Any good training program starts with standardization of procedures so they can be taught and readily duplicated by staff members. Consistency of process is an asset anywhere in your practice but especially in the prep room and surgery.
Using staff in this area is one of the most common forms of staff leveraging and is already widely done in many hospitals. Many of the tasks are technical and can be taught readily to a veterinary nurse and veterinary assistant. This frees up the veterinarian to do what we do best in this area - perform surgery.
When creating training materials you must first identify what needs to be trained and then write it down. The first training documents that need to be created are what we call "service sequences" in our hospital. These explain how a service is to be delivered, in chronological order. For example, when a patient is admitted for a surgical procedure it needs to be outlined who greets the client, who admits the pet, who sets up the kennel, who premedicates the pet and sets up the surgery, who places the intravenous catheter, who monitors the anesthesia and recovers the pet, who calls the client once their pet is recovered and who does the discharge.
Standardizing and writing service sequences for these procedures will remove confusion and miscommunication in your hospital and leaves the veterinarian available to do the surgery. Similar service sequences need to be prepared for day-admit patients and patients that are hospitalized.
When a patient is admitted for surgery, everything should be outlined in advance, including who pre-medicates the pet.
Once these service sequences have been created so that everyone understands the workflow, then identify all duties that need to be trained and prepare written protocols.
Set up protocols for:
- Supplemental heat
- IV set up
- Drug mixtures
- Kennel set-up and cleaning
- Anesthetic machines
- Endotracheal tube selection and cleaning.
- Surgical site preparation
- Set-up for routine surgeries
- Anesthetic monitoring
- Postoperative patient care
- Pain management protocols.
- Dental prophy set-up and clean-up.
- Surgical instrument care and cleaning.
- Autoclave use and cleaning
- Radiology set-up and maintenance
- Anything else that applies to your hospital.
In multi-doctor practices, establish a consensus on the standardized service sequences and other protocols. This may be your biggest hurdle. However, the benefit to the practice far exceeds the effort required to get a collective agreement for training. Staff will be first to celebrate standardization since it alleviates their need to adjust based on what veterinarian they are working with on any given day.
Involve staff in the process
Before you decide that you will never have time to write all these training documents, take time to identify the people in your hospital who perform such duties and have them help prepare the documents. Who better to prepare training materials than those who are already doing it well. These protocols should be concise and useable as a quick reference for staff. Once the necessary documents have been written in a simplified, understandable form, assemble the material into a manual and begin training. Once again, remember those people in your practice who excel at these duties and recruit them to help with training. This manual should be available in the prep room of your hospital at all times so it can be used as a quick reference for your staff. Keep in mind when you are training that everyone has a different learning approach. Once you train the written word it may be useful to run an in-hospital "wet lab" where all trainees can apply the training hands on.
Fig. 1: Anesthesia Admitting Form and Fig. 2: Anesthesia Monitoring.
Practice makes perfect
Once your staff has the necessary training, they need to be scheduled to work in this area on a regular basis to hone their skills. This may mean a rotating work schedule that buddies a more experienced staff member with a less experienced one. Remember, the only way we get good at a technical skill is to practice. It is very difficult to watch a nurse blow a vein while taking blood or placing an intravenous catheter, but it is an essential part of learning. Let them do it.