Detweiler and Weinstein explain the common causes of discrepancies in DEA logbooks, and how to overcome them,

Video interview with Kelley Detweiler and Peter Weinstein, DVM, MBA

Missed out on Fetch Kansas City 2024? No worries—we’ve got you covered! For just $199, 

gives you access to the best sessions, speakers, and over 30 CE credits. Learn when, where, and how it fits into your busy life. Whether you’re catching up between appointments, learning from the comfort of home, or squeezing in a quick session over coffee, Fetch On-Demand gives you the flexibility you need to earn CE credits on your terms.

Ready to jump in? Start exploring the best of

For veterinary professionals that are DEA registrants, discrepancies may appear within logbooks. Sometimes it can be chalked up to human error, maybe someone wrote in the wrong book or maybe someone miscalculated a dosage and wrote down the wrong number. Regardless of how they happened, they need to be dealt with, but what is the correct way to deal with discrepancies?

During an interview at the Fetch Kansas City Conference, Kelley Detweiler and Peter Weinstein, DVM, MBA, explain some common causes as to why these discrepancies can happen, both in the case of human error or human intent, and how veterinary teams can handle it.  

: When it comes to discrepancies, you know it's bound to happen. There are nefarious reasons that they happen, but either way, they need to be addressed. Because if there's a discrepancy, it needs to be resolved or reported, and failure to do that within the 24 hour timeline by DEA and then additional state rules that may have other diversion reporting requirements, it really just messes everything up for the person who's holding the bag. Doc?

: Discrepancy really happens in veterinary hospitals, most commonly because we're so busy, and math errors happen because we're so busy. Forgetting to enter information happens because we're so busy... I can't tell you how many times a staff member put the wrong information on the wrong log. Sometimes you have to stop, take a deep breath, and move slower, because I think in this case, speed leads to problems and leads to discrepancies. And the concern we have is when those discrepancies are not human error, but human intent, that we have to have greater oversight, and that's our responsibility as veterinarians, and especially the veterinary registrants from the DEA.

Videos

Once a veterinary professional discovers an error in their logbook, what happens next?

Dealing with logbook discrepancies 

Theresa Cosper-Roberts, RVT, CVPM, ACE(DE), CVBL, is a distinguished expert of the Academy of Veterinary Educators with more than 10 years of experience in veterinary education. She is also the surgical training center manager at the Louisiana State University (LSU) School of Veterinary Medicine, as well as the senior consultant for National Veterinary Solutions, LLC, which specializes in providing tailored consultations and training for veterinary technicians, students, and assistants. In her role at the LSU School of Veterinary Medicine, she has been placed on the dean’s merit honor roll as an instructor each year, making her the first veterinary technician to achieve this accolade.

, Cosper-Roberts talked about her lecture 

Is Bigger Always Better? Intravenous Catheterization of Companion Animals

, presented at the Southwest Veterinary Symposium in Fort Worth, Texas. In the interview, Cosper-Roberts discussed the process of choosing the right catheter size and the duration a catheter can, and should, be in place. She also explained the role a patient’s physiology plays in the decision.

How should veterinary technicians and assistants choose the right catheter for their patients? What factors should be considered?

“So, the old school thing that we always taught people is ‘bigger is better: get the biggest catheter that you can possibly get in that patient, because you never know if something's going to happen or [if] that patient [is going to] code.’ But that isn't necessarily the case. Yes, we want to choose a large catheter, but it needs to be the biggest catheter that is appropriate for that patient.

I always tell my students, just because I can get an 18-gage catheter in a cat doesn't mean that it's appropriate for that cat to have an 18-gage catheter. So, it's looking at the patient as a whole, and what's going on with that patient, what they're there for, how long that catheter is going to be in dwelling, in order to decide what the best catheter [is] for that patient.”

What role does a patient's physiology play in the type of catheter that should be used?

“Patient physiology has a very, very important role. When we're looking at a Dachshund, I know that if I'm going to put a catheter in a Dachshund, that I probably need a short catheter, because I'm not going to be able to place a 2-inch catheter in most of their legs. If I'm placing a catheter in a Great Dane or a very large breed, I'm probably reaching for a 14- or 16-gage catheter because they're a larger patient who can accommodate a larger size.

Depending on what that animal is there for, instead of doing a peripheral catheter if that animal is going to be hospitalized for a while, or if it's fairly critical, I may place a central line or a midline. So, it truly is looking at the patient as a whole and everything that's going on with that patient to try and decide the best catheter for them.”

How long should catheters be kept in place? How is that determined?

“So, there are 2 schools of thought with that, there's what I refer to as ‘old school’ or ‘new school.’ And ‘old school’ school of thought is 72 hours max it gets pulled because after that there's a risk of infection.

But the CDC recommendations are actually that as long as a patient isn't showing any signs of a catheter site infection or any issues associated with that limb, that catheters can remain indwelling. So, if we're not feeling any heat at the limb, if the animal isn't showing any signs of pain or swelling or from phlebitis or anything like that, that catheter can stay in, because what we don't want to do is pull a perfectly good catheter that doesn't have anything wrong with it because we're getting stuck in ‘Okay, this is the rule. This is what I need to do,’ because every time I poke a dog, I'm risking introducing something into that patient. So we want to minimize the amount of times that we are poking our patients, if we need [to] be.”

Articles

Many veterinary professionals regularly place catheters, but are they doing it right?

Proper catheterization: Size, duration, and patient physiology

Using lab values to identify disease that leads to aging

Brennen McKenzie, VMD, MSc, MA, director of veterinary medicine at Loyal, a biotechnology company, and a clinical practitioner, presented an education session on lab values at the 2024 Southwest Veterinary Symposium in Fort Worth, Texas. In an interview with 

®, McKenzie explained how changes in lab values help identify diseases that lead to canine aging, and be used as predictors. 

The following is a transcript of the video:

: [There are] a couple things that clinicians, I think, do with lab values that may be kind of problematic. One is, we get this idea of the normal range in our head. We take the reference interval and we look at it, and as long as the number is inside that box, everything's okay, and we don't have to worry about it. And I think most of us know, from some place back in our training, that the reference interval is just a statistical construct. You take a bunch of animals, you measure it [and] 95% of them fall in. That's the normal range, and that's considered okay. But it turns out that sometimes things can be outside of that range and still be normal, because 5% of the dogs had who were healthy had values outside that range. But also things can happen inside that box that are problematic, and you can see changes in trends over time that may be indicators of health problems, even though they haven't reached that cutoff threshold that we think of as normal.

What we found is that a lot of things that we often routinely measure can be associated with frailty and quality of life. So, for example, the liver enzymes, ALT and alkaline phosphatase. We measure them all the time. They're a routine part of clinical chemistry and practice, and if they're normal, we tend to ignore them. But both of those increase in dogs as they get older, and that increase is associated with declining quality of life and with an increased risk of frailty. And it may be that that's not causal. I don't think that the liver enzymes are causing those things to happen, but they're indicators. They're biomarkers. And the nice thing about that is they're easy to measure, because we measure them all the time already. So if we could find a way to use clinical lab values that we already are used to looking at in a new way as potentially predictors of problems, then that would flag certain patients for us for more intensive screening, for more aggressive therapies. You know, we would say, ‘well, hey, you know these 6 things, whatever they are, are going up in your dog, and they're still normal, but that's a bad sign that maybe something's coming in the future, and we should think about what we can do to improve weight, to improve diet, to improve exercise, to screen for diseases maybe that are subclinical.’ So that's our idea. These early associations with frailty and quality of life might be a trigger to us, and we could start paying more attention to some of these values before they hit abnormal.

Brennen McKenzie, VMD, MSc, MA, director of veterinary medicine at Loyal, a biotechnology company, and a clinical practitioner, discusses the use of lab values as predictors for disease. 

 I overheard an employee speak in a matter-of-fact tone with a client who called to schedule euthanasia for her dog. As a manager, how can I help my team express empathy when booking sensitive appointments?

End-of-life decisions are emotionally overwhelming for clients. A task as simple as booking an appointment may be one of the most difficult calls of pet owners’ lives. Client service representatives (CSR) need to be good listeners and offer much-needed support and information. Scripts can help your CSR team create consistent, comforting experiences over the phone.

Here are 6 steps to improve the call experience:

Let’s say the caller explains she is thankful for your doctor’s care during her dog’s terminal cancer, but it’s time to say goodbye. You hear the caller’s voice wane. Ask for client and pet names so you may emotionally connect with the caller and access the record. The Companion Animal Euthanasia Training Academy (CAETA) advises to begin calls with empathy statements and open-ended questions.

Say, “Your voice tells me how hard this call is to make. I’m here to listen and support your family [pause]. May I ask your name and your pet’s name so I may access your patient record?”

Use open-ended questions that invite the client to share details about the pet’s condition. To establish trust and emotionally connect with the caller, immediately use client and pet names. Say, “<Client name>, tell me about <pet name>’s condition and your wishes for peaceful euthanasia.”

Add notes to the record that will help the veterinarian and technician understand the family’s interpretation of their pet’s condition. Include information about the patient’s pain, anxiety, eating, and sleeping patterns, recommends CAETA.

3. Ask when the client wants an appointment

Clients may want to wait hours or days. Ask, “When do you want to bring <pet name> in?”

Let clients choose days and times that work best for them. Some may prefer quieter times such as the beginning or end of the day. Allow at least 40 minutes for attended euthanasia, giving clients ample time to say goodbye. Color-code appointments based on the reason for the visit to ensure your team notices euthanasia appointments and can appropriately greet clients and patients. Unattended euthanasia should be 30-minute appointments to allow clients to sign consent forms, choose final arrangements, and say goodbye.

If your hospital offers at-home euthanasia, ask, “Do you prefer the euthanasia service to be performed at your home or here at our hospital?” If the client requests at home, suggest choosing a favorite shade tree, bed, or place where the pet will be relaxed and comfortable. Share at-home euthanasia fees up front.

Whether scheduling in-clinic or at-home euthanasia, ask, “Will family and friends be attending with you?” If yes, ask how many people to expect so you may choose a larger exam room if services will be at your hospital, or, if at home, suggest having blankets or chairs for family who will attend.

because to the family it is not the pet’s body, it is still the pet, advise Mary Gardner, DVM, and Dani McVety, DVM, founders of Lap of Love Veterinary Hospice and In-Home Euthanasia.

 Ask, “What would you want to do with <pet name>’s final arrangements afterward?”

Introduce aftercare choices during the scheduling call, when clients can think more logically. Clients can discuss aftercare options with family members and decide before the day of the appointment. Emotions will escalate on the day of the appointment, making decisions harder.

Say, “You have 3 choices of what to do with <pet name> afterward. The first is to have your pet privately cremated with <crematory name>, our crematory partner who will work with you on final arrangements. The second is to have your pet communally cremated together with other pets with a resting place in a tranquil area on <crematory name>’s cemetery grounds. The third choice is to bury your pet at home, and you may want to check your county ordinances before deciding. You can do what you feel is best for you and <pet name>’s final resting place.”

Explaining fees in advance prepares clients for payment. Give totals or ranges rather than itemizing fees. If the client hasn’t decided on aftercare, provide fees for private and communal cremation. Say, “If you choose <crematory name> for aftercare, a private cremation averages $__ while communal cremation averages $__. I will include a link to their website in your appointment confirmation so you may learn about their services and fees.”

If the client requests private cremation, explain, “To help you prepare for the appointment, the total/range for euthanasia and private cremation services are $__. You will pay in the privacy of the exam room before the procedure and can spend as much time as you want with <pet name>. Afterward, we will prepare <pet name> for her/his final arrangements with the crematory. You may leave when you’re ready through a private exit into the parking lot. Our team can provide additional support and resources during the appointment.”

Ending with “Have a nice day” would be inappropriate. Let the client know what to expect next and offer kind words. Wrap up the call with, “You will receive a text/email shortly with your appointment confirmation. This will a include a link to our end-of-life services web page where you can learn more about the services we discussed and find resources. If you have questions before the appointment, please reach out to us. We are here to support you and <pet name>.”

Plan a CSR team meeting to discuss euthanasia scheduling calls. Have employees map out the process and write scripts together. Your goal is to create a standard operating procedure for euthanasia calls. Your team will diagram what to say in different scenarios, giving them confidence when handling tough discussions. As a result, your CSR team will have consistent, compassionate client conversations.

Need a script for a client conversation? Submit your scenario to info@csvets.com for future consideration.

Rose R. Receiving phone calls about euthanasia: CSRs - this one’s for you. April 15, 2024. Accessed August 1, 2024. https://caetainternational.com/receiving-phone-calls-about-euthanasia-csrs-this-ones-for-you/

Gardner M, McVety D. Handling euthanasia in your practice. 

. 2016;6(1):127-133. https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2016/05/ TVP_2016-0102_PB_Euthanasia.pdf

Wendy S. Meyers, CVJ, explains how managers can help their team express empathy when booking sensitive appointments

Compassionate conversations when scheduling euthanasia

The 2024 Southwest Veterinary Symposium (SWVS) kicked off on Thursday, September 26, in Fort Worth, Texas. With 

, here are 6 more presentations that attendees won't want to miss.

A New Look at Old Labs: Understanding Familiar Lab Values in a New Way as Indicators of Unhealthy Aging

During this session, McKenzie examines evidence that shows not all changes in clinical lab values can be dismissed as “normal aging,” including blood lipids, insulin, and ALP and ALT, among others.

Feline Pain is Purr-tinent, Too: Intervention For Feline Pain

Speaker: Kelly Foltz, CVT, LVT, RVT, VTS (ECC)

This session serves as a companion to Foltz’s lecture 

, and reviews the physiology of pain and ethology of feline pain behavior. Foltz explains current intervention strategies, including pharma and non-phrama alternatives.

Gastrointestinal Roulette: AHDS, GDV, GIFB, Parvo, or a Wild Card?

Sumners discusses triaging a range of GI disturbances and emergencies, in addition to core questions to ask the pet owners, initial interventions, therapies, and monitoring.

An Integrative Approach to Allergic Dermatitis: Curing the Seven Year Itch

Speakers: Steve Marsden, DVM, ND, MSOM, and Kären Marsden, BA, DVM

Steve and Kären Marsden will cover 3 Chinese medical diagnoses, and their associated treatments, aiming to resolve allergic dermatitis with traditional holistic medicine, providing past case examples.

Help! I Have Fallen and I Can’t Get Up: Recumbent Patient Care

In this session, Hart will discuss the effects that recumbency can have on various systems within a patient’s body, including urination and defecation, respiration, nutrition, body temperature, pain responses, and mobility, and explains methods of providing quality nursing care.

The Great Pretender— Addison’s Disease

Speaker: Angela Rathmann, CVT, VTS (ECC), (SAIM)

Rathmann will walk session attendees through the process of recognizing red-flags of a potential Addisonian patient as soon as they enter the hospital, in addition to discussing various pathophysiologies, presentations, stabilization, and treatment methods.

Symposium attendees should check out these events during the final 2 days of this year’s event

6 CE session highlights from days 3 and 4 of SWVS

Theresa Cosper-Roberts, RVT, CVPM, ACE(DE), CVBL, talks about medical errors in the veterinary profession

Theresa Cosper Roberts Medical Errors

In the United States, medical errors are the 3rd most common cause of death in human health care.

 In terms of veterinary care, a study of 606 veterinarians showed that 74% of these veterinarians surveyed had been involved in one or more medical errors, with more than half being affected professionally and personally by these events.

Oops, Whoops, and Oh No: Medical Errors at Veterinary Facilities

 at the Southwest Veterinary Symposium conference in Fort Worth Texas, Theresa Cosper-Roberts, RVT, CVPM, ACE(DE), CVBL, talked about medical errors in the veterinary profession.

She shared the most common reaction veterinary professionals have after making a mistake, and delved into reasons why these errors can occur while explaining what the Swiss cheese model of accident causation is, and more.

Theresa Cosper-Roberts, RVT, CVPM, ACE(DE), CVBL: 

Whenever there's an error, [people] run around screaming like Chicken Little, ‘The sky is falling. The sky is falling. Oh my gosh. What are we going to do?’ We're freaking out. We're blaming everyone. We're trying to figure out whose fault it was, and instead of assigning fault, we need to deal with things calmly and rationally: address the issue, make sure that the patient is okay, make sure that the person who committed the mistake was okay, and then go from there.

The big thing that we need to do as a profession is destigmatize errors. Things happen all the time. Everybody makes mistakes. No one is infallible, and we need to take away the stigma associated with making a mistake. And we need to have a…just culture where everyone has psychological safety, because when people are terrified of making mistakes, they're terrified of being punished or humiliated or embarrassed. They don't admit those mistakes, and that's when patients suffer. So…it's okay to make mistakes, it's okay to admit that we don't know how to do things or to question orders that we may think may be just slightly incorrect. That's how we can really prevent mistakes.

1. Bautista-Alejandre A. Using medical errors as learning opportunities. 

. June 10, 2024. Accessed September 27, 2024. 

https://www.dvm360.com/view/using-medical-errors-as-learning-opportunities