. Moral and spiritual beliefs may prevent them from consideration of some options. The following may be helpful in discussing the client’s choices. Ensure the client initials the appropriate spot on the Euthanasia Request form, or that their choice is clearly recorded in the medical record (witness who confirmed client’s directives should also sign the record if possible). It is also important to let owners know that they have 3 (business) days to make arrangements. If they do not make arrangements within that time, we will take care of disposal of the body. 148 “Another decision you’ll need to make is how you’d like to care for Ralph’s body. There are a number of options open to you. Would it be helpful to discuss those choices now? • • • • Some owners choose to take their pet with them. Some families opt for burial of their companion. If you are interested in burial in a pet cemetery I can make some recommendations for you. Some families opt for burial in a spot closer to home or in one of their companion’s favorite locations. Unfortunately, the laws and regulations governing this option are created locally to protect the public from the potential risk to the water supply, so if you’re thinking of this as a possibility, it might be a good idea to check with local authorities first. Cremation is a popular choice. Many funeral homes/pet cremation services offer the option of having your companion cremated individually (only one pet cremated at a time). Others offer segregated cremation (more than one pet cremated at a time, but separated from each other). In both these options, you may have ashes returned to you. It is important to ask each funeral home/pet cremation service how the body is handled as several methods are in current use. I can make some recommendations about local funeral homes/services that have high standards of care and who have offered excellent service to other families. Because we do not contract with one specific provider, we ask that the owners make the arrangements with the cremation provider or funeral home. You have 3 days to make the call to the provider. The last option is for you to leave your pet with us and we can arrange for him/her to be communally cremated. If you choose this option, your companion would be cremated alongside other animals, therefore, you would not be able to receive your pet’s ashes If you are having difficulty making a decision about body care, or you might need some time to think it over, we also offer the possibility to keeping your companion safe in refrigerated storage for up to 72 hours. If you require holding longer than 72 hours then you must arrange for a funeral home to claim your companion’s body and make arrangements with them directly for a longer holding period. If you do not make arrangements in 3 business days, your companion will be communally cremated and you will receive the bill for that expense ($25). 149 Euthanasia/Disposition Request Form The Ohio State University Veterinary Medical Center 601 Vernon L. Tharp Street Columbus, Ohio, 43210 (614) 292-3551 Euthanasia Request I request that my animal identified above be euthanized at The Ohio State University Veterinary Medical Center (OSU-VMC). I certify that I am the owner (or legal authorized agent for the owner) of the animal described above and hereby release OSU-VMC (including its trustees, employees, agents, and students) from any and all liability for performing the requested euthanasia. Disposition Request I acknowledge that I have received information regarding the available options for both necropsy of my animal AND the options available to me for disposition of my animal that are in accordance with local health codes. To the best of my knowledge, my animal identified above has not bitten any person or animal in the last 10 days and has not been exposed to rabies. I authorize OSU-VMC to euthanize my animal and, except where otherwise required by law, to implement my choices for the disposition of my animal’s body as stipulated below, in accordance with hospital policy. I release OSU-VMC (including its trustees, employees, agents, and students) from any and all liability for performing said necropsy examination and body disposition. My INITIALS in the boxes below indicate my choices: ☐ Perform a COMPLETE necropsy (body is NOT suitable for viewing). ☐ Perform a COSMETIC necropsy, SMALL ANIMALS ONLY (body is generally suitable for viewing). ☐ Do NOT perform a necropsy examination. AND ☐ I am taking my animal’s body with me without a necropsy. ☐ I am leaving my animal’s body for disposal by the OSU-VMC. ☐ My animal’s body should be held for pick-up by myself or a private service provider. I understand that it is my responsibility to arrange for my animal’s body to be retrieved by me or by a cremation service provider, funeral home or pet cemetery within 3 working days of the date below. I understand that if my animal’s body has not been retrieved within 3 working days, the OSU-VMC will dispose of the body. AND ☐ ☐ I have been informed of OSU-VMC approved protocols and authorize the use of my animal’s body for instructional purposes in accordance with these protocols. I have received pamphlets on necropsy and disposition options. Signature (Owner/Agent): _________________________________________Date:______________________ Witness: ____________________________________________________ Date: ______________________ Witness: ____________________________________________________ Date: ______________________ (second witness for phone consent) 150 Identification & Handling of Deceased Patients Once the client has made a decision about necropsy and body care options, ensure the client initials the appropriate spots on the Euthanasia Request form, or that their choice is clearly recorded in the medical record (witness who confirmed client’s directives should also sign the record if possible). Bodies held pending owner decision will be held for no longer than 3 business days. If owners have not made a decision, then they must arrange for a funeral home to claim the body for further storage at the funeral home. Accurate and compassionate handling of the body is expected of all personnel involved. These guidelines should be followed in ALL circumstances. Body Identification and Handling Cleanse and prepare the body appropriately for the possibility of family viewing. Upon request of the family, prepare clay paw print, clip hair and remove other items the family requests for return. (Please see the Small Animal Euthanasia Protocol for specifics.) Timely processing and transport of bodies to Goss should take priority over any other clinical duties. Bodies should never be left in the hallway or treatment room for an extended period of time. ALL BODIES SHALL BE ENTERED INTO THE DECEASED DATABASE, regardless of necropsy choice. This includes ALL patients that die or were euthanized in the VMC, as well as animals that have died before arrival and nonVTH patients presenting to for necropsy. Necropsy requests shall be entered, electronically, in the Deceased Database. DO NOT use hardcopy necropsy request forms. Print one copy of the necropsy request form to deliver with the body. Once data has been entered into the Deceased Database, the computer will direct you to the appropriate colored cardboard tag to use. Pre-printed labels are located in the cabinet in the small animal treatment area. You must hand write some information on two (2) labels. You may choose to attach a patient medical record sticker to the label and add the clinician name and circle necropsy and aftercare choices. Attach one label to the appropriately colored cardboard tag and attach to the patient. (The other label/tag will be attached to the body bag or coffin.) Body Given to Family, Undecided or Hold Body (regardless of necropsy choice): PLACE BODY IN WHITE COFFIN OR ON BLUE TARP. (Coffins are located in the loading dock and tarps are located in cabinet in treatment room or on the loading dock). If body will fit, select an appropriately sized cardboard casket and line with disposable pads. Position the patient in the casket to ensure an acceptable appearance. Close the casket and affix the second label/tag to the top of the casket near one end. Body to Funeral Home or Hospital Disposal (regardless of necropsy choice): PLACE BODY IN PLASTIC BAG-DO NOT USE WHITE COFFIN. Affix the second label/tag to the neck of the bag with a cable tie. Transport the body and the necropsy request to the refrigerated storage unit in Goss Lab and place the body on a shelf (not on the floor) so that the label is visible and place the request form in the wooden submission box in the refrigeration unit. Afterhours obtain the key from ICU. Weekdays (between 7am and 12a) a Veterinary Assistant may be contacted to assist with transport to Goss. 151 Step-by-Step Instructions 1. Determine client choice for necropsy type (standard, cosmetic, none) 2. Determine client choice for body care (hospital disposal/communal cremation, private cremation provider, owner pickup, or undecided-hold 3 days) 3. Enter data/demographic information in Deceased Database 4. Attach patient sticker on (2) identification labels (located in cabinet in Treatment Room), be certain to indicate necropsy and aftercare selections 5. Complete electronic Necropsy Request and print ONE copy 6. Adhere ONE label to appropriate colored tag and attach to patient’s rear toe/foot with cable tie 7. If body care choice is HOLD, UNDECIDED or OWNER PICKUP, place body in a cardboard casket and adhere one label to appropriate colored tag and attach label end of casket on top. (If body does not fit in casket or use a blue tarp and attach the color tag.) 8. If body care choice is HOSPITAL DISPOSAL/COMMUNAL CREMATION or PRIAVE CREMATION PROVIDER, place body in bag and adhere one label to appropriate colored tag and attach to neck of bag with cable tie (DO NOT USE WHITE COFFIN) 9. Transport body to refrigerated storage unit in Goss Lab and place on shelf in appropriate section (follow signage) with identification label visible. Afterhours obtain the key from the ICU. 10. Place Necropsy Request (if appropriate) into wooden submission box in the refrigeration unit 152 Honoring the Bond Program: Info for Clinicians, Staff and Students Joelle Nielsen, MSW, LSW, Program Coordinator (614) 247-8607 joelle.nielsen@cvm.osu.edu Hours: 8:30 a.m. – 5:00 p.m., Mon-Fri (after hours consult for suicidal or severely mentally ill clients) GENERAL • The goal is to supplement, not replace, the skills of the medical team. Involvement of the HTB program allows the medical team to focus on the health and well being of the animal, while the social worker can focus on the well-being of the human. • It is just as appropriate to refer clients that are experiencing “normal” or “typical” emotions as those that are exhibiting extreme or concerning reactions. • While giving bad news is a common occurrence for the medical team, receiving bad news is not the norm for our clients. Please remember that clients may be in shock or repressing their emotions. • There is no cost associated with referral to the HTB program. SERVICES AVAILABLE • Be present to support owners when they arrive to emergency medicine for serious illness or injury • Be present during delivery of “bad” news (death notification, terminal illness, unexpected diagnosis) • Assist owners in processing difficult decisions (treatment, euthanasia, surgery, etc.) • Be present with owners before, during and/or after euthanasia procedures. The social worker can help with discussions with owners regarding body care decisions, filling out the euthanasia consent form, etc. • Provide resources, including reading lists, websites, counselor and pet loss support group referrals, cremation/burial resources, memorial ideas, etc. SUGGESTIONS FOR INTRODUCING THE PROGRAM TO OWNERS • The most effective way may be to call Joelle and have her introduce herself to the client. This way, the client will be able to place a face with the name and may be more comfortable utilizing the services in the future. Clients are always given the option whether they would like to talk or not. • Please feel free to provide client with Joelle’s direct contact information • If you prefer to ask client yourself, you may choose any of the following: • We have a program called Honoring the Bond. Joelle Nielsen is the program coordinator and her role/job is to be here to provide support for you. I’d like to call her for you if you are open to that. Would you like me to see if she is available? • Sometimes it’s nice to put a face to the name. I would like to see if she is available for you to meet, in case you might want to talk to her at a later time. • Sometimes, pet owner’s reactions to different situations vary. Joelle is here, in case you need to talk. • You may receive a follow-up call from someone in the next few days. BROCHURES AVAILABLE FOR OWNERS (please feel free to provide to owners) o o o o o o Difficult Decision-Making Choices after the Death of a Companion Animal (necropsy and body care options) Coping with the Loss or Death of a Companion-Animal Helping Children Cope with the Death of a Pet How Do I Know When it’s Time? Assessing Quality of Life for your Companion Animal and Making End-of-Life Decisions Do Companion-Animals Grieve? 153 CLINICAL MICROBIOLOGY LABORATORY PROCEDURES OSU VTH Room 0047 (Basement), 2-7956 Faculty: Dr. Josh Daniels (7-1725), Staff: Nancy Martin (Service Coordinator), Steve Anderson (Technician) Laboratory Hours: Monday-Friday 8:00am-5:00pm and Saturday 8am-12pm After Hours: 5:00-12:00am (292-7951), and Weekends (292-7944). 1.) A completed order request is required for each sample that is submitted to the microbiology laboratory. The order request should contain as much information as possible including: • • • • Source of specimen Clinician last name Tentative diagnosis/Pertinent history (e.g. “diabetic”, “CRF”, “suspect FPT”) Antimicrobial treatment history including whether or not the patient was on antibiotics at the time of sampling. 2.) When submitting specimens, please use a pre-printed label or mark each container clearly and legibly with the following information: • • • • • Animal name Owner last name Medical record number Sample type Spec ALL SAMPLES SUBMITTED MUST BE 100% IDENTIFIABLE. PROVIDING UNIDENTIFIABLE OR MISIDENTIFIED SPECIMENS TO THE LABORATORY IS INEXCUSABLE. NOTE: There are times when the computer system is down and order requests are not generated. In these instances, the sample still must be submitted with the proper information – i.e. medical record number, animal name, species, owner’s last name, and clinician and left on the laboratory counter of processing. If possible, please alert a technician about this issue. Please remember that the test must be ordered in Vetstar by the submitter once the system returns to normal. 3.) Proper specimen collection and handling greatly influence the diagnostic utility of the microbiology work-up. Careful selection of specimens that are representative of the suspected disease process is critical. When submitting samples to the laboratory, please observe the following guidelines: • • Specimens should be submitted in sterile, leak-proof containers (make sure outside of container is clean and disinfected) Use appropriate transport containers or culturettes (if absolutely necessary) for samples to be cultured Examples of appropriate containers for submission include “French squares”, red top tubes, and designated transport swabs /transport media QUESTIONS ABOUT MICRO SAMPLE SUBMISSION, CHARGES, RESULTS? CALL 2-7956 154 If submitting a culture swab for anaerobic testing, use appropriate anaerobic transport media such as a port-a-cul tube which can be found in Central Supply or acquired directly through the laboratory. Viral transport media is available through central supply or direct from the lab for any viral sendouts or applicable PCR requests. • Do not submit samples for culture in EDTA or any other blood tubes with additives. These additives adversely affect bacterial viability. If you are unsure how to properly submit a particular laboratory sample, call the microbiology lab (2-7956). • 4.) Often times, additional tests are desired using sample material that was previously submitted to other divisions of the clinical laboratory. Material that you know is intended for bacterial culture should always be sent to microbiology in a separate container for reasons related to sample viability and contamination. If you would like to have additional tests performed on left-over clinical material in other labs (e.g. serum left-over from chemistry for a serology test), please do the following: a) Contact the section with your sample to see if there is any specimen material remaining. b) Ask him/her to transport the material to microbiology and inform one of the microbiologists that an order is pending. c) Order the appropriate microbiology or serology test in VETSTAR. 5.) Results • • • • Microbiology culture results and Reference Laboratory Send-out results are reported directly into the INFECTIOUS DISEASE DATABASE until sometime Summer 2013. o Results from in-house snap tests are reported into VETSTAR This includes the SNAP 4DX Plus, FELV/FIV and PARVO test results Preliminary reports are posted to the Infectious Disease Database on a Daily basis Results from outside laboratories are posted as soon as they are received If you have questions about a test or can’t locate a result, please call the laboratory for assistance (2-7956) 6.) Laboratory test cancellation policy • Once a submitted sample has been set-up for culture by the laboratory technicians, the ordered testing may no longer be canceled Exceptions to this rule will be made on a case by case basis at the discretion of Dr. Daniels or the laboratory manager. You must contact the lab ASAP in these cases. (If case has been billed, it’s too late). QUESTIONS ABOUT MICRO SAMPLE SUBMISSION, CHARGES, RESULTS? CALL 2-7956 155 Department of Veterinary Biosciences Orientation for Senior Rotations Contact people in Applied Pathology: Shelly Haramia 247-4795 Necropsy Floor 688-4091 A. Necropsy rotation 1. 2. 3. 4. 5. Necropsies are performed Monday – Saturday. Necropsy orientation begins at 8:00 a.m. on your scheduled start date in room 212b Goss lab. Normal weekday rotation will also begin at 8:00 a.m., unless otherwise noted by the instructor. Saturday sessions begin at 9:00 a.m. – May start earlier during football season due to traffic. You will be responsible for having the following: - scrubs or coveralls (any color) - rubber boots B. Submitting a necropsy 1. 4. Necropsy requests and the animal must be in the Goss lab cooler before 11:00 a.m. Monday – Friday. Any cases presented after this time will be done the next working day. On Saturdays, necropsy requests and animals must be in the Goss Lab cooler by 10:00 am. The procedure for submitting a necropsy is described in a separate section of the Hospital Manual. There are no rabies checks on pocket pets and rodents. C. Funeral homes 1. If owners would like to have their pet privately cremated, the small animal desk has a list of funeral homes that can provide this service. The Equine office has information about equine cremation services. 2. 3. The following procedure is used: a) Arrangements for funeral home pickups are to be done by the owner. b) Once the owner calls the funeral home, the funeral home will then contact the pathology department for release of the animal to them. If no call is received from the funeral home, the animal will not be picked up. 2. For owner pickups only - this is your responsibility to remind the owner that they must retrieve the animal within three working days after placement in the Goss lab cooler. Animals left after three working days will be submitted for disposed. 156 D. Submitting biopsy specimens 1. Biopsy specimens are picked up by the small animal grooms between 7:30 and 9:30 a.m. and are brought to Goss lab for processing. 2. Histopathology requests are submitted through Vetstar. Make sure you charge for the histology and the surgical procedure separately. Example: Surgery performed was a mass removal from abdomen. Charges would be: Histopathology - 1 site Excisional – abdomen 3. Number of sites corresponds to where the specimen was taken. Multiple sites from the same patient should be on one request. 4. If you need to change a charge or add information to a request, re-enter the charge again. Please call Accounting at 2-1360 as they can remove the charge. E. Obtaining results 1. Once reports are complete, necropsy and histopathology results are available on the patient record via Vetstar. Printed copies are sent to medical records. Results are also emailed to the clinician listed on the request form. Prelims are emailed roughly 48 hours post and a final is sent through the Vetstar system in around 4 weeks. 2. If there are any problems or questions, please call Applied Pathology at 7-4795. 157 Standard Procedures For Applied Pathology Department of Veterinary Biosciences THE OHIO STATE UNIVERSITY revised 4.12.13 158 TABLE OF CONTENTS Requests & Submission for Standard Cases Page 3 Submitting Emergency Necropsies Page 4 Submitting Cosmetic Necropsies Page 4 Submitting Cosmetic Necropsies in Which the Brain Must Be Removed Page 5 Diagnostic Tests Available from Applied Pathology Page 5 Infectious Diseases Page 5 Post-Mortem Neurological Examinations Page 8 Post-Mortem Neurological Examination Protocol on Submissions Accompanied by a Neuropathology Request Form Page 9 Clinical Non-localizing neurologic abnormalities Page 9 Clinically localizing neurologic abnormalities Page 11 Large Animal Abortion Necropsies Page 12-15 Disposal of Carcasses Page 15 Rabies Suspects Page 15 Scrapies Suspects Page 16 Submissions of Specimens from Necropsy to Microbiology Page 16 Necropsy Reports Page 16 Request & Submission of Surgical Pathology Cases Page 17 Surgical Pathology Reports Page 17 Research Cases Page 17 Special Stains Available Page 18 Phone Contacts Page 19 Veterinary Pathobiology Library Policies Page 19 159 NECROPSY I. Requests and Submission for Standard Cases A. Necropsy requests should be reviewed and signed by the clinician-in-charge. Outpatient cases should be placed in the necropsy cooler by hospital staff or students along with a complete history. Payment should be made at the Companion Animal desk the cost is $300 for equine, $125 for non-equine species over 500 lbs., and $100 of non-equine species under 500 lbs. for other species. Companion animals have an extra $25 charge to cover communal cremation costs. Payment is due upon delivery of the animal. We do not send out invoices. For those cases that arrive without payment, late payments must be immediately sent to: The Ohio State University Department of Veterinary Biosciences Attention: Business Office 1925 Coffey Road Columbus, Ohio 43210 If payment is not received within 5 days, all tissue from the necropsy will be discarded and a report will not be prepared. The Department of Veterinary Biosciences will send final necropsy reports to veterinarians within four weeks upon completion of the necropsy. B. The following are not charged for necropsy: OSU clients, clients of OSU that were seen in the past 60 days, Columbus Zoo, The Wilds, OSU Marysville, and Ohio Humane Societies and Ohio Rescues. C. Necropsy requests and the animal must be in the Goss Lab cooler by 11:00 a.m. on weekdays. On Saturdays, cases must be in the cooler by 10:00 a.m. *Use of the hoist system in the necropsy cooler is restricted to authorized personnel. *If the owner wants the body saved for cremation, pickup or a cosmetic necropsy is to be performed, make sure it is clearly stated on the request form. Bodies for pickup will be held a maximum of 3 days. We do not call owners for pickup. D. The clinician should indicate which details of the case need to be explained, clarified or confirmed by the postmortem examination. Any organ system the clinician thinks ought to be evaluated histopathologically should be explained in the clinical abstract. E. The number of requests for necropsies on dogs and cats is low. We encourage clinicians to help us increase these accessions since they are an essential component of the students’ education. For cases in which you do not need necropsy to confirm a diagnosis, check the “necropsy optional” area of the form, and ask a student to complete the request. You do not need detailed companion documents (CBC’s, etc) to accompany the necropsy form in these instances. F. Necropsy submission information is given to fourth-year students in the VMC. A copy of this is provided in Appendix A. 160 G. Tissues collected from field necropsies (necropsies in a jar) are not accepted by the Applied Pathology service unless the necropsy falls into the category of an emergency necropsy (see below) or a faculty pathologist makes special arrangements with the submitting clinician. H. Necropsies submitted as “Good Samaritan” cases will be performed at the discretion of the faculty pathologist. II. Submitting Emergency Necropsies Emergency necropsies for OSU Veterinary Medical Teaching Hospital cases can be arranged when needed on weekends, holidays and after regular class hours (i.e. after 11:00 p.m. weekdays and after 10:00 a.m. Saturdays). A Clinical Sciences faculty member must contact the diagnostic pathologist directly for these arrangements. Emergency necropsies are performed on OSU clinic and ambulatory cases only and are strictly defined as cases: a) in which human health may be endangered, b) which involve group health problems (multiple animals affected) and where a necropsy will enhance the ability of the OSU clinician to manage the disease outbreak, c) where an immediate necropsy will deter potential litigation against The Ohio State University concerning medical and surgical management, husbandry or unexpected death of a patient, d) death of an officially-listed endangered species where it is the judgment of the OSU clinician that the results of the necropsy will affect management of the remaining animals. An emergency necropsy not included in the above categories requested by faculty or referring veterinarians will be performed for a fee of $750 for insured animals (all species), $500 for non-insured horses, and $250 for non-insured pet and food animals. This fee can be waived in specially arranged instances when necropsies are performed for mutually-agreed-upon academic reasons on cases of common interest to the pathologist and clinician. Requests for emergency necropsies by referring veterinarians should be directed to the Head of Applied Pathology Services or to the pathologist on call. The pathologist on-call on weekends and holidays will leave a message at the large animal clinic office if he or she plans to be unavailable at the listed phone number for more than two hours. This message will indicate how and where the pathologist can be contacted. 161 III. Submitting Cosmetic Necropsies Cosmetic necropsies are discouraged but are performed upon request. These are performed on small animals only and examination will be limited to the thoracic and abdominal viscera. It is the obligation of the necropsy pathologist to place carcasses of cosmetic necropsies in the Goss Laboratory receiving cooler. Containers containing carcasses from cosmetic necropsies should be labeled with the name of the clinician, owner and date. Owners claiming the carcass are instructed to go to the Veterinary Medical Teaching Hospital’s Small Animal Desk for assistance. There is a limit of 3 working days for holding bodies of animals that owners wish to pick up. Owners should be informed of this when they drop off the body for necropsy and should be reminded of this if they call and inquire about times for pick up. It is not our policy to call owners to remind them that the body is ready to be picked up. IV. Submitting Cosmetic Necropsies In Which The Brain Must Be Removed. Requests for cosmetic necropsies in which the brain must be removed must be made by the faculty clinician in charge of neurological cases. See the neurological examination protocol. V. Diagnostic Tests Available from Applied Pathology Professional services offered by the Department of Veterinary Pathobiology include gross and appropriate microscopic tissue evaluation and diagnostic bacteriology is also available in collaboration with the Diagnostic and Clinical Microbiology Service in the Department of Veterinary Clinical Sciences. Toxicology and virology services are not available. Tissue can be saved for virologic and toxicologic evaluation but it is the responsibility of the veterinarian or owner to have these tests performed elsewhere. Tissues saved for virologic and toxicologic evaluation will be discarded after 60 days from the date of necropsy. Vl. Infectious Diseases A. Control of Spread of Infectious Agents 1. No one, no matter how briefly, no matter the purpose should be on the necropsy floor without removable/washable boots. 2. All boots, aprons and reusable gloves should be washed to remove organic material and then washed with the disinfectant 3. Clothing exposed to fluids from cases highly suspected to have contagious infectious disease should be removed as soon as possible and routinely laundered. Under no circumstance should anyone enter areas of patient care/examination in the VMC wearing clothing with fluid contamination acquired during a post mortem. Specimens from cases highly suspected to have contagious disease should NOT leave the necropsy floor unless in sealed containers (do not bring these specimens to the conference area). B. Personal responsibilities - Necropsy of cases without Zoonotic or Epizootic Disease 1. No one should be on the necropsy floor without removable/washable boots and outer protective clothing apron/smock/coveralls/labcoat. 162 2. Routine necropsies are performed wearing protective gloves, rubber boots and apron. 3. Boots, gloves and aprons are not to be worn off of the post mortem room floor. Disposable boots and gloves are disposed as biohazardous waste. Rubber boots and re-useable aprons and re-useable gloves are to be cleaned of organic debris before leaving the post mortem floor and given final rinse and sprayed with disinfectant in the locker room area. 4. Following necropsy students are required to remove all exposed clothing by going directly from the necropsy area to student locker in the VMC (access by east entry). No special precautions are required in laundering of this clothing. 5. For faculty, residents, staff and visitors outer wear is required over street clothes/scrubs (apron/smock/coveralls/labcoat) while in the necropsy area. Grossly contaminated clothing is not to be worn outside of the necropsy area. Outer wear is not to leave necropsy area. 6. In the case of cuts or needle puncture while performing a necropsy (see below if zoonotic disease) an accident report MUST be completed (student and employee forms attached) and the individual is encouraged to go to Employee Health/Student Health Service after performing standard hygiene care. C. Personal Responsibilities - Necropsy of cases with Zoonotic Diseases 1. A case is considered to have a zoonotic disease if the disease is listed in the compendium cited (See list of diseases and method of spread in Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel, 2008 – JAVMA 233 (3):415, 2008 - attached) above and if this disease is: A. confirmed antemortem by appropriate tests. B. the primary clinical differential on the case. C.suspected to be present based on preliminary gross findings. D. confirmed or strongly suspected from findings of testing after the post mortem has been completed (eg. histopathology, microbiology). 3. Gloves and masks are disposed as biohazardous waste. 4. Boots and aprons are cleaned as described above for routine necropsies. 5. Any contamination of outer wear should be handled as described for exposure to intact skin (standard hygiene). Outer wear can be laundered routinely. 6. Exposure to Zoonotic Disease A. The names of all students, faculty and residents participating in the necropsy of animal with a zoonotic disease should be listed in the student necropsy report. B. In the case of cuts or needle puncture while performing a necropsy on an animal with a zoonotic disease an accident report MUST be completed (student and employee forms attached) and the individual MUST go to Employee Health/Student Health Service after performing standard hygiene care. C. In the event of exposure of intact skin or intact mucous membrane, standard hygiene care should be performed and an accident report MUST be filed and faxed to Employee Health/Student Health Service but medical attention need not be sought unless symptoms occur. D. In the even that a zoonotic disease is suspected AFTER the post mortem has been performed. All participants in necropsy that day need to be contacted to determine level of exposure. E. Individuals must immediately contact Employee Health/Student Health if exposed to a confirmed case of rabies. Names and phone numbers of students performing post mortem on cases to be tested for rabies need to be recorded (as indicated above in A). 163 C. Prevention of Infection Special protective wear is required for performing necropsy on animals confirmed to have or highly suspected to have a zoonotic disease. 1. For diseases spread by contact, double gloves, protective eyewear and surgical mask are required. 2. For diseases spread by aerosol, double gloves, protective eyewear and a 3M N95 mask are required. 3. For diseases spread by contact in which aerosolization is possible due to use of power equipment, a 3M N95 mask is to be worn while using the power equipment. 4. For post mortem of animals with a high suspicion of being rabid, a complete necropsy should not be performed until it is likely that the virus within the carcass is no longer viable (24 hours at 20°C or 3 days at 0-4°C). Prior to this, if necessary for confirmation/rule out of rabies, only the head should be removed. This should be done assuming potential for aerosol exposure (see #2 above). The carcass should be appropriately labeled and wrapped to prevent blood leakage and kept until the times listed above. D. Exposure to Zoonotic Disease. 1. In the case of cuts or needle puncture while performing a necropsy on an animal confirmed to have, or highly suspected to have, a zoonotic disease listed in the Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel, 2008 – JAVMA 233 (3):415, 2008, an accident report should be completed (student and employee forms attached) and the individual should get medical advice from Employee Health/Student Health service after performing standard hygiene care. 2. In the event of exposure of intact skin or intact mucous membrane, standard hygiene care should be performed and an accident report filed. Medical attention need not be sought unless symptoms occur. 3. Individuals should immediately contact Employee Health/Student Health if exposed to a confirmed case of rabies. Names and phone numbers of students performing post mortem on cases to be tested for rabies should be kept on file until the test for rabies has been completed. VII. Post mortem Examination A gross post mortem examination consists of visual examination of the following organs: Larynx, trachea, lungs complete, bronchial nodes, heart, aorta, oropharynx, tonsils, mandibular salivary glands, esophagus, stomach, large and small intestines, mesenteric nodes, liver, gall bladder, pancreas, kidneys, urinary bladder, mammary gland, gonads, uterus, accessory sex glands, pituitary, adrenal, thyroid, parathyroid, thymus, spleen, bone (rib of large animals, femurs or ribs of small animals), bone marrow (of bones sited above), skin, diaphragm, and brain. Tissues to be examined histologically are at the discretion of the pathologist based on the clinical history and postmortem findings. The clinician may list on the necropsy request organs that should be saved in formalin. If there is no justification given for why these organs need to be evaluated histologically, they will be saved for 1 year but not routinely examined histologically. 164 When the final necropsy report returns, if the clinician feels additional tissues should be examined, he/she should discuss with the pathologist the option of cutting in and examining additional tissues that were saved but not cut in. In cases in which the cause of death is not apparent clinically or on gross necropsy, at least the following organs will be examined microscopically: Brain stem, lung, heart, kidney and liver. Note: The attending pathologist must be contacted where manipulation of the specimen has been performed prior to submission (incomplete carcasses, partial necropsy or post-mortem sampling). The attending pathologist reserves the option to decline the submission if post-mortem manipulation interferes with the ability of the service to interpret findings 165 VIII. Post-Mortem Neurological Examination Protocol on Submissions Accompanied by a Neuropathology Request Form A) Clinically non-localizing neurological abnormalities Minimal histopathological evaluation required for a given case is divided into three categories based on the general classification of the clinical abnormality. Brain, non-localizing Four coronal sections of brain should include the following structures... 1) Frontal cortex Olfactory white matter tracts 2) Parietal cortex (A) Basal nuclei (B) Lateral ventricle (C) Choroid plexus (C) Thalamus (D) 3) Occipital cortex (A) Hippocampus (B) Mesencephalon (C) 166 4) Cerebellum (A) Pons/myelencephalon (B) Fourth ventricle (C) Choroid plexus (E) 167 Spinal cord, non-localizing One section from each of the major spinal cord segments (ie; cervical, thoracic, lumbar, and sacral spinal cord) together with a segment of a major peripheral motor nerve (eg; sciatic) will be sampled. In addition, for equine cases in which a wobbler syndrome is identified (eg; equine degenerate myeloencephalopathy, herpesviral myelitis, cervical vertebral stenosis/instability, or protozoal myeloencephalitis), tissues sampled should include at least the following: 1) myelencephalon at the level of the obex (See figure below.) 2) three sections of cervical spinal cord eg; proximal, middle, and distal Gross evaluation of spinal canal diameter and vertebral articular facet surfaces will be included. Clinical evaluation may have localized the deficit to the cervical spinal cord or a specific region therein. In this instance the case would be treated as a localized spinal cord abnormality (see below). Disseminated (brain and spinal cord), non-localizing Sampling is a combination of that outlined above for brain and spinal cord. B) Clinically localizing neurological abnormalities These cases should be accompanied by a neuropathology request form to facilitate identification of relevant anatomical areas by the pathologist. This will also enhance the clinician's ability to interpret the significance of pathological findings or lack thereof. This selective sampling may be used in lieu of that outlined for non-localizing lesions if lesions are identified at the sites predicted by the clinical neurological abnormality. The specific approach taken in this instance should be based on communication between the clinician and pathologist. 168 IX. Large Animal Abortion Necropsies A. Postmortem examination of fetuses from horses, cattle, sheep, goats, and pigs will be performed under the following guidelines: 1. 2. 3. B. All fetuses submitted from OSU clinic cases will be treated as routine necropsy submissions. Freshly aborted fetuses presented to OSU at the request of a veterinarian will be examined. However, OSU will not accept "mail in" cases. A necropsy report will be sent only to the veterinarian requesting the examination. The following protocol should be followed for standard postmortem examination of all fetuses: 1. 2. 3. 4. 5. 6. 7. Sex fetus and obtain a crown-rump measurement or biparietal measurements in camelids Determine the degree of autolysis. The pathologist on duty has the right to judge whether the degree of autolysis is advanced enough to preclude bacteriologic examination. HISTOPATHOLOGY - Collect lung, liver, kidney, spleen, adrenal gland, cerebral cortex, brain stem and placenta (if presented). Sample any tissue with a gross lesion. Place tissues in 10% formalin. MICROBIOLOGY - Collect abomasal contents and lung aseptically and place in sterile bottles. Submit to Microbiology Laboratory (Rm 0047) in Veterinary Hospital. VIROLOGY - Collect lung, liver, kidney, spleen and adrenal gland in fecal cups, label with path numbers, tissue, and date. Deliver to Microbiology Laboratory. Refrigerate if processing will not be delayed. Otherwise, store in -70C freezer. SEROLOGY - If possible, obtain heart blood or clot and place in sterile bottle. Submit to Microbiology Laboratory. REQUEST a. b. c. d. Bovine aerobic bacterial cultures direct darkfield examination of abomasal contents for leptospires, Campylobacter and Trichomonas vial isolation/FA for BVD, IBR Ovine aerobic bacterial cultures direct darkfield examination of abomasal contents for Campylobacter serology for Chlamydia, Toxoplasma, Coxiella, Bluetongue Equine aerobic bacterial cultures viral isolation/FA for rhinopneumonitis Porcine aerobic bacterial cultures direct darkfield examination of stomach contents for leptospires viral isolation/FA for parvovirus, pseudorabies serology for pseudorabies 169 C. Services - virus isolation and FA will be performed once per week at the Ohio Department of Agriculture Laboratories (ODA) in Reynoldsburg. Tel. 614-728-6200. There is no fee for food animal submissions but postage and handling charges will be assessed. A fee will be charged for special OSU laboratory procedures not considered routine such as Toxoplasma and Chlamydia serology. Bacterial cultures, darkfield examination and histopathology will be performed without charge. Generally charges will not exceed $30.00 unless special diagnostic tests are performed at outside referral laboratories. D. CAUTION! Remember, several of the agents which are important causes of abortion may also cause zoonotic disease. Use extreme caution when handling specimens from aborted fetuses. Wear protective clothing. E. Summary of Diagnostic Procedures to be Performed on Large Animal Abortion Submissions. 1. Bovine a. Bovine viral diarrhea (BVD) Histopathology (OSU Vet. Path.); virus isolation and fluorescent antibody (FA) (ODA). Neutralizing antibody (SN) from heart blood (ODA). b. Infectious Bovine Rhinotracheitis (IBR) Histopathology; virus isolation, FA, SN (ODA). Virus isolation by OSU Microbiology Laboratory is under development. c. Leptospirosis Histopathology (silver stains when appropriate); direct darkfield examination of abomasal contents by OSU Microbiology Laboratory. FA (ODA). d. Campylobacter Histopathology; direct darkfield examination and culture of abomasal contents. e. Brucella Histopathology; culture f. Listeria Histopathology; culture g. Actinomyces Histopathology; culture h. Fungi Histopathology; culture if lesions present 2. Ovine a. b. c. d. e. f. g. Listeria - same as bovine Campylobacter - same as bovine Brucella - same as bovine Chlamydia Histopathology of placenta with Gimenez stain; serology (ELISA, OSU Microbiology Lab); FA (ODA) Toxoplasma Histopathology of placenta; serology (OSU Microbiology Lab). Coxiella Histopathology of placenta with Gimenez stain; serology (sent to Wisconsin) Bluetongue Serology (ODA) 170 3. Equine a. Rhinopneumonitis (Herpesvirus) histopathology; virus isolation/FA (ODA) and underdevelopment in OSU Microbiology Lab b. Fungi - same as bovine c. Bacteria - same as bovine 4. Porcine a. Parvovirus virus isolation/FA (ODA) b. Pseudorabies histopathology; virus isolation, serology (ODA) c. Leptospirosis - same as bovine X. Disposal of Carcasses 1. Owners can retrieve their pet’s body for individual cremation or disposal, which these animals will be placed in the necropsy cooler in Goss. It is imperative that animals for owner pickup be clearly marked; otherwise they will be removed for group cremation. There is a limit of 3 working days for holding bodies of animals that owners wish to pick up. The bodies can be claimed by going to the small animal desk in the Veterinary Medical Teaching Hospital. Owners should be informed of this when they drop off the body for necropsy and should be reminded of this if they call and inquire about times for pick up. It is not our policy to call owners to remind them that the body is ready to be picked up. XI. Rabies suspects No charge is made for these tests on domestic animals and wild animals known to act as carriers of the rabies viruses. A charge is made for tests on pocket pets and wild animals not known to be rabies carriers (e.g. squirrels, wild rodents, rabbits). People requesting tests for rabies on animals for which there would be a charge should be sent directly to the Ohio Department of Health Laboratory on in Reynoldsburg. The Ohio Department of Health requests the name and address of anyone bitten. Please include this information on necropsy requests on rabies suspects. Examinations for rabies are done by fluorescent antibody tests on unfixed brain specimens by the Ohio Department of Health. The necropsy technician will be responsible for submitting the entire unfixed brain to the Ohio Department of Health laboratory for fluorescent antibody testing for viral antigen. If subsequent histopathologic evaluation is indicated, brains are submitted together with a jar of formalin, so that brain tissues may be returned in fixative following tissue sampling. On cases in which rabies is the primary differential diagnosis, the postmortem will be delayed until the results of the rabies examination are known. On cases in which rabies is a remote diagnosis but still in the differential, the pathologist is encouraged to perform the postmortem examination prior to completion of the rabies examination. In any event this decision is to made by the pathologist. 171 XII. Scrapie Suspects Scrapie confirmation will be provided by the NVSL (National Veterinary Services Laboratory). The local federal office (Dr. John Clifford, 469-5602) should be contacted to obtain approval to submit a case. Send 1-H&E and 2-unstained slides (tissue should represent medulla at the level of the obex) along with a copy of the necropsy request and the necropsy report to Dr. Taylor, 711 E Lincoln Way, PO Box 844, Ames, IA 50010. XIII. Submissions of specimens from Necropsy to Microbiology Specimens must arrive in Microbiology by 3:30 p.m. on weekdays and by 11 a.m. on Saturdays. XIV. Necropsy Reports Daily gross can be viewed on VetStar once approved by the pathologist. This is usually within 48 working hours of the necropsy. Final necropsy reports can be viewed on VetStar once approved by the pathologist. This is usually within 3-4 weeks from date of necropsy. Applied Pathology will send email copy (via VetStar) of the final necropsy report to the clinician(s) listed on the written necropsy request. Note: Special stains, in-house consultations and recuts could add up to 2 additional weeks. Special stains are to be performed at the discretion of the pathologist. If a clinician feels a special stain was indicated but not done, he/she should make inquiry to the pathologist who read the case. If still unresolved, the clinician should contact the Head of Applied Pathology who will solicit the opinion of the faculty pathologist regarded as an "expert" in the area of question. If the expert pathologist is in agreement with the clinician, the stain will be done. If not, the Head of Applied Pathology will make the final decision. SURGICAL PATHOLOGY XV. Requests and Submissions Submission of Surgical Biopsies: Surgical biopsy specimens are brought to Goss Laboratory by hospital staff between 7:30 and 9:30 a.m. Mondays through Fridays. Surgical biopsies must be requested through VetStar and must have a computer label and printed off request form with history when left at the designated drop-off areas. Samples that are placed in the bin after the groom has picked up specimens for that day will be picked up the following working day. Requests for special stains will be honored if they are among the battery of special stains offered by the department. Special stains are performed on Wednesdays and Fridays. Charges: Fees for surgical biopsies are billed to the hospital. 172 XVI. Surgical Pathology Reports If the lesion is definitive, the report can be in the form of a morphologic diagnosis with severity, distribution and time (if appropriate) modifiers. If the lesion is not definitive, the lesion will be described and given a morphologic diagnosis. The pathologist should speculate on the cause and pathogenesis of non-definitive lesions. Surgical pathology reports are available late the next day following receipt of request AND specimen(s) via VetStar only. Currently, results are on VetStar 48 hours after the specimens are received. Clinic cases are listed by medical record number. If information is added or changed after the initial report has been printed, an addendum will be added and imported into VetStar. Printed copies of the reports are sent to Medical Records by Veterinary Pathobiology Library Personnel via campus mail or courier. Consultations: Clinicians requesting pathology consultation on surgical pathology reports should first contact the original surgical pathologist. If the issue remains unresolved the clinician is free to seek a second opinion. XVII. Research Cases Applied pathology will perform necropsies on experimental animals in order to determine either the cause of unexpected death or the presence of spontaneous disease unrelated to the experimental protocol. XVIII. Special Stains Available Alcian blue Verhoffs Alcian blue-PAS Von Giesen Aldehyde Fuchsin Aniline blue Von Kossa Alizirin Red Warthin-Starry Bodian Wilder’s reticulin Brown-Brenn Gram Wright’s Congo Red Elastic XIX. Giemsa Giminez Goodpasture Gram Stain Gridley Grocott Hall's HBS Iron Stain Kinyoun's Acid Fast Luna Luxol fast blue Masson’s Machiavello Methylsalicilate Mucicarmine Nissl Oil Red Osmium PAS PAS-methenimine silver (PAMS) Prussian Blue PTAH Rhodanine Saffronin O Thioflavine T Toluidine blue Trichrome (Massons) Phone Contacts Inquiries about necropsy and surgical reports should be made to Shelly Haramia in the Veterinary Pathology Library (247-4795). The library has records of surgical reports, daily gross reports and necropsy reports as well as access to histopathology slides, 2x2 slides, Veterinary Pathology Journal and AFIP sets. Necropsy submission questions and pet releases should be directed to Shelly Haramia (614-247-4795). 173 XX. Veterinary Pathobiology Library Policies • • • • Requests for library searches on should be made to: o 247-4795 (Shelly.Haramia@cvm.osu.edu) o Department of Veterinary Biosciences, Goss room 310 Photocopies of requested reports will be provided rather than the originals. Microslides and 2x2's will be loaned for no longer than 4 weeks, unless some arrangement was made with the Library. New materials will not be loaned until overdue materials have been returned. 174 PHARMACY POLICY AND PROCEDURES Everything is sold by prescription only. You may not have a client stop by the pharmacy to pick up an item without a prescription. The patient must be a client of the OSU Veterinary Hospital and have been seen within the previous year before a new prescription will be filled by the pharmacy. Prescription form requirements (SEE ATTACHED FORM) 1. In-hospital prescription requirements: a. Patient sticker or hand-written information that includes: case number, client’s name, patient’s name, patient’s address, and species of animal. b. Date, outpatient or inpatient, description of service, refill, doctor’s name, student’s name c. Licensed D.V.M.’s should personally sign all prescriptions if possible. This helps to avoid potential mistakes made by the students when writing prescription orders. d. Write legibly e. Plan orders- they are filled in order received, unless emergency f. Must have a licensed D.V. M.’s signature on all the following or the prescription will not be filled. 1. Controlled substance prescriptions 2. Student purchases 3. Outpatient prescriptions 2. Outside prescription requirements: Need to obtain a blank prescription form from the pharmacy. The outside prescription forms are locked in the pharmacy safe and will only be dispensed during regular hours of operation. A limited quantity of prescription blanks are in stock for Pyxis for afterhours use. Only write one item per RX blank. 3. DEA numbers All licensed D.V.M’s must have a DEA number to prescribe controlled substances. On any prescription for a controlled substance to be filled at any outside pharmacy, the quantity must be written as “#100 (one hundred)” (numerically and long hand.) 175 Formulary: 1. There is a notebook of prescription items carried by the pharmacy located at both the Small Animal and Large Animal counters. The list is alphabetized by generic name, if available, or by brand name if no generic is available. The prescription item list also contains the price of the medication that the client will be charged. 2. If you want a product that the pharmacy does not carry, the doctor must talk to the pharmacy. Usually we will order it, but it will depend on the quantity that has to be ordered and the expense. 3. Formulary – Veterinary Drug Handbook by Plumb—one at both the small animal and large animal counters. Contains medication information and doses. Hours of Operation: Monday - Friday 8:00 a.m.to 8:00 p.m. Saturdays 8:00 a.m. to 12:00 p.m. The pharmacy is closed on Sundays and University-observed holidays After Hours Procedure: 1. All routine prescriptions should be turned in during regular pharmacy hours. Also, clients must be told they can only pick up pharmacy items when the pharmacy is open. 2. Most of the pharmacy items needed after the pharmacy has closed will be available from the small animal Pyxis for small animal emergencies or the Equine Center Pyxis for equine or food animal emergencies. These machines are only to be used when the pharmacy is closed. There are a few exceptions to this, which will be discussed when you are trained individually for Pyxis use. 3. Most of the items in the Pyxis are available in small amounts to get the patient treated until the pharmacy is open when we can fill a prescription for larger quantities. 4. Pyxis and Vetstar are electronically connected-- items removed from the Pyxis are billed to admitted patients. 5. There are three Pyxis machines: 2 in small animal, 1 in Large Animal. 6. If an item is needed after hours and is not available from the Pyxis, just a few personnel have access to the pharmacy to obtain the item. They are most of the emergency veterinary technicians and ICU veterinary technicians. You may only request items that you absolutely need for an emergency case. 7. Controlled substances are kept in all Pyxis machines for after hours use. They may be removed from the machine throughout the day ONLY for ICU patients. For all other patients, controlled substances must be obtained from the pharmacy when it is open. If a non-ICU patient needs a controlled substance when the pharmacy is closed, the medication may then be obtained from the Pyxis. Not everyone who has access to the Pyxis has access to the controlled substances. 176 8. Any controlled substance that has been obtained for an in-patient must be stored in the lockbox or Pyxis in either small animal ICU or equine ICU if it will not be used immediately upon retrieval. Also, any UNUSED controlled substance must be returned to the appropriate ICU lockbox, Pyxis, or to the pharmacy when open. They cannot be kept anywhere unlocked. 9. When you are in the emergency and surgery rotation, you will be trained so you can access only the small animal Pyxis for items needed, except controlled substances. 10. People with access to Pyxis are ICU veterinary technicians, emergency veterinary technicians, interns, and some residents who work emergency hours. Handling Precautions 1. Notify student affairs if you are pregnant of have other medical conditions that might affect rotations. 2. Chemotherapeutic agents – injectables should only be handled by regular personnel in the oncology department 3. Controlled substances- procedures discussed above Staff and student purchases: 1. Prescriptions for your own pets will only be filled during regular hours of operation. 2. The pharmacy will not fill prescriptions for personal use. 3. Students, faculty, and staff of the OSU Veterinary Hospital receive a 20% discount off the listed client price for prescriptions. Returns: Once a prescription medication has left the hospital, it is no longer returnable for credit. 177 COMMON PRESCRIPTION ABBREVIATIONS ac-----------before meals pc-----------after meals au-----------both ears ad-----------right ear as-----------left ear gtts---------drops sid----------once daily (veterinary medicine only) Best is to write once daily bid----------two times daily tid-----------three times daily qid----------four times daily q ------------every, each qod---------every other day q h---------every hours (example q6h which is every six hours) po-----------by mouth, orally prn----------as needed, when necessary ou-----------both eyes od-----------right eye os-----------left eye ml----------milliliter oz-----------ounce tsp----------teaspoonful x days or for days--- (x 10 days or for 10 days) 178 COMMON EQUIVALENTS Dry Measure 1000 mcg = 1 mg 1000 mg = 1 g (gm) 1000 g = 1 kg 64.8 mg = 1 grain (gr) 28.35 g (usually round to 30 g) = 1 ounce (oz) 454 g = 16 oz = 1 lb 2.2 lb = 1 kg Liquid Measure 5 ml = 1 teaspoonful (tsp) 15 ml = 3 tsp = 1 tablespoonful 29.57 ml (usually round to 30 ml) = 1 oz 240 ml = 8 oz = 1 cup 473 ml (usually round to 480 ml) = 16 oz = 1 pint (pt) 946 ml = 32 oz = 1 quart (qt) 1000 ml = 1 liter (l) 3784 ml = 128 oz = 1 gallon (gal) The equivalents are slightly different for dry and liquid measurements, so 454 gm = 16 oz in dry and 473 ml = 16 oz in liquid. Gram is abbreviated as g or gm, NOT gr which is grain. A few items may still be expressed in grains, such as phenobarbital and aspirin. 179 Rabies Vaccination Policy Rabies vaccination and its official certification must be performed by a licensed veterinarian. (Franklin County Rabies Control Regulation 709.04). Unless you are a licensed veterinarian in Ohio you CANNOT vaccinate for rabies. Therefore, the pharmacy will sell rabies vaccine only to licensed, accredited veterinarians for use in their own personal pets. That veterinarian must sign the vaccination form and leave a copy with General Practice so they can submit it to Franklin County. It is important that you keep a record of the tag number and vaccination certificate, since we cannot verify these vaccines as having been given at our facility (no chart generated). For all other staff, if you want your personal pets to be vaccinated for rabies through this facility, you must register an official visit for this purpose. An official record of rabies vaccination needs to be documented in the pet’s record to comply with the state law. In addition, Franklin County now requires a rabies tag number on all dog license applications. If the number is not provided, they will not license the dog. As students, staff, and faculty, you will still be able to purchase other vaccines (distemper, bordetella, etc.) for your own personal pets without creating an official visit. However, please be aware that if you purchase and vaccinate your own animals, the hospital will NOT be able to verify vaccination. No vaccination certificates for boarding kennels, obedience classes, health certificates, licensing bodies, or bite investigations can be issued. If you need certification for any reason, your pet must be seen at the hospital in an official capacity. Thank you for your cooperation. Chemical Handling/Labeling In order to comply with OSHA guideline for “secondary” (non-original) containers for all chemicals used in the college, the containers must be properly labeled. Labels with all of the required information (chemical name, manufacturer, address, phone number, intended use, hazard warnings, target organs, protective equipment, and safety ratings) are attached to the secondary containers. Some items, such as isopropyl alcohol and bleach are stored in pre-labeled plastic bottles. A list of chemicals used in the hospital follows. Formalin for preservation of biopsy specimens is available in the pharmacy in pre-filled jars - 20ml, 45ml, and 60ml. Larger biopsy specimen jars and buckets are available in 1144 in the large animal hallway. Ether is stored on the bottom shelf in the mustard-colored flammable cabinet in central supply. It cannot be stored anywhere else in the hospital and is returned to the cabinet after use. Wards/treatment areas/ refrigerators are routinely checked for expired medications. Expired medications cannot be disposed in the trash. Some can be discarded down the sink, including fluids, eyewash, and ear cleaning solutions, but the rest are returned to the pharmacy for disposal. Intravenous or irrigating fluids are kept no longer than 24-48 hours once they are opened or are out of the protective over wrap. 180 Chemicals used in the hospital: Benzalkonium solution (Zephiran) Bleach (undiluted) Bleach (diluted) Chlorhexidine digluconate 2% scrub Chlorhexidine gluconate 2% solution Chlorhexidine gluconate solution (diluted) Glutaraldehyde (Cidex) Formalin (formaldehyde 10%) solution Isopropyl alcohol 70% solution Phenol (diluted) Povidone iodine 0.75% scrub Povidone iodine 1% solution Roccal –D Plus 13.7% solution (dimethyl benzyl ammonium chloride) Ultrasound gel Stains: Accustain gram stain Protocol Hema 3 stain Cleaners: Best Scent Ocean Breeze pH7 Ultra Profoam VF7 TB Plus Tergo Uniwash Safe Handling of Antineoplastic Agents I. Managing Hazardous Drug Handling A. Storage, use of biological safety cabinets, personal protective equipment, drug administration, disposal, spills, and use at home of antineoplastic agents B. Should not handle if pregnant, breastfeeding, or trying to conceive, physician should be consulted C. No food or drink may be stored or consumed in areas where antineoplastic medications are prepared or administered D. Personnel that can prepare or administer antineoplastics 1. Personnel must be trained in the proper preparation and administration of all antineoplastic agents 2. May only be prepared by clinicians, residents, and veterinary technicians working in oncology (occasionally prepared by pharmacists) 181 3. Antineoplastics used in small and large animal patients are administered by oncology technicians or doctors 4. If needs to be prepared after hours, doctor in oncology needs to be contacted for preparation and administration II. Labeling, Storage, and Transport A. Label all containers immediately 1. Name of medication 2. Green antineoplastic sticker on vial or syringe if not in original container B. Store at eye level or lower Store separately from other medications, if possible C. Keep in plastic bags during transport, so if dropped, the spill is contained III. Biological Safety Cabinets A. Must be used for preparation of all injectable antineoplastic medications B. Use Class II, type A - minimum requirement C. Type B hood – ideal as it vents to the outside D. No objects over intake or rear vents E. Keep on 24 hours (do not turn blower off) F. Inspect and recertify every 6 months G. Clean with deionized water or cleaner, Do not use aerosol cleaners H. Can use isopropyl alcohol as disinfectant I. Put all material, empty vials, syringes, needles, cleaning materials in bag while still in hood J. Clean weekly Use 2 pairs of gloves, gown, mask, and eye protection (keep second pair of gloves on until dispose plastic bag in sharps container) IV. Protective equipment A. Gown 1. Wear only in work areas 2. Non-permeable, tight cuffs, no lint B. Chemo plus gloves only 1. Wear 1 pair of chemo gloves 2. Change if torn or contaminated 3. Wash hands thoroughly before and after gloving C. Dust and mist respirator or HEPA respirator D. Shoe and hair protection E. Eye protection – goggles suggested V. Preparation of antineoplastic injectables A. Put everything in hood before start and wear protective equipment B. Do not store other items in hood as may block airflow C. Use luer lock syringes D. Inject diluent slowly into powdered antineoplastic medication, keep needle in vial, pull air into needle and hub, then remove from vial 182 E. If must push out air, inject into empty sterile vial, so it is not aerosolized F. Put filled syringe, vial, or IV bag in plastic bag for transport to area where medication will be administered G. Put all waste in plastic bag and then in appropriate biohazard container VI. Drug Administration A. Wear chemo gloves, gown, mask, and eye protection B. Small animal administration - in oncology ward or in ICU C. Large animal administration – in stalls D. Put pad under small animal when administering E. Wrap gauze around needle to trap aerosols when getting air out before administration F. Place ALERT sign on cage or stall and mark under “risks” as medication/chemical and also mark what protective clothing should be worn G. Put any medication, fluids, or other items left over in plastic chemotherapy-labeled bag and then in appropriate biohazard container VII. Spills A. Use cytotoxic spill kit provided in 1 of 4 areas 1. Oncology room 2. Oncology ward 3. SA ICU 4. Pharmacy B. Spill kit contains 1. Mask 2. Goggles 3. Rubber gloves 4. Gown 5. Head cover 6. Absorbent pads for soaking up spill 7. Absorbent material 8. Scoop 9. All of the above should be returned to the white bucket and disposed in appropriate biohazard container VIII. Oral and compounded oral medications A. Use separate tray for counting Clean with alcohol and detergent B. Compound in hood if need to make a different strength Wear rubber gloves, gown, mask, and eye protection C. Compounded oral medications will only be prepared by a pharmacist IX. Home health care A. Inform owner of risks - should avoid pets’s urine, feces, vomit, and saliva for 48 hours after administration of antineoplastics B. Pregnant women and children should avoid contact with antineoplastic medications C. Pharmacy includes information sheet on some medications - see pharmacy for sheets 183 X. Students in oncology rotation A. Course syllabus provided from oncology informing students of risks 1. Avoid patient’s urine, feces, vomit, and saliva for 48 hours after administration 2. Students will not prepare or administer antineoplastics at OSU B. Brochures from NIOSH regarding handling of antineoplastics in notebook along with MSDS’s (material safety data sheets) – located by oncology wards XI. Injectable antineoplastic medications we use A. Asparaginase B. Carboplatin C. Cytarabine D. Cyclophosphamide E. Dactinomycin F. Doxorubicin G. Gemcitabine H. Fluorouracil I. Mitoxantrone J. Vincristine K. Etoposide L. Vinblastine XII. Oral antineoplastic medications we use A. Chlorambucil B. Cyclophosphamide C. Lomustine D. Melphalan E. Methotrexate 184 DIAGNOSTIC IMAGING AND RADIATION ONCOLOGY SERVICE Hours of Operation - The diagnostic imaging and ultrasound technical staff are available from 8:00 am to 5:30 pm Monday - Friday. Routine diagnostic imaging and ultrasound studies are generally made as follows: A VetStar request with a complete, concise case history and a contact clinician is required before ANY study is imaged. 1. Diagnostic Imaging Studies Routine large and small animal radiographic procedures are generally performed between 9:00 a.m. and 5:30 p.m. Monday - Friday. The emergency service performs routine radiographic procedures afterhours. Emergency radiographic interpretations and/or large animal studies requiring the overhead tube are performed by the radiology residents. 2. Ultrasound Examinations Both large and small animal ultrasound examinations are performed on a first-come, first-served basis between 9:30 a.m. and 5:00 p.m. Monday – Friday, scheduled with a VetStar request. An emergency fee is applied to examinations performed after 5pm M-F and over the weekend. Ultrasound examinations are scheduled in 30-minute blocks. Small animal patients are imaged in dorsal recumbency and must remain still without struggling or panting. If sedation is necessary to perform the study, a prescription should be placed in pharmacy at the time the VetStar request is submitted. Owner consent for US guided aspirates must be acquired prior to the examination. Horses should be sedated and clipped before the scheduled appointment. US guided cystocentesis can be performed between examinations after consultation with the faculty or resident in ultrasound. A separate VetStar request (with a fee) is necessary for a cystocentesis that is not part of an abdominal examination. 3. CT Examinations CT studies are performed hourly from 9:00 a.m. to 5:00 p.m. Monday - Friday. The CT faculty radiologist and/or resident must be consulted before scheduling all CT examinations. Coordination with the anesthesia service is necessary prior to finalizing a CT appointment time. Deep sedation may be considered for specific studies after consultation with a radiologist. An emergency fee is applied to afterhours CT studies. 4. Nuclear Medicine Examinations Nuclear medicine examinations are performed from 10:00 a.m. until 4:00 p.m. on Monday - Friday. Consultation with the faculty radiologist and/or resident is required prior to scheduling any study. The nuclear medicine technologist should be informed as early in the day as possible to confirm availability of the radiopharmaceutical for the study the following day. The radiopharmaceutical must be ordered before 3:00 p.m. for the next day’s study. There are informational handouts available for the individual studies that describe specific patient preparation. 185 5. Magnetic Resonance Imaging (MRI) MRI examinations are acquired at the Wright Center of Innovation. Appointments are made for studies on Tuesday (10 am – 5 pm) and Thursday afternoons (1:00 – 5:00 pm). Consult with a faculty radiologist to make an appointment. Whole body fluoroscopy is scheduled the day prior (for Tuesday scans) or the day of the MR (for Thursday scans) is performed on each patient to evaluate for metal foreign material. A request is necessary for the fluoroscopy. Patients may not leave the hospital between their fluoroscopy and their MR scan. A special MRI checklist is required to schedule an appointment and a VetStar request is required the morning of the study. 6. Radioactive Iodine Therapy (131I) Consult with the radiology faculty and/or resident and the nuclear medicine technologist to schedule 131I therapy in hyperthyroid cats. The 131I must be ordered before 3pm the day before it is administered. Once a cat is injected with 131I, they will remain in radiation isolation with very limited contact for 3-7 days. An informational handout is available and provides more specific instructions for patient preparation and aftercare. Clinical appointments and estimates for treatment costs are handled through Internal Medicine. A faculty radiologist and/or resident must review radiation safety procedures with the client at the time of discharge. Discharges should not occur on the weekend. 7. Special Radiographic Procedures All contrast radiographic examinations must be scheduled through the radiology faculty, and/or residents PRIOR to submission of a VetStar request. Consultation with the radiology faculty and residents will help determine the best procedure for each case and any necessary steps (i.e. enemas) to prepare the patient for the procedure. 8. Requesting Patient Imaging Studies on DVD Clients and referring veterinarians may request a copy of their patient’s imaging studies. These studies are burned on a DVD with a DICOM viewer. A form for this request is available in Radiology. A fee is charged to the client for each DVD. Revised 04/17/2013 186 Triaging an Animal for an Emergency Small Animal Clinic Policy Whenever an animal is presented for evaluation as an emergency at the front counter, the Emergency technician is called on the triage phone, 7-6315. This call requires students and/or techs to respond immediately to assess the animal’s medical condition. Triage involves obtaining a BRIEF history (presenting complaint, duration of signs, major previous medical issues) and BRIEF examination (observation of mentation and breathing, feeling pulses, checking mucous membrane color/CRT) for detection of any immediately life-threatening problems such as (but not limited to): loss of consciousness, seizures, acute external hemorrhage or active arterial bleeding, respiratory distress, shock (pale mucous membranes, prolonged capillary refill time, tachycardia, and poor peripheral pulse quality), inability of the patient to stand or ambulate normally. The patient should also be assessed for non-immediately lifethreatening conditions that may still benefit from triage back to the treatment room, such as (but not limited to): severe nausea, protracted vomiting or diarrhea, recent toxin exposure, and any condition that appears painful or uncomfortable for the patient. Patients meeting the above criteria will be taken to the treatment room immediately and the client will begin the registration process while the pet is examined further. Under most circumstances a triage exam should not be performed on cats in the lobby (especially if in a carrier). The patient can be brought to the treatment room for brief assessment and returned to the client if deemed stable. In circumstances whereby an animal is deemed to be unstable and in need of immediate diagnostic and therapeutic intervention, an Emergency Service clinician or technician may deem it necessary to obtain and acute estimate or “3-5”. The senior student may be asked to have this discussion. Basically, initial intervention may cost $300-$500, and a deposit of $250 on top of the ER exam fee is required. The idea is to make the client financially aware of what might need to happen over the next 1-2 hours. So we do not spend a bunch of money the client doesn’t have. An example explanation might include: “The ER staff is currently dedicated to addressing “Patient Name’s” medical needs. Based on their initial assessment they have determined that “Patient Name” is in need of immediate therapy and testing to help get him/her stabilized and gather more information. It is important for you to know that it is often necessary to spend $300-500 in the first 1-2 hours under these circumstances. And so, at this time we would ask for the $150 ER exam fee as well as a deposit of $250, as per our financial policy. As soon as we have a more complete picture as to “Patient Name’s” status we can discuss things further.” If agreed to then the student should let the Client Services staff know. Client Services will have the client sign a pre-printed estimate form and collect the additional deposit. If not agreed to then notify the attending clinician immediately so that other options can be discussed. If the patient is considered stable, inform the client of the standard receiving protocol and that someone examine their animal as soon as possible. 187 Things to Know When You Have a Patient in ICU Our responsibilities: • ICU technicians and students will perform all treatments except for 8:00 a.m. treatments. • ICU will provide common crystalloid fluids and injectable medications located at the central treatment center. You will not need to order these. • We will clean cages if the patient urinates or defecates. Your responsibilities • You are responsible for all 8:00 a.m. treatments. Morning treatments should be scheduled at 8:00 a.m. unless it is otherwise absolutely necessary to do so. • You are responsible for ordering and picking up all medications from the pharmacy. Please plan ahead to ensure that you have enough medications to last overnight and throughout the weekend. • If you are unsure how to administer a medication we strongly recommend that ask you one of the ICU staff. For reference there is also a protocol book at the central treatment counter. • Students on the primary service are responsible for walking that service’s patients. • Patient orders should not be removed from the ICU until after 7:30 for any reason. Sheets from the day before are an essential part of morning rounds. • Orders should be posted by 9:00 a.m. daily and should be signed by the primary clinician by no later than 10:00 a.m. If you are unsure how to complete any aspect of the treatment sheet, please ask the ICU staff. • Please make sure to weigh your patient daily. • Inform the ICU staff if you are admitting or discharging a patient so that we can prepare a cage (admit) or make sure that all charges have been entered (discharge). • If a patient is being admitted to the ICU/SDW and needs an IV catheter in placed please provide advance warning to make sure ICU staff are available. Please do not wait until the end of the day! Otherwise it may be necessary for the service techs in your area to place the catheter. • Completing treatment orders prior to bringing the patient to ICU will allow us to set up fluids, pain meds, etc. in advance and facilitate admission. • Please make sure to wear gloves if indicated and wash your hands between patients. Client communication: • Please do not tell owners to call ICU staff or students for updates. Only the primary clinician or the student on the case may give patient status updates to owners. • Owner visits should be arranged through the primary clinician or student on the case. If possible, a patient should be taken to visit with the owners in a visitation room. For those that are unable to be removed from ICU (oxygen dependent, CRI medications), owners may visit in ICU. These visits should be kept to 15 minutes or less in length. The primary student or clinician on the case should stay with the owner at all times and be ready to escort them from the room should an emergency arise. • All owner visits within ICU should be cleared with the ICU technicians or faculty prior to the visit. Please do not schedule owner visits in ICU during busy times (7 – 10 a.m.; 6 – 8 p.m.) • The ICU/ER will not facilitate owner visits or discharges. These are the responsibility of the primary student or clinician. If the owner comes to the hospital and the primary student or clinician is unavailable, they will not be allowed to visit. 188 Things to Know When You Have a Patient in the Step-Down Ward (SDW) Our responsibilities: • ICU staff will provide analgesics (injections of hydromorphone or buprenorphine, administer Tramadol, etc.) as indicated on the orders. We will also administer acepromazine and other sedatives as needed and monitor a single CRI • ICU staff will monitor fluid lines and provide crystalloid therapy as indicated on the orders. You will not need to order these. • ICU staff will clean cages if the patient urinates or defecates, and will offer oral feedings. Your responsibilities: • You are responsible for ALL other treatments, TPRs, blood pressure readings and administration of all medications except analgesics and fluids. We will not contact you to remind you to do your treatments. When writing orders, please keep appropriate administration times in mind (i.e., do not order a dose of Sucralfate to be given at 2 a.m. unless you want to come in to give it). Common treatment times include 8 a.m., 4 p.m. or 6 p.m. (toward the end of the clinic day), and 10 p.m. (when ward students come in to walk patients and perform treatments). • Devices (e.g. feeding tube, wound drain, etc. though not urinary catheters), are allowed in the SDW. However, the primary service is responsible for all care and use of any device. • If you are unsure how to administer a medication we strongly recommend that ask you one of the ICU staff. For reference there is also a protocol book at the central treatment counter. • Students on the primary service are responsible for walking that service’s patients. • If you would like the SDW staff to perform your treatments for you, the patient will be charged at the appropriate ICU level for that 8 hour shift. • You are responsible for ordering and picking up all medications from the pharmacy. Please plan ahead to ensure that you have enough medications to last overnight and throughout the weekend. • Students on the primary service are responsible for walking that service’s patients. • Patient orders should not be removed from the ICU until after 7:30 for any reason. Sheets from the day before are an essential part of morning rounds. • Orders should be posted by 9:00 a.m. daily and should be signed by the primary clinician by no later than 10:00 a.m. If you are unsure how to complete any aspect of the treatment sheet, please ask the ICU staff. • Please make sure to weigh your patient daily. • Please remember to wash your hands between patients and wear gloves if indicated. • Inform the ICU staff if you are admitting or discharging a patient so that we can prepare a cage for them (admit) or make sure that all charges have been entered (discharge). • Completing treatment orders prior to bringing the patient to the SDW will allow us to setup fluids, pain meds, etc in advance and facilitate admission. Client communications: • Please do not tell owners to call SDW staff or students for updates. Only the primary clinician or the student on the case may give patient status updates to owners. • Owner visits should be arranged through the primary clinician or student on the case. Patients should visit with the owners in a visitation room and not in the Step-Down Ward. • The SDW/ER will not facilitate owner visits or discharges. These are the responsibility of the primary student or clinician. If the owner shows up to the hospital and the primary student or clinician is unavailable, they will not be allowed to visit. 189 SMALL ANIMAL SURGERY General Information Surgery ward assignments The surgery technician coordinator (Mary Ross) will post ward assignments outside the surgery office at least one week ahead of your rotation. You are responsible for confirming your assignment. General surgery small /medium dog housing is located in Ward D, orthopedics uses Ward E. 3 Ward system Mixed ward- Combined General Surgery and Orthopedics (Chief or Mixed Ward) Soft Tissue - General Surgery I Orthopedics- Orthopedics I 4 Ward system General Surgery I (STSX1) General Surgery II (STSX2) Orthopedics I Orthopedics II Receiving/ Surgery Ward Schedule General Surgery I & Orthopedics I Receive cases Monday and Wednesday morning Receive emergencies only on Friday Surgery Tuesday and Thursday General Surgery II & Orthopedics II Receive cases Tuesday and Thursday morning Surgery Monday, Wednesday, and Friday In House Consults 1. Consults for surgery should be posted on the ward 1 door after technician notification. 2. Use a general consultation request form. 3. An anesthesia/ surgery request form may be posted on the ward door with consult form. 4. Responsibility for preparing the patient for surgery remains with the medicine ward. 5. The medicine student is required to complete the patient SOAP and diagnostic and treatment plans by 8:00 a.m. the morning of surgery. 6. Exotic animals: Surgery service only acts as consultants on exotic cases. 190 Aftercare The case returns to the medicine ward after surgery if surgery is for diagnostic reasons only, no major surgical complications are anticipated, or the medicine ward requests the case back. The case is transferred to the surgery ward following surgery if there is risk of major surgical-related complications or the surgeon requests primary care post-operatively. Transfers Overnight transfers should be posted on the door of the service ward receiving the following day. Patient may be placed in the surgery ward unless it needs intensive care. The emergency student is required to complete the patient SOAP, ICU orders (when applicable) and treatments the morning of the transfer. Scheduling Surgery Times Cases received by a surgery service generally have surgery the following day. Consult (transfer) cases needing surgery may go to the OR the following day or can be scheduled on a future day as the service schedule allows. Cases requiring emergency surgery will be evaluated by the receiving service first. The receiving service will transfer the case to the service performing surgery that day. Surgeons will schedule the exact time of the surgery including for consult and transfer cases. Cases bumped from the surgery schedule may be done the following day or during the ward’s next surgery day. Drop-offs on the day of surgery can only be approved and scheduled by the specific service (ward) clinicians or SAS ward technicians. Requirements for Surgical Cases 1. Physical Exam by surgeon/ resident Cases that have a verbal consult only and have not had a complete physical performed by the surgery service must have a scheduled appointment with the surgery service before the surgery is scheduled. 2. Bloodwork • Minimum of PCV/TP on young, healthy animals • Patients over 5 years old require a CBC and Profile • Other bloodwork may be requested as deemed necessary 3. SOAP Patient SOAP should be completed on the morning of surgery by 8:00 a.m. The medicine/ outpatient student is responsible for completing all patient orders including SOAP for transfer cases on the day of surgery. 4. Anesthesia/surgery request form Include current weight, location, date of surgery, and exact procedure on the form. Exact time/ order of cases will be determined by the surgeon. Surgery request forms for consult cases may be posted on the ward 1 door with consult forms. Most procedures should be scheduled starting at 9:30 a.m.; on special occasions, table time can be arranged earlier. See the anesthesia tech supervisor. 191 Emergency Surgery after 5:00 p.m. The schedule for the on-call emergency surgeon is posted in the general practice hallway. The surgeon on call should be contacted when immediate surgical intervention is required, or when more information/ care is required for a potential surgical case by the attending emergency clinician. The oncall emergency surgeon schedule is the responsibility of the surgery faculty. Miscellaneous Information Elective surgery Spays, castrations and declaws are performed by senior students. Students handle all aspects of these cases. All other cases are handled jointly by the service head and resident in the respective ward. Visitation • Owner visitation is discouraged on surgery days. • If the visit is approved, the patient should be transported to an exam room, if at all possible. • If the patient must remain in ICU, arrangements must be made with ICU personnel first, and a student must be present during visitation. Client Communication Surgery students are required to communicate with owners daily while their patient is hospitalized. 192 SURGERY SERVICE CONTACT INFORMATION Soft Tissue Surgery Faculty Room Phone E-Mail Mary McLoughlin, DVM DACVS Associate Professor 1105 mcloughlin.1@osu.edu Chris Adin, DVM DACVS Associate Professor 1027 Kat Ham, DVM DACVS Assistant Professor, Clinical Tatiana Motta, DVM Assistant Professor, Clinical 1014 4-8683 740-503-2299 (C) 740-654-7340 (H) (24)7-1853 585-750-6526 (C) 614-725-1423 (H) (68)8-3507 (517) 290-8082 (C) (29)2-3395 607-270-5573 (C) Orthopedic Faculty Room Phone E-Mail Jonathan Dyce, DSAO DACVS Associate Professor Section Head 1022 jonathan.dyce@cvm.osu.edu Bianca Hettlich, DVM DACVS Assistant Professor Matthew Allen, VetMB, PhD Associate Professor 1015 4-8690 614-270-0925 (C) 614-775-0869 (H) (24)7-1852 614-973-9008 (C) (24)7-7020 614-561-9619 (C) 614-750-2197 (H) 005H 048 christopher.adin@cvm.osu.edu kathleen.ham@cvm.osu.edu tatiana.motta@cvm.osu.edu bianca.hettlich@cvm.osu.edu matthew.allen@cvm.osu.edu Clinical Instructors Room Phone E-Mail Lily Su, DVM, Clinical Instructor Katy Townsend, DVM DACVS Clinical Instructor 0006A (29)2-6999 614-625-3042 (C) (29)2-5928 607-342-7964 © lillian.su@cvm.osu.edu Residents Phone E-Mail 3rd (24)7-1832 919-757-1716 (C) (24)7-6012 614-824-9154 (C) (68)8-1378 614-530-4301 (C) lauren.pugliese@cvm.osu.edu Lauren Pugliese 3rd Vincent Wavreille 2nd Bronwyn Fullagar townsend.678@osu.edu vincent.wavreille@cvm.osu.edu bronwyn.fullagar@cvm.osu.edu 193 2nd Audrey Wanstrath (68)8-1377 513-515-8441 (24)7-6073 908-720-9310 2-7237 judith.bertran@cvm.osu.edu Technicians Phone E-Mail Mary Ross 2-0461 614-361-7637 2-1374 614-582-8576 4-9987 614-307-0496 2-0694 614-563-9403 7-1854 614-309-2587 7-7923 614-425-1835 4-2611 614-570-6552 4-86712-7866 ross.324@osu.edu 1st Jennifer Song 1st Judith Bertran Kim Penrod Mat Kerzee Kristie Brush Amy Weatherall Michelle Gilliam Nikki Brown Tomi Spyker – Overnight ward tech Tracy Pejsa – Rehab, Rm 0156 7-1830 audrey.wanstrath@cvm.osu.edu jennifer.song@cvm.osu.edu penrod.49@osu.edu kerzee.1@osu.edu brush.19@osu.edu wilcoxon.12@osu.edu gilliam.50@osu.edu brown.1739@osu.edu Overnight treatment book in ICU tracy.marsh@cvm.osu.edu 194 Small Animal Veterinary Assistant Information Veterinary Assistants are responsible for cleaning the wards and assisting with patient care as needed. Current Veterinary Assistants are: Small Animal: Cathy Leuszler, Catlin Flemming, De Anna Lopez, Jaime Board, Todd Tensley. Hours: 5:00 a.m. – 12:00 a.m. Monday – Friday and 7 a.m. – 11 a.m. Saturday and Sunday • • • • • • • • Bath requests after 8:00 a.m. should be brought to a vet assistant. If we are occupied we may not notice a new request. Cat litter and pans are located in the hallway between ICU and ward A (behind the wards.) Dirty laundry (towels) should be taken to the appropriate containers, which are located near the bathtubs and in the hallway across from the S.A. kitchen Disinfectant and cage cleaning supplies are located by the exit for the dog walk ramp. (in case you need them after we leave.) Metal water bowls are located in the kitchen. Use paper bowls for feeding. Cage Paper: 2-3 sheets in top cages. 3-4 sheets in bottom cages Soiled cage pads should be placed in the cans provided--do not place soiled pads in the tall laundry carts unless they are properly bagged. The laundry company will refuse to accept carts with loose pads in them. Personal pets: Must have a locator card. Also, please clean up after your pet. Cleaning Protocol - Small Animal Wards/Cages and Runs This cleaning protocol is for the small animal holding areas and includes all the small animal wards and their associated cages and runs. Empty cages where animals have gone home are identified by the yellow locator card lying on the floor of the cage. The cage paper is removed from the cage and put into plastic trash bags and hauled to the trash bins at the loading dock (room 0072). Water bowls are taken to the kitchen area for cleaning with hot water and Joy detergent. Litter pans are washed with Joy detergent in the bathtubs and disinfected with PH7Q. Cage pads and other laundry items are removed to the laundry carts in the run hallway. • • Cage Cleaning: Cages are hosed from the front to the back drain to remove small organics and wet surfaces. Cage is then scrubbed with Ph7 ultra cleaner and a brush, all surfaces including cage fronts. With door closed, rinse cage front to back. Squeegee excess water from surfaces. Disinfect entire cage and door with PH7 ultra disinfect. Allow a 10 minute contact time. Ward floors: Each ward floor is disinfected daily after the cages have been cleaned. Hose from the west entrance of each ward, down the slope and out to the trough drains in the run areas. Scrub floor with PH7 ultra cleaner and rinse. Squeegee excess water from floor into run drains. Disinfect with mop solution of PH7 Q from wall dispenser in run hallway. Contact time for the disinfectant solution should be no less than ten minutes. 195 • • • • Sinks and Exam Tables: The sinks and exam tables are wiped clean and disinfected with PH7Q disinfect daily. Ward Wall: Walls and other low contact areas are cleaned and disinfected in the same manner as the cages on a weekly basis and spot cleaned as needed. Ward and Run Repairs: any broken equipment (cages, runs, plumbing problems, etc.) are to be reported to Stan Highley in Hospital Administration or the Veterinary Assistants for repairs. Zoonotic Outbreak: In the event of a disease outbreak in a ward or run area, affected animals will be removed from the area and isolated for treatment. The ward or run area will be steam cleaned with the portable steam cleaner. All surfaces will be disinfected with a phenolic disinfectant allowing sufficient contact time. Cultures will then be taken from cages and other affected surfaces and submitted to the labs to insure quality disinfection. All areas will then be rinsed and disinfected with PH7Q disinfect. 196
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