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PRACTICE ADVICE
Who does what ?
UNDERSTANDING DELEGATION ON THE VETERINARY TEAM
Veterinarians rely on their highly skilled support staff to help deliver safe , quality care to patients . The veterinary team includes veterinarians , ( registered ) veterinary technicians , assistants and administrative staff . Each member of the team brings specific skills , knowledge and experience that work together to provide veterinary services .
This team approach helps to build efficiency and effectiveness into practice . The College is often asked for a list of procedures support staff are allowed to perform . Such a list does not exist ( at least not anymore as policies have been updated ). Instead to answer this question , we need to review the action of delegation .
Regulation 1093 refers to all non-veterinarian staff as “ auxiliaries ” and does not make distinctions based on education or training level . A veterinarian uses his / her professional judgment and knowledge of his / her team members ’ competencies to determine who could be delegated which tasks and under what level of veterinary supervision .
The delegating veterinarian must ensure the auxiliary can perform the task as competently and safely as a veterinarian . At all times , the veterinarian remains accountable for his / her patients , and patient care is not to be compromised by delegation . This requires a cohesive team dynamic based on trust and respect . Tasks that may not be delegated to auxiliaries are diagnosis , prognosis , prescribing or performing major surgery .
Determining the level of supervision of auxiliaries as they perform delegated tasks is again up to the veterinarian ’ s judgement and based on such parameters as the level of risk of the task . Supervision can be immediate ( in the clinic and can see / hear the auxiliary ), direct ( in the clinic and accessible to the auxiliary in a timely and appropriate manner ) or indirect ( not in the clinic but communicates with the auxiliary before and after the task is performed and can be available to the auxiliary as required ).
As with all other aspects of practice , delegation can only occur within the context of an established veterinarian-client-patient relationship ( VCPR ), with informed client consent . Let ’ s look at a few examples based on questions received by the College .
Can my staff weigh a patient and dispense Heartworm / Flea / Tick preventative medication if my client wants the same medication as in previous years ? Prescribing may not be delegated . A protocol can be set so staff can gather information on a patient , such as weight , and draw blood for diagnostic tests . This information would be reported to the veterinarian to prescribe . The labelling and dispensing of medication could then be delegated .
I would like to send my RVT out to my client ’ s farm to ultrasound some of her sheep to perform pregnancy checks . An RVT can gather clinical information , such as performing an ultrasound and can be supervised indirectly . It is common for RVTs with the appropriate skill set and competencies to be involved with the performance of diagnostic imaging modalities that the veterinarian has ordered . However , only a veterinarian can make a diagnosis and pregnancy checks , by any means , to confirm pregnancy in an animal , is a diagnosis .
I would like to offer free dental exams to my patients / clients . My RVTs would examine the patients and prepare a dental treatment plan and quote for our clients . Assessing teeth in order to develop a treatment plan requires a diagnosis to be made . Diagnosing may not be delegated . Only a veterinarian can assess teeth / the oral cavity of a patient in order to develop a diagnosis and / or determine a treatment plan .
Can my RVTs neuter cats ? Surgical procedures cannot be delegated .
A client was upset when they found out my RVT administered the anesthetic to his animal . As part of the informed client consent process , clients are to be informed if auxiliaries will be providing some or all the care of the animal ( s ).
I would like my technicians to do vaccine booster appointments so that I can charge my clients less . Auxiliary staff are a valuable part of the appointment process to improve efficiency and effectiveness . They can gather information that assists the veterinarian in assessing the patient to reach a diagnosis ( in this case that the animal is healthy and able to receive a booster vaccine ). If a recent examination by the veterinarian was conducted and additional information gathered by the auxiliary staff satisfies the veterinarian that further examination of the animal is not required , a veterinarian can delegate the vaccine to be given .
These scenarios highlight how veterinarians can delegate appropriately so risks to their patients and the public are mitigated . Veterinarians use various data to formulate their assessment of a patient to make a diagnosis and / or develop a treatment plan . Auxiliary staff can help gather this information and they can be responsible for implementing all or part of the treatment . Clients need to know when auxiliary staff will be performing aspects of a procedure or treatment so they can ask questions or decline consent for an auxiliary to perform a task . When delegating , be sure you are meeting your professional obligations to minimize risk to your patients , your staff and yourself .
If you have a question associated with the practice of veterinary medicine , please contact the College ’ s free and confidential practice advisory service .
1-800-424-2856 / 519-824-5600 x2401 or practiceadvice @ cvo . org
Summer 2018 / 7