Patients and records

The receptionist’s role 2

Communicating with clients 3

Scheduling appointments 6

Patient records 8

Client confidentiality 12

Admission of animals 13

Discharging animals 17

Identifying animals in your care 19

Client / patient separation anxiety 22

The receptionist’s role

The receptionist’s role includes obtaining important information from clients, such as ensuring that the clinic has up-to-date names, addresses and phone numbers. The receptionist is usually the first person who the client comes into contact with and is therefore responsible for the client’s first impression of the clinic.

How to create a good first impression

The receptionist must be aware that she or he is the first person that clients encounter at a practice and will therefore set the scene.

Receptionists / must be neat, presentable in appearance, pleasant, professional and friendly in manner
Prompt attention on arrival / is important and conveys the message ‘you are important’ to the client
Name badges / make identifying staff easier for the client
A clean tidy office / conveys a message of a well- managed business, as does a warm friendly décor, comfortable chairs, and up-to-date magazines

Communicating with clients

Greeting clients

The client relationship is one of the most important aspects of a clinic. It is important to acknowledge clients as soon as possible when they enter the clinic.

If you are busy with another client or are on the telephone, you can nod or gesture to the client that you are aware of their presence. If possible, briefly interrupt your conversation and inform the client that you will be with them shortly.

If the veterinarian is delayed for any reason, you should apologise for the delay and keep the client informed of any progress or changes. If necessary, offer some refreshments or reading material.

Behaviours that influence communication

Verbal behaviour

·  be polite and calm

·  be non-judgemental

·  focus on the client’s feelings

·  summarise or paraphrase to ensure that you understand

·  use terms the client can understand

·  answer their questions honestly

·  do not ‘put words into their mouth’

·  respond to their concerns

Non-verbal behaviour

·  have good eye contact

·  maintain a comfortable distance (personal space)

·  speak at a moderate pace and in a moderate tone (do not shout or whisper and do not rush)

·  show responsive facial expressions

·  face them and lean slightly towards them to show that they have your attention: do not keep looking or turning away

·  avoid yawning, scowling or closing eyes

Telephone answering protocol

You should answer the telephone promptly, confidently and efficiently by:

·  saying ‘good morning’ (or afternoon or evening)

·  giving the name of the practice

·  speaking clearly and remembering that your greeting will create a favourable or unfavourable impression of the practice as a whole.

Some practices may require that you then state your name and ask:

·  ‘How may we help you?’

·  Always ask who is calling

·  If you are unable to deal with the inquiry yourself, obtain as much information as possible and notify the caller that you are placing them ‘on hold’ while you see if someone else is able to assist.

Pre-empt any queries or lapses of memory by surgery staff about the waiting caller by giving them the relevant information before putting the call through:

·  this will also create a favourable impression with the client

·  in the meantime keep going back to a caller ‘on hold’ to apologise for any delay

·  they may be required to call back at a more appropriate time or you may need to obtain details from them so that the call can be returned

Telephone messages

It is a good idea for all telephone messages to be recorded in writing. This may be by using a central message book or a book of separate telephone message receipts which can then be passed onto the relevant person. It’s also worthwhile confirming that the person has actually received the message.

Giving advice to clients

Generally speaking, the advice given by a veterinary nurse must have the approval of the veterinarian. This does not mean you always have to seek permission before giving advice, only that you need to be aware of the practice policy concerning that advice.

Scheduling appointments

Methods of appointment scheduling will vary between practices. Some use appointment books, others only use computers while some will use a combination of both.

Most veterinary clinics prefer the appointments to be ‘booked in’ with clients either ringing or coming in to make prior arrangements. This helps in organising the day’s work and minimises client waiting time. It also gives a good opportunity to check client and animal details before they arrive.

‘Walk-ins’ or clients arriving without appointments will occur from time to time. First, ascertain the nature of the owner’s concerns and if the situation appears urgent alert the veterinarian on duty.

If the request is for routine services, there are a number of options:

·  Explain the appointment system and schedule the appointment at an appropriate time.

·  If there is time available ask the vet if the client can be seen immediately. If not, ask the clients if they would be prepared to wait until they can be seen.

Important considerations

When you schedule appointments, consider these issues.

Which veterinarian? / ·  Some clients only want to see one particular vet.
·  Which veterinarian is the most appropriate to deal with the presenting complaint? Veterinarians within the practice may have specialised interests, eg medicine or surgery
Time allocation / ·  Clinic policy for appointment times, eg consulting hours, surgery days.
·  Be aware of time intervals required for appointments and how many the owner will bring in.
·  Beware of over-booking. This needs to be taken into consideration when more than one person makes appointment bookings.
·  Client preference.
Allowing ‘catch up’ appointment times to keep on time / ·  For each hour book a variety of patients which include short or quick procedures (eg vaccinations, suture removals).
·  lf there are a lot of complicated appointments together, the vets may easily get behind time.
·  This also gives them a chance to clear their minds and start each new case with a clear head.
Emergencies / ·  Special consideration must be taken into account for emergencies. They are unpredictable and can sometimes take a lot of time.
·  Other appointments may need to be rescheduled to avoid lengthy waiting delays for the clients so always get details so that you can contact the client if you need to reschedule.
Call outs / ·  Remember to include travel time to and from out-calls. A half hour drive to a client’s property also means a half-hour drive back.
·  Sometimes, you have to allow extra time just in case the vet gets lost!
·  It is helpful to use local travel times so you can anticipate how long it will take clients to come in.
Preparations / ·  Special treatments/equipment to prepare or order before a particular procedure can be done.
·  When making appointments, note if there are any instructions that should be given for the preparation prior to the appointment—eg fasting 12 hours before arriving at the clinic. You may need to check if it is a non-routine procedure.
Appointment outcomes / ·  Think of the likely outcomes of the appointment and whether that should influence the schedule—eg surgical admission, grooming booking, euthanasia.

Patient records

The importance of medical records

It is important to create and keep accurate and complete records of a patient’s history, examination, diagnosis and treatment.

This is necessary because:

·  It is a legal requirement to keep them in a permanent form (eg paper file, card, computer disc) for seven years (and at the workplace for the first 3-4 years. After that period they can be stored elsewhere).

·  They document an animal’s progress and response to treatment

·  They ensure appropriate care and treatment are given by all staff involved in the animal’s care

·  They can be used as evidence in legal disputes.

The forms, record method and abbreviations used will vary between clinics but aim to follow a systematic approach so that all problems will be identified and dealt with. Whether it is a consultation at 10am or out of hours at 3am, nothing should be missed!

/ Don’t forget that these records are legal documents and must be complete Memory is rarely as good as clear written documents.
You should always encourage and practise the following when creating medical records.

·  Objectivity: avoid bias or be aware of it.

·  Precision and accuracy: avoid ambiguity. Use correct terms and figures.

·  Consistency: record detail, not interpretation.

·  Uniformity: repeat the steps each time so it is possible to compare.

·  Reliability: ask yourself, would the same results be obtained by a different observer?

·  Legibility: make sure what you write can be read by others.

·  Avoid offensive language

Types of records

Types of records that may be associated with a patient data file include:

·  medical records including results of physical examinations, differential diagnosis treatments and animal’s response to treatment

·  vaccinations, worming, heart worm (date and type)

·  laboratory reports

·  radiographic and ECG findings

·  referral reports

·  surgical and anaesthetic reports

·  dental records

·  post mortem reports

·  client financial history with the clinic.

Methods of keeping records

Methods of record keeping may include:

·  manual card filing systems

·  record books

·  envelopes, eg radiographic films

·  folders, eg for pathology reports

·  computer-based records

·  photographs

·  video clips.

/ Remember to always file accurately. A record that cannot be found is useless!

General considerations for gathering client and patient data

Good communication skills are needed! / ·  Obtaining and recording relevant information from clients requires good communication skills to get the most from interview techniques, and a systematic approach is needed for you to be thorough and accurate.
·  Remember to use open questions and avoid asking leading questions accidentally. Be brief but accurate.
·  As it requires owner involvement, showing interest can be a good PR tool, but it may take tact and patience especially with anxious clients. It is important not to be judgemental or disapproving. Suppress feelings of condescension, affection, pose, revulsion and apathy. Many owners already feel guilty!
Diagnosis (and prognosis) is the responsibility of the veterinary surgeon! / ·  Nurses often assist the vet, particularly in the early stages of collecting patient information, history and distant examination or observation.
·  They may be called on to restrain animals for physical examination or to ascertain the so-called ‘cardinal signs’. Vet nurses may also be required to measure these, particularly when monitoring hospital cases. The level of involvement varies from practice to practice.
History collection / ·  Vet nurses should establish their practice policy on how much history they collect.
·  Determine the difference between observation and interpretation by the owner; clarify ambiguous phrases or conflicting information; avoid leading questions.
·  Use general questions initially, to prevent influencing the owner’s answer. Use appropriate vocabulary. Recheck the points for accuracy, order and importance.
Routine admissions / ·  Even routine admissions (eg boarding, de-sexing) should entail collection of some basic information for the medical record, weight, history and results of a clinical examination or record of cardinal signs.
·  Identify and record the presenting complaint.
Dealing with owner requests / ·  Depending on the request, you may need to check clinic policy or refer the request to your supervisor.
Other paperwork you may need to deal with / ·  Authorisation forms (eg consent forms for surgery, euthanasia, treatment).
·  Cost estimate forms.

Specific patient history details and data

Find out what details your workplace requires from clients and how to enter them into the filing system. History includes both medical and environmental information about the animal.

·  It may relate to the past of the animal or its present condition.

·  It is the first step in diagnosis and often the most useful information.

·  It is a description of important events and environment prior to the appointment.

Components of the history

Patient details / ·  name and case number
·  breed
·  sex
·  age
·  reproductive status
·  temperament
Presenting (or chief) complaint / ·  the reason for the visit—the owner’s concerns
·  triage. The animal may require immediate treatment by vet
History of presenting complaint: / ·  brief notes of observations including: onset, duration, severity, signs, therapy and response
Past history: / ·  medical including specific tests and treatments
·  surgical
·  trauma
·  vaccinations – and dates
·  parasite control – gastrointestinal and heart worm
·  diet
·  family and environmental history
Environmental history: / ·  housing, numbers, in contact
·  travel
·  diet
·  uses (work, breeding)
·  litter mates/siblings
Specific information: / ·  immediate medical history
·  weight on admission/arrival
·  have there been any changes since the animal was last seen?
·  when was the animal last fed/ate – fasting?
·  fluid intake
·  last medication given
·  any allergies, eating habits
·  last bowel motion/urination and any observations
·  last ‘in season’ if female – oestrus phase
·  any items to be left with the patient
·  obtain signature of owner on standard consent forms
·  useful to enquire about proposed method of payment
·  note any further relevant details

Client confidentiality

/ Security and confidentiality of the practice files is very important.

Staff in the veterinary practice must keep the practice files secure and confidential. This includes patient medical records, client financial records and information and practice’s financial records.