Clinic HQ makes it to easy to enter exam information in real-time in a paperless system.
In a high volume spay/neuter clinic, the goal of a presurgical exam is to determine if the patient is healthy enough for anesthesia, detect any causes for increased anesthetic risk and ensure they are not already sterilized. Getting the weight and doing the exam should take no more than 2 minutes.
Exam Requirements
Different states require different things on an exam. Furthermore, veterinarians have preferences for what they prefer to be in an exam. High volume spay/neuter clinics and high volume wellness clinics differ from traditional veterinary offices by the sheer amount of patients treated in a day. An exam at a high volume clinic should take two minutes or less. If you do 40 patients, that’s still an hour and and twenty minutes for exams. It’s important to keep in mind the purpose of the exam: to determine if the animal is healthy enough for anesthesia on that day. Therefore, things like body conditional scores and detailed notes are typically not included in high volume exams, unless required by your state regulations.
Here are the essential seven checkpoints for an exam:
- Weight
- Sex
- Sterilization status
- Reproductive cycle
- Health (meaning checking for upper respiratory infections, distemper, parvo, skin issues such as mange, wounds, limb issues such as fractures and any other issues)
- Abnormalities that include cryptorchidism, umbilical hernias and heart murmurs
- Vitals, includes pulse, and respiratory rate and temperature.
- For temperature we suggest a Braun ear thermometer.
- Ear thermometers are a common time and stress-saving practice in many spay/neuter clinics.
- Not all clinic take a temperature, some only take a temperature if the animal feels feverish. It should be noted many states REQUIRE a temperature at the moment of exam.
- You should check your state vet med regulations to know whether a temperature is or is not required.
Auto-complete exams, HQ for the win
In HQ, all exam findings are automatically marked as normal, as this expedites the examination process, and any abnormalities can be easily changed. In our software, we can also put in a Team Note during the exam, which is then visible to your team. This is a way to give your team a heads up about any issues. Once this is all input into the computer, Clinic HQ will auto-populate the premedication dose amounts on the screen.
Declines & High Risk Waivers
The most common surgical declines are the following: heart murmurs, upper respiratory infections and fevers. You may want to seek high-risk waivers most commonly for over- or underweight patients.
Pre-Meds
Once the weight and the maturity of the patient is put in, pre-medication doses are auto-populated in HQ. The drug drawer (either the veterinarian or a licensed vet tech) will then draw the appropriate premedication drugs into a syringe, place a fresh needle onto the syringe and pass the syringe of premedication off to the veterinarian. The veterinarian will then give the premedication intramuscularly to the canine patient. If your clinic is not entirely paperless, a scribe may mark the time and amounts of which drugs were given on the physical treatment sheet.
The drug drawer will mark the drugs as given and the examination as done, allowing the patient to move over to the next screen for the team to begin pulling up induction drugs.
Dog Identification
The dog is placed in a kennel with a pre-printed cage card. The clear tape for the cage cards is placed on the kennels the night before to avoid messing with tape during the exams. It may seem redundant to have multiple forms of identification for a single patient; however, it is essential to ensure that no patients are mixed up throughout the day. The entire process takes approximately 2 to 3 minutes per patient.
Feline Patients
The flow for feline patients is very similar, with a few key adjustments. The examination, physical treatment sheet and online software remain the same. Cats arrive via curbside drop off, ideally after dog check in is already done, perhaps from noon to 1:00 in order to minimize cat stress. There’s no reason for them to wait several hours in the morning while the dogs are being done when your team may not even begin cat surgeries until around noon.
Cats may be kept in their carriers or put in kennels, which should be labeled with masking tape with the cat’s first name and the owner’s last name as well as a pre-printed cage card. This provides two forms of identification in case one falls off.
The examination follows the essential seven checkpoints already mentioned. Cats may or may not receive a premedication; for example, the ASPCA does use gabapentin as a premed for cats. Cats are placed back in their carriers, or in a kennel, after exam.
Some feline patients may arrive with multiple patients in one carrier. For surgical induction or recovery, it is essential that there is one cat per carrier. Feline patients should be separated during the examination process and clinic-owned carriers should also have a label indicating that they are clinic owned. If cats are not able to be examined, it is acceptable to examine them on the surgical table, but an examination should be done nonetheless. If possible, cats should be placed in a room away from the hustle and bustle of the clinic. Ideally they would be placed on shelves so their vantage point is higher and they will feel safer.
General Flow for Dog Exams & Pre-Meds
- Cover scale in newspaper or wipe down with a Rescue wipe
- Bring dog into lobby
- Take pre-written dog neck collar from packet and put it on dog’s neck
- Technician puts dog on scale and weighs dog, noting if scale is set to kgs or lbs
- Enter weight (making sure HQ is set to kgs or lbs depending on the scale) in Patient Flow
- Click drop down for Adult or Pediatric. This designation is can be decided by veterinarian but the reason it’s built into the interface here is because many clinics use injectable meloxicam. For inj. meloxicam, the ASPCA Spay/Neuter Alliance’s protocols (which many clinics follow) halves the dose of meloxicam (injectable and oral) for dogs 5 months and younger. It should be noted, the medical insert for injectable meloxicam is not suggest for dogs under 5 months and younger. So here it’s important to appropriately “age” the pet, since it has implication for drug doses
- Note the pre-med dose amounts presented in HQ
- The drug drawer (either the veterinarian or a licensed vet tech) will then draw the appropriate premedication drugs into a syringe, place a fresh needle onto the syringe and pass the syringe of premedication off to the veterinarian.
- The veterinarian will then give the premedication intramuscularly to the canine patient.
- If your clinic is not entirely paperless, a scribe may mark the time and amounts of which drugs were given on the physical treatment sheet.
- The drug drawer will mark the drugs as given and the examination as done, allowing the patient to move over to the next screen for the team to begin pulling up induction drugs.
General Flow for Cat Exams
- Curbside, label cat carriers with either two masking tapes with the cat’s first name and last name. Or a masking tape and the pre-printed cage card.
- Cats are brought in from the cars in cat carriers. A clinic owned carrier can be provided to the owner curbside to put in cats that are not in a carrier.
- Cats can put put on a high shelving unit until all cats are checked in.
- In a room with a closed door, cats can be weighed and examined.
- If a cat cannot be handled, an estimated weight can derived.
- If a pre-med is being given, it can be given at this point.
Why is my patient not in Patient Flow?
- Verify the patient is checked in.
- Ensure you are filtering by the correct species in PF.
- Change the Anesthetic/Non-Anesthetic dropdown menu to see if they pop up under the Non-Anesthetic patient list. If so, find the patient and click Change to Anesthetic.
- For advanced wellness patients that are still not found, check that the wellness appointment type is enabled in Patient Flow under Wellness Settings.
