Sample Operations Manual 2010

Sample Operations Manual
2010
version
2010
SAMPLE Operations Manual
2010
Table of Contents Clinic Information

Mission Statement Vision Statement Clinic History Core Values Goals & Action Plans 3 4 4 4 4 4 5 6 7 8 9 10 11 12 14 15 16 17 27 28 29 29 31 39 40 41 45 46 47 51 55 56 57 58 59 60 61
Clinic Director
Job Description & Responsibilities Organizational Chart
Office Manager
Job Description & Responsibilities
Transport Personnel
Job Description & Responsibilities Transport System Contract Training Checklist
Veterinarian
Job Description & Responsibilities Surgery Instructions
Medical Support Staff

Job Description & Responsibilities Veterinary Technician Job Description & Responsibilities Veterinary Assistant Medical Support Staff Job Requirements Training Protocol
Standard Operating Procedures

Office Procedures Surgical Program Requirements Surgery Room Procedure AM / PM Procedures Surgical Pack Procedures Disease Control Procedures Budget Process & Financial Guidelines Important Phone Number, Websites, & Resources
Risk Management
Insurance Guidelines Crisis Response Procedures Code of Conduct
Forms
Clinic Information
Clinic Information
Clinic Information
Mission Statement
Insert Mission Statement Here
Vision Statement
Insert Vision Statement Here
Clinic History
Insert Clinic History Here
Core Values
Insert Core Value Here
Goals & Action Plans

Insert Goals & Action Plans (for the current year)
Clinic Director
Clinic Director
Clinic Director

JOB TITLE: JOB SUMMARY: Clinic Director To give direction and leadership toward the organizations mission, strategy, and annual goals and objectives. To implement and manage the strategic programs, services, goals and objectives of the organization. Board of Directors
REPORTS TO:
RESPONSIBILITIES: 1. Support operations and administration of Board by advising and informing Board members. Operate organization according to policies set by Board of Directors. Report progress and statistical performance measures quarterly. 2. Manage the design, marketing, promotion, delivery, and quality of programs and services. Identify and implement the goals, objectives, methods, and resources necessary to accomplish the specific mission and programs of the organization (strategic direction planning, business planning, project planning, staff planning, etc. 3. Recommend yearly budget for Board approval and manage organizations resources within those budget guidelines. 4. Oversee the human resources of the organization according to personnel policies and procedures. 5. Write and oversee grant applications including planning and implementation, identify resource requirements, research funding sources, establish strategies to approach grants, approve proposals and administrate records, documentation, and appropriate expenditures. 6. Measure the organizations performance with regard to finances and specific program services.
Clinic Director
Organizational Chart
Here are 2 examples of an organizational chart (adjust accordingly) SAMPLE 1
Board of Directors
Clinic Director
Veterinarian
Office Manager
Transport Personnel
Vet Tech
Volunteer
Vet Assist
Sample 2
Board of Directors
Veterinarian
Clinic Director
Vet Tech
Office Manager
Transport Personnel
Vet Assist
Volunteer
Clinic Manager
Office Manager
Clinic Manager

JOB TITLE: JOB RELATIONSHIPS: JOB SUMMARY: Office Manager Reports to Executive Director/Director of Clinic Operations; provides supervision for all office personnel and volunteers. Responsible for overall operations of office and service counter; maintain complete records of clinic activities.
RESPONSIBILITIES: Supervision and Client Services: 1. Oversee operations of the main service counter. 2. Ensure quality client service. 3. Report employee or client problems to Director. 4. Assist the Executive Director in administrative duties. 5. Make daily bank deposits. 6. Maintain accounts receivable. Patient Information: 1. Maintain patient database. 2. Create rabies certificates. 3. Ensure proper paperwork goes home with each patient. 4. Maintain complete records for all patients. 5. Ensure that proper supplies are kept on hand. 6. Provide in-person and telephone client services and answer questions. 7. Ensure that owners are happy and comfortable with leaving their pets in a safe and loving environment. Office Manager Duties: 1. Billing: Check with veterinary technician to see if all scheduled vaccines were administered and all scheduled surgeries were performed. If not, remove appropriate charges from invoice; add anything extra the animal may have received. Post invoices at the end of every day. Check daily invoices for errors. Retain a copy of each invoice. 2. Accounts Receivable: When payments are received, make a copy of all checks and attach to appropriate retained invoices. Record payments on the day sheet. Enter payments in the database. 3. Account Reconciliation: Prepare monthly accounts receivable reports. Contact any overdue accounts. Send report to the accountant. If a problem cannot be resolved, notify the Director.
Transport Personnel
Transport Personnel
10
Transport Personnel

JOB TITLE: JOB RELATIONSHIPS: JOB SUMMARY: Transport Personnel Reports to Executive Director Responsible for transport of animals between shelters and the clinic, including scheduling of transportation and maintenance of vehicle.
RESPONSIBILITIES: General transporting: 1. Schedule pick-up and delivery by the month; accommodate groups with regard to day and time, if possible. 2. Be punctual for pick-ups; if unavoidably late, advise by phone. 3. Carefully screen all animals to determine fitness for surgery. Any animals showing signs of illness will not be loaded on transport. 4. Be careful and gentle with animals in loading and unloading. 5. Make sure all animals are in crates and crates are closed. 6. Secure all crates in back of transport vehicle. 7. Call the clinic with an animal count at completion of pick-up. 8. Make sure all animals are on return delivery (check-off on transport list). 9. Drive defensively with care and caution; observe speed limits and all good driving rules. Vehicle Care: Clean and sanitize the animal compartment of vehicle each day. Clean the exterior and driver compartment of vehicle on a regular basis. Responsible for maintenance of the vehicle on a regular basis; breakdowns jeopardize the animals and cause unnecessary delays.
11
Transport Personnel
Transport System Contract

OUR GOAL The goal of [CLINIC NAME] is to reduce future generations of unwanted animals through the non-lethal solution of surgical sterilization. In addition, by requiring rabies vaccinations at the time of surgery, we hope to help control the incidence of rabies in our community. PAPERWORK Admission forms will need to be obtained from [CLINIC NAME] at a cost of $0.00 per xxx. All forms must be completed. If there is not an owner signature, we cannot legally do the surgery. Please be certain that every animal has an admission sheet. If the owner has two or more animals, an individual admission sheet is required for each animal. WHAT OWNERS NEED TO KNOW Surgical fees Your organization will be invoiced for all patients received at the clinic. The invoice will be sent in hard copy with your return transport. Vaccinations. The following vaccinations are available: DA2LPPv Bordetella FVRCP FELV Rabies (canine distemper/parvo) (kennel cough) (feline distemper combo) (feline leukemia) ([CLINIC NAME] requires proof of rabies. If no proof is provided, the animal will receive the vaccination and the owner will be charged.)
Pre-op instructions. Animals older than 4 months must not have any food after 12:00 midnight the night before surgery (water is okay). Animals younger than 4 mo. may have food and water. This is very important for the safety of the animal. If there is any question that the animal may have had food, please ask the owner to re-schedule. Tattoos All owners need to be notified that their animals will receive a small tattoo on their underbelly near the incision sight. The tattoo is very important to identify that the animal has been spayed or neutered. This is to ensure that if lost, the animal will not have to go through unnecessary surgery in the future. Prior medical concerns Please ask the client if their animal has any prior medical concerns. Females that are pregnant or in heat are done by [CLINIC NAME] daily; however, it is good to let the owner know that they are at a slightly higher risk during surgery. Advanced age is also a concern; we require a preanesthetic blood panel before surgery for any animal eight years old and up. Strays Please let us know if female animals are strays and could already have been spayed. Scheduling Proper scheduling is crucial to the daily success of our clinic. It is very important to call in your appointments (divided by sex and species) no later than 12:00 pm, three business days prior to your transport. This gives us time to fill in any gaps with our public appointments. If we are not
12
Transport Personnel
notified of your appointments within 72 hours your transport may be canceled. Name collars (disposable) Make sure the animals name, the owners last name, and the shelter ID are on the animals collar. If there is no owner a shelter number is required. Animal carriers It will be your responsibility to have enough carriers for your transport. Please make sure that all carriers are lined with newspaper and labeled with the animals name and/or number. Fees Money and change are the responsibility of the organization; the driver does not carry change. The shelter will be invoiced for all animals (shelter and owned) on their transport. Dates and times The transport schedule will be set up at least two weeks in advance. Normally you will have a rotating schedule. However, the schedule is subject to change. Make sure to have the owners arrive in enough time to do the paperwork, collar the animal, and label the carrier before the transport van arrives. Surgical Costs Female dogs Male dogs Male cats Female Cats Vaccinations Heartworm Test FIV/Felv Test $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Signatures: I understand and agree to follow the above procedures while participating in animal transport with the [CLINIC NAME]. ____________________________________________(Name) ____________________________________________(Organization) Date:_________________________
_____________________________________________ [NAME], Clinic Director, [CLINIC NAME] Date:_________________________
13
Transport Personnel
Training Checklist
TRANSPORT GROUP___________________ PICK-UP SITE__________________________ RETURN DATE________________________ DATE OF TRANSPORT____________ PICK-UP TIME____________________ RETURN TIME___________________
CHECKLIST 1. All scheduled animals and their corresponding paperwork should be ready at least 30 minutes prior to the arrival of the [CLINIC NAME] transport vehicle. 2. All pets must be secured in clean, plastic, size appropriate crates. For the health and safety of the animals, wire crates are not acceptable. Doors on crates must fasten securely. 3. Make sure that bolts are not missing from the perimeter of the crate. If they are, please fasten top and bottom of crate together with heavy-duty zip ties. 4. Animals should not be muzzled, for their own health and safety. 5. If pet owners send blankets, towels, toys, collars, leashes or other personal items in crates, please inform them that there is no guarantee that these objects will be returned with their animal. 6. No more than one animal allowed per crate! Exceptions are small puppies less than 16 weeks old (no more than 3 per crate) and domestic cats from the same house-hold (no more than 2 per crate). 7. Feral cats must be in live traps. 8. EACH CRATE MUST BE CLEARLY MARKED WITH THE FOLLOWING IDENTIFYING INFORMATION: Animal first and last name and the transport groups ID letters or name. 9. All animals must have paper neckband/collars for identification. No regular collars, flea collars or leads. Using permanent marker, please include the following information on the neckband: animals first and last name and the transport groups ID letters or name. For very large dogs, or for fractious dogs or cats, the ID neckband may be attached to the crate handle. PLEASE ENSURE ALL PAPERWORK HAS BEEN PROPERLY COMPLETED AND SIGNED BY THE PET OWNER PRIOR TO THE ARRIVAL OF THE [CLINIC NAME] TRANSPORT VEHICLE. 10. A transport group representative must witness proof of rabies vaccinations and verification of such must be initialed on the Admission Form. PLEASE NOTE: If there are no initials, [CLINIC NAME] must administer a 1-year rabies vaccination and charge the transport group accordingly. 11. Admission Sheet must be signed. [CLINIC NAME] will not perform surgery without a signed admission form. 12. Please have sufficient number of staff/volunteers to help with the transport loading process.
14
Veterinarian
Veterinarian
15
Veterinarian

JOB TITLE: JOB RELATIONSHIPS: Veterinarian Reports to Medical Director/ Executive Director, provides supervision for all veterinary technicians, veterinary assistants, kennel staff and volunteers. Responsible for daily care and sterilization of all surgical patients and maintenance of preventative health programs and medical protocol. Quality patient care is first and foremost.
JOB SUMMARY:
RESPONSIBILITIES: 1. Supervise veterinary technicians, veterinary assistants and kennel personnel. 2. Examine animals pre-op to determine their ability to withstand surgery. 3. Perform surgical sterilizations. 4. Examine animals post-op as necessary to ensure appropriate healing. 5. Inoculate animals and provide recommendations for follow up care. 6. Supervise cleaning program for prevention of infectious/zoonotic disease. 7. Continue research and maintenance of safe and efficacious medical protocol regarding anesthesia and surgery. 8. Supervise handling and recording of controlled substances by veterinary technicians. 9. Supervise post-op rechecks and order of medical treatments as necessary to ensure complete surgical recovery. 10. Actively promote spay and neuter, and educate clients on responsible animal ownership. 11. Actively support associate staff and volunteers, and promote the development of skills related to the advancement of our goals and mission. 12. Represent the [CLINIC NAME] in a professional and courteous manner at all times. 13. Provide quality service to clients, volunteers, and staff recognizing their individual contributions to the success of our organization. 14. Participate on committees and special projects as assigned. 15. Other duties as assigned.
16
Veterinarian
Surgical Program Requirements

All patients are given a physical exam before any injections are given: 1. 2. 3. 4. 5. 6. 7. Auscult heart and lungs Mentation/activity level Body condition (Tufts animal care and condition scale) Ocular and/or nasal discharge Hydration status Mucous membrane color Any obvious abnormalities
If any abnormalities are noted, a complete physical exam is performed including temperature evaluation and a decision is made as to the animals fitness for surgery. The following conditions are examples of basis for rejection: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. URI of any magnitude Diarrhea Vomiting Moderate to severe skin disease Ocular disease Severe obesity Poor body condition Depressed attitude Sneezing/coughing Heart murmur
Anything that might indicate an undiagnosed condition that may compromise the patient during anesthesia, recovery, and/or healing will be considered reason for refusing surgery. Although the mission of [CLINIC NAME] is to sterilize as many animals as possible, OHEs and castrations are still elective procedures, and the individual animals well-being comes first. If it is in the animals best interest to have the surgery postponed, then arrangements are made to do so. Females that are in labor when they arrive are not subjected to surgery; at this point it is too late. They are either sent home or given food, water, and a warm bed in a quiet environment and allowed to give birth. Also, when a patient vomits undigested food, we will not do surgery on that day. We may hold the animal over until the next day or reschedule, depending on the circumstances. Minor conditions that are noticed after induction are reported to the owners on the post operative sheet, to be referred to an area veterinarian for treatment, and recorded on the medical record. Cats have their ears checked by the staff during prep, and those that appear to have ear mites may be treated. We have Doramectin for treating shelter, rescue, and feral cats for ear mites. Most of these cats will never be seen by a veterinarian again, and we feel an obligation to try to relieve them of such conditions while the opportunity exists. Anesthesia is always to be avoided when not necessary. All females over 16 weeks of age with unknown history must be shaved for signs of having already been spayed (ABS). This includes shelter, rescue, and public animals that were stray. Signs that indicate an ABS are: mid-line scar, tattoo, undeveloped nipples and vulva on an older
17
Veterinarian
female. Keep in mind that very large scars may indicate a C- section, which may have left the uterus intact. The whole picture must be considered in each case. All males must be checked for two testicles. Cryptorchid animals less than 6 months of age should be rescheduled to allow time for the testicle(s) to descend. Male cats without testicles should be checked for cheek development and spines on the penis to determine if they have already been neutered (ABN). Prior to performing a cryptchorid surgery, the surgeon should palpate the inguinal area. Final pre-op considerations Doctors need to check their patients anesthetic machine for correct set-up before beginning each and every surgery. Mistakes are sometimes made and early detection saves lives. Doctors also need to check feline patients sex before draping in - occasionally a male is prepped as a female, and it is ultimately the doctors responsibility to prevent a male cat from having his abdomen opened. Also, always check female patients for scars - although we try to identify ABSs prior to pre-med, they are occasionally missed by the staff, and the doctor should not make the mistake of missing a scar before opening the abdomen on an animal that has already been spayed. Surgery Five knots on all sutures. This technique has been proven to eliminate dehiscence, and must always be used. Large bites on the Linea alba: include at least 5 to 8 mm muscle tissue in the linea closure in cats and up to 10 to 12 mm in large dogs. We never use simple continuous patterns in the linea-only cruciate or simple interrupted. Large bites in the subcutaneous tissue. At least 3-layer closure-linea, SQ, and subcuticular plus skin glue or staple/skin sutures. No crushing sutures in closing - linea and subcutaneous tissue should be snugly and completely closed but never crushed. Dead space should be closed and the SQ should be anchored at least at both ends of the linea incision. Linea and subcutaneous tissue are closed with absorbable suture. Skin edges should be properly apposed - never allow one side to flap over the other or extend above the other. Skin glue should not be applied between the skin edges but on the surface after apposing the edges. Millers knot - we use this knot on the ovarian pedicle and the uterine body. It is extremely secure, minimizing complications. We may use a Millers knot in conjunction with a modified transfixing ligature on the uterine body of a pregnant female with very large uterine vessels. Modified transfixation ligature - We use this ligature on adult dog castrations. Canine castrations are usually done as closed, except on older dogs where it is more difficult to separate the epididymal ligament from the scrotum. If an open castration is performed, the vaginal tunic is closed before placing the subcutaneous sutures. Cat and puppy neuters, special technique: for neuters of cats and puppies under 12-14 weeks of age, we tie the vas deferens and vessels off on themselves in a figure 8 knot. This knot is much less likely to come untied than a simple square knot. A diagram is available illustrating this technique.
18
Veterinarian
In cryptorchid male dogs, we have found that a para median incision through the muscle layers is preferable to a midline incision since it allows easier location and externalization of abdominally retained testicles. Surgery begins as early as possible in the shift, and doctors should be ready to perform surgery at this time. One doctor should arrive earlier in order to examine animals to be approved for surgery as they are checked in. Doctors rotate recovery. This is an informal arrangement made each week. Post-operative care To calm patients recovering from surgery, environmental stress is reduced as much as possible. Human activity is minimized and lights are kept off. The door to the cat room is kept closed. Doors to the dog kennel should be kept closed at all times. Blankets should be hung over cages of overly excited patients. Pain Management Veterinary medicine now requires a standard of care that incorporates pain relief for patients undergoing painful procedures. OHE and castration are both known to be painful procedures requiring treatment for pain. Pain is best controlled by prevention, and incorporating effective drugs into the pre-medication or induction protocol can effectively prevent windup of nociceptors and greatly reduce the level of pain experienced by the patient, as well as the amount of drug needed during recovery. Our protocol reflects this data. The current recommendations encourage the use of multimodal analgesic therapy. In fact, two to three different forms of analgesics used in combination appear to be the most effective. Of those combinations, the most common ones utilized by boarded specialists are opioids with NSAIDS. The recommendation that hydration status should be closely evaluated and that SQ fluids be administered preemptively is appropriate. Specifically, in addition to Morphine for canine patients and Buprenorphine for feline patients, supplemental pain medication is also utilized (Meloxicam or additional Buprenorphine). Anecdotally, we have had serious post-operative hemorrhaging resulting from the use of Ketoprofen in dogs, and no longer use this drug. Supplemental Support All pregnant females in the third trimester have an IV catheter placed and fluid therapy administered appropriately during the procedure. Ideally, fluids should be warmed. Any other patients needing fluid therapy for any other reason also receive it in SQ or IV form. Immediately after removal of the uterus, fetuses of third trimester pregnancies are removed from the uterus and euthanized. All cats, kittens, puppies, and small dogs get hot water bottles or rice bags, and sugar lips upon removal from the surgery table. Anyone showing signs of hypothermia gets a heated rice bag and extra blankets as needed. Every patient gets a clean, appropriately sized blanket; the patients entire body should be placed on his/her own blanket, not on the larger community blanket, which covers the entire recovery area. The recovery area needs to be kept clean at all times. Adult male dogs may receive a scrotal wrap to help reduce the incidence of scrotal swelling post-op. The scrotal wrap is removed prior to discharge. Antibiotics are available for patients that need them (pyometras, URIs that arent caught until after induction, sterile field contamination, etc.).
19
Sample Operations Manual Recoveries
Veterinarian
Dogs stay in the recovery area until sternal or actively trying to get up. Cats stay until lifting their heads. We have found that one of the best indicators of a normal recovery is level of consciousness. Regardless of vital signs, an animal that is not regaining consciousness at a normal rate should be closely assessed for post-operative hemorrhaging. If unresponsive to stimulation, an abdominocentesis and hematocrit should be performed. The animal should be re-anesthetized and explored if blood is obtained on the abdominocentesis and/or the hematocrit level is of concern to the veterinarian. Patients are never left unattended until consciousness has been regained - those that need to be monitored overnight for any reason should be sent to a full service 24-hour facility for additional care, after the owners have been contacted. At the end of the day, all patients are given a final check by a doctor. They are assessed for recovery status, signs of complications, and are ensured of a clean, dry, warm bed. Male cats are especially prone to urinate on their beds during recovery. No patient should ever be made to lie in a soiled bed overnight. Cats having a rough recovery from Telazol may receive a low dose of sedative to smooth out their recovery and prevent self-injury. The staff gives a small amount of dry food to recovered adult patients at the end of the day. Pediatrics who are fully awake are given a small amount of dry food and water. The water is always removed at the end of the day, not left in the kennel overnight. Re-checks: When possible, doctors should try to see their patients re-checks and contact the owners of their patients. This is not always possible with part-time doctors, so we try to assist when needed. Health Exam for Dogs and Cats Eyes - Look for signs of discharge from the eyes. This is an indication of an upper respiratory infection. Nose - Look for signs of nasal discharge. This is also an indication of an upper respiratory infection. Body Condition - The animal should have good muscle mass (ribs, vertebrae, and hips should not be easily visible). Mammary Glands - If heavily lactating, the animal should not undergo surgery. Check to see if milk comes out easily. If glands are hard, the animal may have mastitis. Hydration Status - Lift up skin between shoulder blades. Tenting of the skin is abnormal and indicates a level of dehydration. Mucus Membranes - Gum and conjunctiva should be pink and moist. Stool - Runny/watery diarrhea or loose stool with blood in it indicates that the animal is a poor surgical candidate. Heart and Lungs - Auscultation to evaluate status.
20
Sample Operations Manual Surgery Room Procedure Once the assistant brings the patient into surgery, the surgeon verifies that: Appropriate levels of oxygen and isoflurane are set. Appropriate size re-breathing bag is attached. The pulse oximeter is attached.
Veterinarian
The surgeon ensures that the patients vital signs are within normal limits. The surgeon gloves in using sterile technique. The surgeon retrieves sterile surgical instruments necessary for the given procedure (spay or neuter) from the instrument table, as well as sterile suture material and needle. Administer vaccines post-op 1. Canine Rabies SQ R Distemper SQ L Kennel Cough (Intra-nasal) 1. Feline - administer all feline vaccines in leg (not foot), as low as possible FELV SQ L rear leg FVRCP SQ R front leg Rabies SQ R rear leg
Surgery Instructions
INTRODUCTION While cost is consistently a factor at high-volume, high-quality, spay/neuter clinics, the quality of our procedures must always come first. Quality is routinely defined as a degree of excellence and it is with this concept in mind that we must address each aspect of patient care. The quality of our procedures should encompass not only the surgery, but pre- and postoperative care as well. In order to implement the highest standards, each patient is monitored with a pulse oximeter, the greatest attention to detail is given to the cleaning and sterilization of surgical packs, and the use of cold sterile techniques has been eliminated from our protocols. Additionally, each surgeon is required to cap, mask, and glove, and gown if deemed necessary, for each patient. Our standards provide for more than ensuring the well being of our patients; they enhance the overall community perception of our program. Client and veterinary acceptance is a vital tool in promoting the reputation and recommendation of high-volume, high-quality, spay/neuter clinics. In addition, we constantly strive to improve our protocols, through reading current publications and making and maintaining relationships with prominent faculty at research institutions. PROCEDURAL OVERVIEW The surgical procedure itself should maintain a routine sequence of events to verify that each patient is receiving the same standard of care. The surgeon should ensure that the technicians follow a thorough protocol for surgical prep of the patients including but not limited to complete clip, debris removal, surgical scrub, and bladder expression in females. As the surgeon approaches the patient in the OR, a generally accepted practice would be to double-check the status of the patient. For example, the patient should be properly connected to the anesthesia machine, oxygen and
21
Veterinarian
isoflurane levels are appropriate and the pulse oximeter is operational. Also, it should be confirmed that the patient is at the correct plane of anesthesia and the veterinarian must verify sex of the patient, especially with cats. Finally, it should be noted that the patient is in proper position for the surgery and that the light source is directed toward the incision site. At this point, the veterinarian may glove-in and proceed. The patient is draped in with dealers choice. This simply means that the surgeon might select 3 or 4 quarter drapes, with or without a fenestrated drape. Any combination of the above is considered acceptable, with the most important feature being that there is an appropriate barrier to prevent contamination of the surgical site. The incision placement will obviously vary with both the sex and the species of the patient. We have also determined that varying the incision placement depending on the age of the patient can improve the efficiency of the entire procedure. Incisions in adult female dogs are generally placed approximately 1 inch caudal to the umbilicus, while the incision in a pediatric female dog would be placed approximately half way between the umbilicus and pubis. When spaying an adult or pediatric cat, the incision is approximately half way between the umbilicus and pubis. In adult male dogs, the standard approach is a prescrotal incision. However, in pediatric male dogs, the routine approach is scrotal. In fact, many spay/neuter veterinarians will actually perform a modified scrotal castration in adult dogs that have non-pendulous scrotums. The most important factor being that the same meticulous tissue handling is observed as in any other procedure. A tattoo is applied to all patients to ensure no future unnecessary anesthesia or surgery. We perform a scoring procedure to accomplish the tattoo, by placing a small (~1cm) incision in dermis near the incision site and applying ink (see illustration). We prefer paste vs. liquid ink in that it is neater and stays in place better, and green is more obvious, especially on animals with darkly pigmented skin. CANINE OVARIOHYSTERECTOMY The overall size of an incision will vary depending upon various factors, the most obvious being the experience and/or comfort level of the surgeon. Repetition over time will tend to naturally decrease the size of the incision to as little as 0.75cm in some patients. Another factor that aids in efficiency is the use of the blade without the scalpel handle; even a practice as minute as this saves time and creates less instrument cleaning. Once the skin has been excised, a small amount of subcutaneous adipose tissue is removed to improve visualization of the linea. This technique decreases the time necessary to enter the abdomen, but it also decreases both the time and difficulty of the closure. With this approach, the layers of linea, subcutaneous and subcuticular tissues can be more straightforwardly apposed. The linea is incised by utilizing the thumb forceps to tent the linea. The scalpel blade is positioned sharp side up to puncture the linea and the incision is extended while using the thumb forceps as a guide to safeguard the abdominal contents. Once entry is made to the abdomen, the falciform ligament is dissected as necessary. Due to the small size of the incision, it is typical practice to utilize a spay hook to locate and exteriorize the first ovary. Learning to properly use a spay hook can occasionally be a challenge in itself. In most cases the best technique for its use comes with trial and error. As a rule, the thumb forceps are used to tense the body wall and the spay hook is inserted with the hook toward the midline but held tightly against the body wall. (the Vet School flip or turning the
22
Veterinarian
instrument once inside has been ineffective for us). The spay hook is advanced to the dorsal most aspect of the abdomen and lift between colon and bladder. The recommendation during vet school has classically been to do the left side first since the ovary is more caudal and easier to locate. However, we have found that going for the right ovary is many times easier to locate with the spay hook because of the tightness of the uterine horn on that side. The ovary is frequently higher on the right and therefore, more obvious tension is felt when the spay hook is retracted. Anecdotally, we have noted that the horn and/or broad ligament is more easily located in dogs when the spay hook is advanced caudally during the abdominal slide. In cats, we have found that advancing the spay hook in a perpendicular fashion is more productive. Usually, the surgeon will report the status of the uterus to the technician at this time. At this point, the suspensory ligament is broken. This is accomplished by placing tension on the ligament and applying digital pressure to tear. It is helpful to recognize the groove created just below the border of the proper ligament. In rare cases you may need to nick the ligament with a blade to facilitate its rupture. In order to isolate the ovary, create a window in the broad ligament and place the appropriate size carmalt well below the ovary seated tightly. It is extremely important to give yourself room for a tag above the carmalt. This will allow for efficient ligature placement without slippage of the pedicle from the clamp. Place a clamp above the ovary for hemostasis and while leaving the tag, cut the ovary away. Select appropriate size suture and place Millers knot below carmalt. Double ligation may be necessary in some large breed and/or pregnant or in-heat dogs. Use thumb forceps or hemostats to hold tag to verify no oozing as carmalt is released. Follow the uterine horn to the bifurcation and repeat the steps above on the opposite ovary. It is more efficient to tear away the broad ligament when proceeding to each new step. This prevents the necessity to go back and deal with it later. Occasionally, some bleeders may need to be ligated in the broad ligament. This may be accomplished via suture or instrument tie. Proceed to the uterine body and ensure a complete ovariohysterectomy is performed. This eliminates the possibility of a stump pyometra and decreases the risk of adhesions to the bladder. The uterine body is exteriorized to allow for proper placement of ligature(s). Place a Millers knot securely above the cervix but below the bifurcation. In some in heat or pregnant patients a modified transfixing suture may also be necessary. Keep in mind that in pregnant patients when the uterus is removed, a natural reflex will be contraction of the tissue. Thus, the knot security should be closely checked. In patients with extremely friable tissues, remember that less may be more. Place clamp for hemostasis but not too close to ligatures to prevent unnecessary distortion of tissue. Cut proximal to clamp and remove uterine body. Check for oozing as the clamp is released and tension on uterine body is decreased. Complete a visual sweep of the abdomen. Perform closure of the linea making certain to acquire full-thickness bites through the linea. The surgeon should select an appropriate suture size and close with cruciates. NO continuous patterns in the linea. The cruciate is more efficient because it allows for effective apposition without relying on one pattern to hold the entire incision closed, and is faster than simple interrupted. The last cruciate should leave one tag long and one end as the runner to proceed into the subcutaneous closure. Perform closure of the subcutaneous and subcuticular tissues. The runner from the linea is used to place a simple continuous closure of the subcutaneous tissue to the opposite end of the incision tagging down to the fascia as you go. Then, the subcuticular tissue is closed with an alternating continuous (railroading) back to the last tag of the linea. The runner is then tied off to the last tag and the knot is buried. The knot is buried to prevent wicking and to ensure appropriate skin apposition. The closed incision then has glue applied to the skin surface. The glue should be applied on, NOT in the incision. Glue in the incision can lead to a foreign body
23
Veterinarian
situation and delay healing. Rolling of the incision (inverting the incision) can be helpful in pediatrics to avoid issues with licking and wound contamination by creating a natural bandage. Ensure patient has been removed from inhalation anesthetic and administer any vaccines/injections intended for that patient. FELINE OVARIOHYSTERECTOMY The feline spay is performed in much the same way as the canine spay, with one notable exception. We routinely use a method commonly referred to as the pedicle tie. Basically, an instrument tie is performed on the ovarian pedicle similar to the technique many veterinarians use in neutering a male cat. Upon isolation of the ovarian pedicle, the pedicle is feathered over the surgeons finger to allow identification of the individual structures. The suspensory ligament is located and torn/cut. The ligament can be cut with scissors or blade or torn with digital pressure or a hemostat. A mosquito forcep is utilized to tie off the ovarian pedicle. (see illustration) One trick for improving the efficiency of this technique is to clamp the forcep just enough to secure the pedicle initially, and then lock the box completely as the tie is secured. This assists the surgeon in sliding the knot off of the hemostat. CANINE CASTRATION In the adult male, the closed technique is the preferred method because it is more efficient (saves time not to close tunic), there is less foreign material (suture) in closure and there is less bleeding. The incision is prescrotal. We exteriorize the testicle (to minimize incision size, expose from pole to pole vs. side to side) by stripping away excess tissue. Once exteriorized, we place Millers knot while leaving a tag to ensure no slippage. One knot is usually sufficient. A modified transfixing ligature (pass needle between the cord & vessel) can be used in place of the Millers knot if preferred. This method is repeated on the opposite testicle. Closure can be accomplished on males with a simple continuous pattern in the subcutaneous and subcuticular tissues by using the runner method as utilized in the OHE. Glue is placed over the incision as with the OHE. In the pediatric male, one incision is placed over the scrotum along the median raphe. The testicle is exteriorized and excess tissue is stripped away. Either the open or closed technique work equally well in the pediatric male. A figure 8 knot is placed and a tag left. This procedure is repeated on the opposite testicle. The incision is closed with glue and the rolling technique is used to prevent licking. A modified scrotal approach is sometimes used which is essentially the same procedure, except the tunic is opened but the tunic is not removed from the pole until after the tied cord/vessel is placed back into the tunic. The tunic is then stripped of excess tissue and tied with a simple instrument tie. (See illustration). This technique is used on large breed puppies and other non-pendulous scrotums. FELINE CASTRATION An incision is made over each testicle. Both testicles should be exteriorized before either is removed to ensure the surgery doesnt accidentally get half completed. Open or closed techniques both work well. Open does not require closing the tunic and closed should ensure the double-pop (an anecdotal description of the feel of the fascial breakdown allowing complete exteriorization of the spermatic cord). Most surgeons commonly use an overhand knot but I actually prefer a figure 8 knot. This knot is extremely secure and allows less chance for the knot to slip. This technique is repeated on the opposite side and the incisions are left open.
24

Appendix
Veterinarian
Figure 8 Knot Figure 8 Knot
11
12 12
13
13
25
Sample Operations Manual Feline Ovarian Pedicle Tie Feline Ovarian Pedicle Tie
Veterinarian
14
14
15
15
26
27
Job Description & Responsibilities Veterinary Technician

JOB TTITLE: JOB RELATIONSHIPS: JOB SUMMARY: Veterinary Technician Reports to Head Veterinarian, provides supervision for all veterinary assistants, kennel staff and volunteers. Responsible for daily care of all surgical patients, provide client services and education
RESPONSIBILITIES: Supervision and Client Services: 8. Supervise all kennel personnel and veterinary assistants. 9. Report employee or client problems to director. 10. Provide in-person and telephone client service and answer questions. 11. Actively promote spay and neuter, and educate clients on responsible animal ownership. 12. Actively support associate staff and volunteers; promote the development of skills related to the advancement of our goals and mission. 13. Represent the clinic in a professional and courteous manner at all times. Provide quality service to clients, volunteers, and staff, recognizing their individual contributions to the success of our organization. 14. Maintain medical inventory and supplies. Patient Care: 11. Triage all patients as they are checked in. Report health concerns to attending veterinarian. 12. Provide excellent patient care. 13. Assist veterinarians in surgery as needed. 14. Calculate and administer anesthesia to all surgical patients per anesthetic protocol. 15. Maintain all necessary drug logs and patient records. 16. Stay current in knowledge of emergency drugs and protocol. 17. Administer animal vaccinations, tests, medications and treatments as directed. 18. Participate on committees and special projects as assigned. 19. Other duties as assigned.
28
Job Description & Responsibilities Veterinary Assistant

JOB TITLE: JOB RELATIONSHIPS: JOB SUMMARY: Veterinary Assistant/Medical Support Staff Reports to Veterinary Technician Responsible for daily care of all surgical patients, assist doctors and technicians with surgical and anesthetic procedures, general housekeeping
RESPONSIBILITIES: General housekeeping 1. Perform daily cleaning of kennels, cages and public areas when necessary. 2. Stock prep room and operating room. 3. Spot clean throughout the day. 4. Clean prep room and operating room at the end of the day. 5. Wash and sterilize all surgical packs throughout the day. 6. Clean the kitchen. 7. Clean parking lot(s). 8. Other duties as assigned. Patient Care 1. Triage all patients as they are checked in. Report health concerns to veterinary technician or attending veterinarian. 2. Restrain all patients during anesthesia induction and intubation. 3. Monitor all patients on gas anesthesia. 4. Prepare patients for surgery as instructed. 5. Transport patients from prep room to operating room. 6. Assist veterinarians in surgery as needed. 7. Keep supervisor informed of animal behavior, health, or concerns. 8. Assist clients with necessary paperwork. 9. Monitor patients in recovery. 10. Assist transport driver with handling and unloading transport animals. 11. Provide excellent patient care. 12. Other duties as assigned.
Medical Support Staff Job Requirements

Client Education 1. Must be able to learn basic veterinary medical concepts including but not limited to vaccine protocols and anesthetic risks 2. Must also be able to communicate basic veterinary concepts to owners and be able to repeat information relayed by a veterinarian 3. Will be asked to take medical histories for surgical rechecks 4. Will be asked to communicate with the public on a daily basis in a professional manner Animal Handling 1. Will be asked to handle (on average) 100 dogs and cats per day 2. Must be able to learn characteristics of animal behavior (for example: be able to identify aggressive or fearful behavior) 3. Must be able to use appropriate safety equipment for fractious or feral animals (will train) the use of safety equipment is mandatory
29
Sample Operations Manual 4. Must possess excellent reflexes 5. Should be able to identify own limitations and be willing to ask for help 6. Must become proficient at animal restraint for various procedures
Physical Requirements 1. Must be able to work standing or sitting for 8 or more hours 2. Must be able to lift and carry up to 50 pounds repeatedly throughout the day with help 3. Must be able to bend and kneel repeatedly 4. Must be able to see fine detail in a variety of situations 5. Must have good hearing including ability to distinguish changes in pitch 6. Must have reasonable degree of agility to move through tightly cramped areas in various situations 7. Must have acceptable sense of touch and smell 8. Must have good range of motion in joints especially wrist, knees, elbows 9. Must have good range of motion in your back for instance twisting 10. Must be able to work in potentially extreme environmental temperatures 11. Must have acceptable sense of balance 12. Must be able to work and reach on hands and knees 13. Must be able to use a ladder and or step stool 14. Must possess excellent hand-eye coordination 15. May be asked to move large oxygen tanks 16. Must possess an acceptable degree of dexterity in hands and fingers 17. Must have good vision including peripheral vision, fine detail, distance, depth perception and ability to focus Emotional/Mental Requirements 1. Must be able to work under stressful conditions and work efficiently and effectively under those conditions 2. Must be able to respond quickly to a variety of medical situations (with training) 3. Must be able to cope with death either due to surgical complication or euthanasia 4. Ability to rapidly and accurately process information 5. Ability to delegate tasks 6. Ability to recognize a need for assistance and ask for help 7. Ability to control instinct (for example: while restraining it is most often required to tighten grip and NOT release the animal when they begin to struggle) 8. Ability to make decisions 9. Ability to cope with frustrating situations and remain calm Potential and Prolonged Exposures 2. Prolonged exposure to various aqueous solutions including but not limited to dish soap, chlorhexidine and spectra soap 3. Prolonged exposure to isopropanol, hydrogen peroxide 4. Potential exposure to formalin solution 5. Potential/Prolonged exposure to isoflurane gas 6. Prolonged exposure to quartenary ammonium cleaners and bleach 7. Prolonged exposure to pressurized steam 8. Potential exposure to sharps including needles and surgical blades
30
Training Protocol
PHASE ONE Receive and release 1. Speaking to the public 2. Admission form and release 3. Surgery and vaccine cost Female and male dogs- $0.00 Female cats- $0.00 Male cats- $0.00 Vaccines- $0.00 each 4. General surgical procedure 5. Spay Procedure (what is removed, etc.) 6. Neuter Procedure (what is removed, etc.) Scrotal and pre-scrotal 7. Age/weight 8. Pain management 9. Post op instructions 10. Vaccines 11. Animal triage Identification of poor surgical candidates Owner explanation of poor surgical candidates URI of any magnitude Severely obese Too thin Too old Pediatric cryptorchid Suspicious mass Lactation Heart murmur Mange and effect of stress Identification of high risk surgeries Pregnant In heat Obese Too Thin Breed considerations (Boxer, etc.) Heartworm positive FIV/Felv positive Owner explanation of high risk surgeries Engorged vessels with heat Friable tissues associated with excess weight Accurate age determination 12. Name tags and cage cards First and last name Vaccines and abbreviations 13. Animal weigh-in and proper cage selection Importance of accurate weight Cage selection separation of public and shelter Decreased risk for exposure to infectious disease Easier to load
31
14. Release of animals to proper owner Double check animal ID (be aware of duplicate names) Incision inspection Spay Appearance of normal incision Gum color and overall demeanor Signs of complications Pale Lethargic Weak pulses Low temperature Neuter Appearance of normal incision Normal swelling Reasons to keep an animal and alert a doctor Removal of scrotal wrap 15. Relay information to owner upon release Explanation of minor surgical complications such as heat or pregnancy (any other complications should be referenced to the head technician) Explanation of any concerns doctor may have Accurate response to owner questions or direction to proper person Kennels 1. Cage cleaning Remove all newspapers, blankets, and organic debris Spray all surfaces with A-33 (sides, top, bottom and doors) Let sit for at least 10 minutes Scrub cage door with brush and wipe out all cages back to front Clean clipboard and cage card holder Place clean newspaper in cage 2. Run cleaning Remove blankets and organic debris from runs Scrub all surfaces with A-33 solution and water Let sit for 10 minutes Rinse out well and wipe dry Place clean sheet/blanket in run 3. Crate cleaning Remove newspapers and organic debris Spray all surfaces Let sit for 10 minutes Wipe all surfaces front to back Place clean newspaper in crate 4. Infectious diseases and their routes of transmission Packs 1. 2. 3. 4. 5. 6. 7. Proper maintenance of autoclave and ultrasonic cleaner Washing surgical instruments Complete knowledge of instruments and their function Assembling surgical packs Autoclaving all packs Assembling and autoclaving surgical instrument trays Assembling needle packs
32
Sample Operations Manual 8. 9. 10. 11. Cleaning endotracheal tubes Disinfecting masks and muzzles Proper folding of pack laundry Weekly cleaning of autoclave
PHASE TWO Canine Restraint 1. Proper restraint for SQ injection 2. Proper restraint for IV injection (induction) 3. Proper handling during loading and unloading Wear gloves Animal behavior signs Acceptable ways to handle aggressive or fractious animals Proper muzzle placement Feline Restraint 1. Proper restraint for IM injection and venipuncture 2. Proper handling during loading and unloading 3. Net technique 4. Pour technique 5. Complete understanding and respect for feral cats and how to handle Anesthesia Monitoring 1. Proper anesthetic levels for canines Maintenance 2% Maximum 5% 2. Proper anesthetic levels for felines Maintenance 0.5% Maximum 2% by mask (higher levels can cause respiratory distress) 3. Proper order for hooking up and disconnecting anesthesia Turn on Oxygen (1L) Turn on Isoflurane Connect hose to ET tube 4. Stages of anesthesia Stage I Analgesia Disorientation, fear Salivation Urination/defecation Stage II Delirium or excitement Struggling Irregular respiration Eyelids open and iris dilated Reflex vomiting Urination/defecation Stage III Plane I pain responses still present, cardiovascular function minimally affected Plane II respiratory rate decreased, cardiovascular function is mildly depressed Plane III entrance into this plane is marked by the beginning of paralysis of the intercostal muscles
33
5.
6.
7. 8. 9.
10.
Potentially dangerous level of anesthesia Respiratory depression is marked Cardiovascular function is noticeably depressed Plane IV complete paralysis of intercostal muscles Passage into plane IV is marked by cessation of all respiratory effort and dilation of the pupil Cardiovascular function is generally impaired and producing hypotension and decreased cardiac contractility Stage IV respiratory arrest followed by circulatory collapse (death ensues within one to five minutes) Recovery Ability to recognize a surgical complication Pale gums Weak pulses Rapid heart rate Abdominal distention Hematocrit Components of gas anesthesia machines Flow meter Oxygen Vaporizer Isoflurane Pop off valve Flush valve Proper maintenance of anesthesia machines Pressure checks Clean and inspect machine, hoses and bags Pressure alarm if pressure alarm sounds, unhook patient from anesthesia machine immediately Re-breathing bag size depending on the size of the animal Very large dogs 3L Medium dogs 2L Puppies, small dogs and cats 1L Soda sorb Function of soda sorb absorbs exhaled carbon dioxide Frequency of change
Surgical Preparation of Dogs and Cats 1. ET tube Dogs - Never more than 3-cc Cats - cuffless tubes are used 2. Apply sterile eye lubricant dont leave uncapped 3. Administer pain medication Canine Morphine IM injection in hind leg Proper administration Structure to avoid-sciatic nerve 4. Proper clipping of surgical area (enough for abdominal exploratory surgery) 5. Express bladder general knowledge of anatomy (where bladder, spleen, etc. is located and ability to locate on palpation 6. Scrub surgical area 7. Spray surgical area 8. Proper sterile transportation of animal into surgery 9. Complete understanding of sterile fields and surgical procedure
34
Vaccine Protocol 1. Learn complete canine vaccine protocol Rabies vaccine at 12 weeks of age DA2PP (leptospirosis at 12 weeks) at 6-8 weeks of age, then repeated every 3 weeks until 16 weeks of age Bordetella vaccine at 8 weeks of age, then repeated at regular vets discretion Heartworm test at 6 months of age 2. Learn complete feline vaccine protocol Rabies vaccine at 12 weeks of age FVRCP at 6 weeks of age, then repeated every 3 weeks until 16 weeks of age FELV at 9-12 weeks of age, then repeated in 3 weeks, then yearly FELV/FIV test at 8-9 weeks of age any positive FELV or FIV test should be repeated in 3 months ALL VACCINATION BOOSTERS SHOULD BE DISCUSSED WITH YOUR REGULAR VETERINARIAN AS CURRENT PROTOCOLS CHANGE ROUTINELY. Maintenance 1. Proper cleaning and maintenance of all machines in the prep area, including, but not limited to: Ultrasonic cleaner Autoclave Microscope Centrifuge Pulse oximiter PHASE THREE Complete drug and emergency protocol 1. Canine and feline anesthetics and pre-medications Acepromazine Tranquilizer and pre-anesthetic Lowers respiratory rates Give SQ to dogs Give IM to cats with Buprenorphine Raises central venous pressure should be avoided in patients with glaucoma, etc. May cause bradycardia contraindicated in boxers very sensitive to bradycardiac effects, may cause secondary heart block Allows for lower doses of general anesthetic Atropine/Glycopyrrolate Approved for use in cats/dogs Increases heart rate Counteracts bradycardia Buprenorphine Analgesic give IM pre-med to cats Morphine narcotic (opiate) Pre-emptive analgesic used for the treatment of acute pain in dogs (always given IM) Respiratory depression Sedation May cause constipation CNS effects
35
2.
3. 4. 5.
6.
Euphoria Sedation and confusion Cardiovascular effects bradycardia Increased bladder sphincter tone Side effects: Drying of respiratory secretions Nausea and vomiting Hypothermia Over-dosage give Naloxone Telazol- (Tiletamine/Zolazapam) injectable induction agent Indicated for restraint or anesthesia combined with muscle relaxation for surgeries lasting less than 30 minutes Side effects: Hypothermia in small animals Eyes remain open use sterile eye lubricant Tachycardia Emesis during recovery Excessive salivation IM injections are painful (cats)- dilute with sterile water to counteract Proper administration of injections SQ subcutaneous IV intravenous IM intramuscular IT intratracheal IC intracardiac SL sublingual Proper placement of IV catheters in routine and emergency situations Complete emergency drug protocol Emergency Drugs Epinephrine (Adrenalin) Increases heart muscle contractility Direct stimulation of the heart Used for cardiac resuscitation Antagonizes effects of histamine Raises systolic blood pressure Emergency protocol Recognition of emergency situations Normal heart rate for dogs: (80120) beats per minute Normal heart rate for cats: (130200) beats per minute Normal respiratory rate for dogs: (1530) breaths per minute Normal respiratory rate for cats: (2030) breaths per minute Mucous membrane color and CRT Calculate accurate heart rate Check distal pulses Steps once an emergency is identified Call for a doctor Secure the airway Begin ventilation with Oxygen (turn off Isoflurane flush machine) Get the crash cart Place animal in sternal recumbency Prepare the animal for intubation Properly bag the animal (positive pressure breathing)
36
Never let pressure on anesthesia machine go above 20 cm of water High pressure alarm is set at 20 cm of water Correctly perform CPR (chest compressions) Correct use of stethoscope Emergency drug dosages (see appendix) Place an IV catheter
PHASE FOUR Specific to Veterinary Technician Patient Flow technician duties 1. Canine pre-medication (done by vet in morning until surgery begins) Canine pre-medication and dosages Correct dosages SQ injection about 20 minutes before induction 2. Canine induction Canine anesthesia Double-check dosage based on amount in syringe Locate cephalic vein and administer injection 3. Canine intubation verify correct placement 4. Feline pre-medication Proper IM injection IM injection at least 30 minutes before induction 5. Feline induction Proper IM injection Path of sciatic nerve and proper injection site Administer injections to fractious cats (ability to use shield and net) Administer injections to feral cats (ability to use trap dividers) 6. Feline intubation Quickly intubate cats with or without lidocaine in routine or emergency situations 7. Patient Flow Acute awareness of general pace of doctors and staff Effectively direct staff to ensure efficient pace Memorization of emergency protocol and drug dosages Administer animal tests, medications, and treatments Effectively handle all re-checks as liaison between doctor and client Knowledge of infectious diseases and signs thereof Surgical protocol and aspects of all surgeries Medical Records Technician 1. Complete knowledge of canine and feline anesthetics 2. Calculate and draw up all canine and feline pre-medications and anesthetics Canine anesthesia Telazol To reconstitute add 5.0 ml sterile water To calculate dosage multiply 0.0075 x animal weight in lbs. Canine pre-medication- Acepromazine Feline Anesthesia Telazol To reconstitute add 5.0 ml sterile water To calculate dose multiply 0.023 x animal weight in lbs. Feline pre-medication Acepromazine (dilute 9:1) and Buprenorphine given IM
37
Sample Operations Manual 3. 4. 5. 6. 7. 8. 9. 10.
11.
Complete daily drug log as required by DEA Complete medical record (treatment sheet) on each animal Complete post-op sheet Compile and submit appropriate lists for each day Too young for rabies list No surgery list Call no surgery owners and transports Effectively relay information about an animals condition to the owner Complete knowledge of medical protocol regarding no surgeries Balance drug logs at the end of each day File drug logs appropriately each month Take all medical calls (head tech only) Complete knowledge of the [CLINIC NAME] protocol regarding treatment of animals with surgical complications Identify a surgical complication vs. another illness Schedule rechecks and make sure a doctor is available Calculate antibiotic dosages per the doctors request Fill a prescription Maintain and store all anesthetics daily as required Maintain and keep records of inventory Order all medical supplies
38
39
Office Procedures
SCHEDULING APPOINTMENTS Appointment Sheet We provide written scripts for scheduling appointments. This ensures we provide the same information to all clients. We anticipate a 5% no-show rate and a 5% declined for surgery rate and schedule accordingly. Animals are transported to our facility for surgical sterilization Monday through Thursday. A 72hour notice of number of appointments from each transport is required. The three-day advance notice allows us sufficient time to adjust public appointments. Appointment Narrative What type of pet do you have? (dog/cat, male/female) Our earliest opening is M/Tu/Wed/Th/Fri, (month) (day). Youll need to bring him/her in at 8:00am, and pick him/her up at 7:30am the following morning/5:00pm the same day (5:00pm release on Fridays only). How old is your dog/cat? (Good opportunity to find out if pet is over 8 yrs (will need pre-operative blood work) or under 4 months (does not need to be fasted prior to surgery) What is your name? What is the best phone number to reach you? The night before surgery, you need to keep your pet indoors, and no food after 12:00 midnight (remember, under 4 months old do not need to fast!). Water is okay. Does your pet have a current rabies vaccination? If yes, please bring in his/her tag or certificate If no, we will need to administer that vaccination while they are here Our veterinarians highly recommend that your pet be vaccinated two weeks prior to surgery. They will be around a lot of other animals and could be exposed to something (just like when you send your kids to kindergarten). It takes two weeks for a vaccination to become fully effective. RECEIVING PATIENTS Clients are asked to bring their animals at 8:00am each morning. Typically, we receive patients from 8:00am until 9:00am daily. We make special allowances for clients with special situations. Typically, admission of a patient is completed within 10 minutes of the clients arrival. Our clients are encouraged to pay at the time of admission, but we do accept payment when we release the patient. We do not experience any problems with clients not returning for their pets. We schedule a veterinary technician and an office representative to receive patients and answer clients questions. The clients are instructed to complete the admission form. Upon completion, the office representative reviews the admission form, advises each client on vaccinations recommended for his or her animal, inquires about the purchase of supplemental pain medication for the patient, checks for patient age and client signature, and collects the fee.
40
The client is then directed to the veterinary technician who confirms NPO status, determines any medical concerns and provides identification for the pet. The questions asked are: 1. When was the last time (name) had anything to eat? 2. Was he/she indoors last night? 3. Any health concerns for him/her? 4. Is (name) on any medication, topical sprays, and ointments? 5. Has he/she received any medication and/or injections in the last month? A member of our medical staff then receives the patient. Clients are provided a copy of their admission form and requested to present that form when they return for their pet. Admission forms are submitted to the office manager for entry into the computer database. The post-op and treatment sheets are provided to the veterinary technician after the animal information has been entered into the computer system. The office manager retains supportive information and completes rabies certificates. RELEASE OF PATIENTS Our medical staff releases patients from 7:30am until 8:00am Tuesday through Friday, and again at 5:00pm on Fridays. Post-operative instructions are reviewed verbally by the medical staff with the clients and written instructions are also provided for each patient. We provide the clients with a list of veterinarians in our community who provide free post-operative exams. Clients are required to sign the clinics copy of the admission form for release of the patient. We charge a $0.00 boarding fee for late pick-ups. Transport patients are returned with written postoperative instructions. The directors of the organizations scheduling the transports are trained to review the instructions with the clients.
Surgical Program Requirements

All patients are given a physical exam before any injections are given: 1. 2. 3. 4. 5. 6. 7. Auscult heart and lungs Mentation/activity level Body condition (Tufts animal care and condition scale) Ocular and/or nasal discharge Hydration status Mucous membrane color Any obvious abnormalities
If any abnormalities are noted, a complete physical exam is performed including temperature evaluation and a decision is made as to the animals fitness for surgery. The following conditions are examples of basis for rejection: 1. 2. 3. 4. 5. 6. 7. 8. URI of any magnitude Diarrhea Vomiting Moderate to severe skin disease Ocular disease Severe obesity Poor body condition Depressed attitude
41
Sample Operations Manual 9. Sneezing/coughing 10. Heart murmur
Anything that might indicate an undiagnosed condition that may compromise the patient during anesthesia, recovery, and/or healing will be considered reason for refusing surgery. Although the mission of [CLINIC NAME] is to sterilize as many animals as possible, OHEs and castrations are still elective procedures, and the individual animals well being comes first. If it is in the animals best interest to have the surgery postponed, then arrangements are made to do so. Females that are in labor when they arrive are not subjected to surgery; at this point it is too late. They are either sent home or given food, water, and a warm bed in a quiet environment and allowed to give birth. Also, when a patient vomits undigested food, we will not do surgery on that day. We may hold the animal over until the next day or reschedule, depending on the circumstances. Minor conditions that are noticed after induction are reported to the owners on the post operative sheet, to be referred to an area veterinarian for treatment, and recorded on the medical record. Cats have their ears checked by the staff during prep, and those that appear to have ear mites may be treated. We have Doramectin for treating shelter, rescue, and feral cats for ear mites. Most of these cats will never be seen by a veterinarian again, and we feel an obligation to try to relieve them of such conditions while the opportunity exists. Anesthesia is always to be avoided when not necessary. All females over 16 weeks of age with unknown history must be shaved for signs of having already been spayed (ABS). This includes shelter, rescue, and public animals that were stray. Signs that indicate an ABS are: mid-line scar, tattoo, undeveloped nipples and vulva on an older female. Keep in mind that very large scars may indicate a C- section, which may have left the uterus intact. The whole picture must be considered in each case. All males must be checked for two testicles. Cryptorchid animals less than 6 months of age should be rescheduled to allow time for the testicle(s) to descend. Male cats without testicles should be checked for cheek development and spines on the penis to determine if they have already been neutered (ABN). Prior to performing a cryptchorid surgery, the surgeon should palpate the inguinal area. Final pre-op considerations Doctors need to check their patients anesthetic machine for correct set-up before beginning each and every surgery. Mistakes are sometimes made and early detection saves lives. Doctors also need to check feline patients sex before draping in - occasionally a male is prepped as a female, and it is ultimately the doctors responsibility to prevent a male cat from having his abdomen opened. Also, always check female patients for scars - although we try to identify ABSs prior to pre-med, they are occasionally missed by the staff, and the doctor should not make the mistake of missing a scar before opening the abdomen on an animal that has already been spayed. Surgery Five knots on all sutures. This technique has been proven to eliminate dehiscence, and must always be used. Large bites on the Linea alba: include at least 5 to 8 mm muscle tissue in the linea closure in cats and up to 10 to 12 mm in large dogs. We never use simple continuous patterns in the linea-only
42
Sample Operations Manual cruciate or simple interrupted.
Large bites in the subcutaneous tissue. At least 3 layer closure-linea, SQ, and subcuticular plus skin glue or staple/skin sutures. No crushing sutures in closing - linea and subcutaneous tissue should be snugly and completely closed but never crushed. Dead space should be closed and the SQ should be anchored at least at both ends of the linea incision. Linea and subcutaneous tissue are closed with absorbable suture. Skin edges should be properly apposed - never allow one side to flap over the other or extend above the other. Skin glue should not be applied between the skin edges but on the surface after apposing the edges. Millers knot - we use this knot on the ovarian pedicle and the uterine body. It is extremely secure, minimizing complications. We may use a Millers knot in conjunction with a modified transfixing ligature on the uterine body of a pregnant female with very large uterine vessels. Modified transfixation ligature - We use this ligature on adult dog castrations. Canine castrations are usually done as closed, except on older dogs where it is more difficult to separate the epididymal ligament from the scrotum. If an open castration is performed, the vaginal tunic is closed before placing the subcutaneous sutures. Cat and puppy neuters, special technique: for neuters of cats and puppies under 12-14 weeks of age, we tie the vas deferens and vessels off on themselves in a figure 8 knot. This knot is much less likely to come untied than a simple square knot. A diagram is available illustrating this technique. In cryptorchid male dogs, we have found that a para median incision through the muscle layers is preferable to a midline incision since it allows easier location and externalization of abdominally retained testicles. Surgery begins as early as possible in the shift, and doctors should be ready to perform surgery at this time. One doctor should arrive earlier in order to examine animals to be approved for surgery as they are checked in. Doctors rotate recovery. This is an informal arrangement made each week. Post-operative care To calm patients recovering from surgery, environmental stress is reduced as much as possible. Human activity is minimized and lights are kept off. The door to the cat room is kept closed. Doors to the dog kennel should be kept closed at all times. Blankets should be hung over cages of overly excited patients. Pain Management Veterinary medicine now requires a standard of care that incorporates pain relief for patients undergoing painful procedures. OHE and castration are both known to be painful procedures requiring treatment for pain. Pain is best controlled by prevention, and incorporating effective drugs into the pre-medication or induction protocol can effectively prevent windup of nociceptors and greatly reduce the level of pain experienced by the patient, as well as the amount of drug needed during recovery. Our protocol reflects this data. The current recommendations encourage the use of multimodal analgesic therapy. In fact, two to three different forms of analgesics used in combination appear to be the most effective. Of those
43
combinations, the most common ones utilized by boarded specialists are opioids with NSAIDS. The recommendation that hydration status should be closely evaluated and that SQ fluids be administered preemptively is appropriate. Specifically, in addition to Morphine for canine patients and Buprenorphine for feline patients, supplemental pain medication is also utilized (Meloxicam or additional Buprenorphine). Anecdotally, we have had serious post-operative hemorrhaging resulting from the use of Ketoprofen in dogs, and no longer use this drug. Supplemental Support All pregnant females in the third trimester have an IV catheter placed and fluid therapy administered appropriately during the procedure. Ideally, fluids should be warmed. Any other patients needing fluid therapy for any other reason also receive it in SQ or IV form. Immediately after removal of the uterus, fetuses of third trimester pregnancies are removed from the uterus and euthanized. All cats, kittens, puppies, and small dogs get hot water bottles or rice bags, and sugar lips upon removal from the surgery table. Anyone showing signs of hypothermia gets a heated rice bag and extra blankets as needed. Every patient gets a clean, appropriately sized blanket; the patients entire body should be placed on his/her own blanket, not on the larger community blanket, which covers the entire recovery area. The recovery area needs to be kept clean at all times. Adult male dogs may receive a scrotal wrap to help reduce the incidence of scrotal swelling post-op. The scrotal wrap is removed prior to discharge. Antibiotics are available for patients that need them (pyometras, URIs that arent caught until after induction, sterile field contamination, etc.). Recoveries Dogs stay in the recovery area until sternal or actively trying to get up. Cats stay until lifting their heads. We have found that one of the best indicators of a normal recovery is level of consciousness. Regardless of vital signs, an animal that is not regaining consciousness at a normal rate should be closely assessed for post-operative hemorrhaging. If unresponsive to stimulation, an abdominocentesis and hematocrit should be performed. The animal should be re-anesthetized and explored if blood is obtained on the abdominocentesis and/or the hematocrit level is of concern to the veterinarian. Patients are never left unattended until consciousness has been regained - those that need to be monitored overnight for any reason should be sent to a full service 24-hour facility for additional care, after the owners have been contacted. At the end of the day, all patients are given a final check by a doctor. They are assessed for recovery status, signs of complications, and are ensured of a clean, dry, warm bed. Male cats are especially prone to urinate on their beds during recovery. No patient should ever be made to lie in a soiled bed overnight. Cats having a rough recovery from Telazol may receive a low dose of sedative to smooth out their recovery and prevent self-injury. The staff gives a small amount of dry food to recovered adult patients at the end of the day. Pediatrics who are fully awake are given a small amount of dry food and water. The water is always removed at the end of the day, not left in the kennel overnight.
44
Sample Operations Manual Re-checks:
When possible, doctors should try to see their patients re-checks and contact the owners of their patients. This is not always possible with part-time doctors, so we try to assist when needed. Health Exam for Dogs and Cats 1. Eyes - Look for signs of discharge from the eyes. This is an indication of an upper respiratory infection. 2. Nose - Look for signs of nasal discharge. This is also an indication of an upper respiratory infection. 3. Body Condition - The animal should have good muscle mass (ribs, vertebrae, and hips should not be easily visible). 4. Mammary Glands - If heavily lactating, the animal should not undergo surgery. Check to see if milk comes out easily. If glands are hard, the animal may have mastitis. 5. Hydration Status - Lift up skin between shoulder blades. Tenting of the skin is abnormal and indicates a level of dehydration. 6. Mucus Membranes - Gum and conjunctiva should be pink and moist. 7. Stool - Runny/watery diarrhea or loose stool with blood in it indicates that the animal is a poor surgical candidate. 8. Heart and Lungs - Auscultation to evaluate status.
Surgery Room Procedure

Once the assistant brings the patient into surgery, the surgeon verifies that: 1. Appropriate levels of oxygen and isoflurane are set. 2. Appropriate size re-breathing bag is attached. 3. The pulse oximeter is attached. The surgeon ensures that the patients vital signs are within normal limits. The surgeon gloves in using sterile technique. The surgeon retrieves sterile surgical instruments necessary for the given procedure (spay or neuter) from the instrument table, as well as sterile suture material and needle. Administer vaccines post-op Canine Rabies SQ R Distemper SQ L Kennel Cough (Intra-nasal) Feline - administer all feline vaccines in leg (not foot), as low as possible FELV SQ L rear leg FVRCP SQ R front leg Rabies SQ R rear leg
45
AM / PM Procedures
AM PROCEDURES Run autoclaves Load cats into carriers Check each incision, bring concerns to doctor Double check collar matches name on carrier Clean dog and cat kennels Set up Prep Room Put out clippers V-tray Pee bowl Eye lube Scrub buckets ready Set up OR Buckets for instruments (spectra soap), needles (spectra soap), and tubes (dilutechlorhex) Put out ink caps Turn on oxygen Turn on scavenger Set up recovery area Turn on surgery lights Plug in heated V-trays Set up extras tray and needles pack Open surgical blades onto needles pack Tip suture (doctor) Set up Pack Area Fill sonicator with enzyme cleaner Deflate and sort tubes Fill bucket with A-33 for masks and muzzles Set up Tech Table Get drug logs out Get drugs from safe etc Start Laundry
PM PROCEDURES Prep Room Clean prep tables Fill scrub buckets Fill all spray bottles Clean clipper blades Turn off all oxygen and flush lines Turn off scavenger Fill isoflurane Empty trash Vacuum and mop Empty vacuum OR Turn off oxygen and flush lines
46
Sample Operations Manual Clean tables Throw out ink caps Fill isoflurane Unplug heated V-trays Sweep and mop Throw out trash Turn off surgery lights Wash out sugar lips container Throw out old bags of fluids (3 days or older)
Packs Finish washing all instruments and tubes Make all packs Assemble extras tray and needles packs Rinse all masks and muzzles and hang to dry Wash and disinfect pee bowls Empty sonicator (as needed) Lint roll and fold all pack laundry Load autoclaves Rest of Clinic Feed dogs and check to make sure all animals are in clean cages Sweep and mop entrance area and hallways Clean bathroom/s and empty trash Empty all trash in clinic Turn off all lights, washers and dryers and coffee pot Turn off autoclaves/not running
EXTRA DUTIES Change soda sorb as needed and perform pressure checks on machines o OPEN POP OFF VALVE! Soak and rinse all reservoir bags and hoses in dilute chlorhexidine solution for 10 minutes Wash walls, anesthesia machines, table bases, surgery lights Organize all shelves Sweep and mop laundry room/area, wash down washer and dryer, empty trash
Surgical Pack Procedures

COMPLETE LIST OF INSTRUMENTS USED: 1. Olsen-Hegar needle holders 2. Thumb forceps 3. Towel clamps 4. Metzenbaum scissors 5. Straight carmalts 6. Curved carmalts 7. Curved hemostats 8. Straight hemostats 9. Straight crile 10. Spay hook 11. 4x4 gauze squares 12. Fenestrated drape
47
Sample Operations Manual 13. Blue surgical towels 14. Re-usable cloth pack wrap DUTIES 1. 2. 3. 4. 5. 6. Wash and sonicate surgical instruments Assemble packs and autoclave Tend to pack laundry Clean endotracheal tubes Prepare hot water bottles for OR person Maintain clean cat masks and muzzles
INSTRUMENT CLEANING Take all instruments from surgery (soaking in spectra soap solution) Scrub instruments with soft bristled brush (NEVER use wire brushes, they will damage the instruments) Use cleaning solution of spectra soap Pay close attention to hinged areas (boxes) and ridges (blood and tissue collect here) Rinse in clean water Place instruments in ultrasonic cleaner with enzyme cleaner for NO LESS THAN 10 minutes Do not overload All instruments should be BELOW the surface of the enzyme cleaner Rinse with clean water, blot dry with towel, spray on instrument milk, and sort (instrument milk should be left on instruments) SURGICAL PACK ASSEMBLY *The contents of the following packs may change per your surgeons request/preferences. Starting with pack wrap and one bottom towel FEMALE DOG PACK (FD) 2 carmalts (preferably one straight and one curved) 1 spay hook 1 crile 1 curved hemostat 1 needle holder 1 thumb forcep 1 pair of tissue scissors 2 towel clamps FEMALE CAT PACK (FC) 1 Carmalt 1 spay hook 1 crile 1 straight hemostat 1 curved hemostat 1 thumb forcep 1 pair of tissue scissors 1 needle holder 2 towel clamps *MD and FD packs are priority wrt towel clamps, if not enough, leave out of this pack first
48
Sample Operations Manual MALE DOG PACK (MD) 1 x-large crile or carmalt 1 needle holder 1 thumb forcep 2 towel clamps
All of the packs described above receive (exactly) 5 pieces of gauze, a steri strip and 3 towels on top MALE CAT PACK (assembled using a wrap and placing contents between two bottom towels) 10 hemostats (usually curved) 10 pieces of gauze 10 blades unopened (opened blades will dull with autoclaving) Packs should be wrapped tight enough so that when thrown against the wall they do not come open. Place a small piece of autoclave tape on the outside and mark accordingly (i.e. FD, FC, MD) IMPORTANT INFORMATION ABOUT PACK WRAPPING If a wrap has a hole in it (even one side, even if it is small) THROW IT OUT A hole in the material will allow microorganisms from the environment to enter the inside of the pack and contaminate it If a towel has a hole in it THROW IT INTO THE RAG PILE A hole in the towel may allow hair from surrounding area of surgical field to contaminate incision site A hole may allow microorganisms from the environment to enter the surgical field Blood should NOT be present on any pack wraps, towels or instruments assembled into surgical packs While blood can technically be sterilized in the autoclave, IT MAY FLAKE OFF AND FALL INTO THE SURGICAL OPENING It will become a foreign object in the patients abdomen possibly creating complications for the patient Hair and fuzz should be removed from towels and pack wraps before assembly Hair and fuzz may become deposited unknowingly into the abdomen and create complications for the patient Use of the lint roller prior to assembly helps reduce the amount of hair and lint on pack laundry DO NOT ratchet instruments closed before autoclaving You are not able to ensure the sterility of the metal-to-metal contact point (the steam will not be able to reach the area) Water trapped in the ratchet grooves may increase the chance of rusting thereby decreasing the life of your instruments Remove all indicator and masking tape prior to washing pack wraps Successive cycles of washing and drying may leave a permanent sticky residue that may pick up hair and fuzz from the environment SPECIALTY PACKS Instrument Trays/Extras Tray * The contents of this tray may vary, its purpose is to provide the surgeons with extra instruments, gauze etc. There should be two of these in case one is contaminated during the day. Instrument
49
trays and their lids should be autoclaved separately. Remember to include a steri strip and autoclave tape for each. Contains a couple of each instrument (no more than 5 except for hemostats/carmalts) A small stack of gauze (about 20 pieces, any more will be wasted) 2 towels 1-2 fenestrated drapes a steri strip Needle pack Ensure that there is a variety of needle sizes, a small stack of gauze and steri strip There should be at least 2 packs in case one is contaminated during the day Specialty packs Examples: Gauze pack Laporatomy sponges Retractors Suction components
Outside tape should contain Identification of the contents Date (if pack will not be used daily) Initials of preparer (optional) DO NOT forget the steri strip or the autoclave tape on the outside in these packs Should be rewrapped and sterilized every three months USING AUTOCLAVE SLEEVES/POUCHES (some tips that may prove useful) 1. Place all instruments and gauze inside being careful not to puncture plastic front or paper backing 2. The bag is its own indicator (locate indicator on outside of bag to familiarize yourself) 3. Once instruments are placed inside fold over ends that are not factory sealed and tape all the way across and fold tape over each end (some bags have their own sealing flaps) 4. When autoclaving place pouches plastic side down on metal trays 5. If placed paper side down the moisture has a tendency to weaken paper and allow instruments to poke holes into pack and thereby contaminate the pack 6. DO NOT remove/touch packs until completely dry (same reason as above) 7. Sometimes the plastic will singe on the metal tray while heating in the autoclave, however this occurs less frequently than #5 AUTOCLAVING 2. Follow instructions set forth on your autoclave 3. Packs must be at 2500F for no less than 30 minutes 4. The steri strip DOES NOT indicate sterility, it ONLY indicates that the autoclave hit the specific temperature and NOT that it stayed there for the required length of time 5. The steri strip however DOES indicate an unsterile pack 6. The red pointer located in the temperature/pressure window indicates that the autoclave has reached a specific temperature. It will not move on its own, therefore it is helpful in assessing whether or not the autoclave is losing pressure during a run. Check the autoclave several times during its run to ensure it is maintaining pressure and temperature for the entire run. The red pointer should be returned to zero after each run. 7. Once the autoclave has finished running and the pressure returns to zero, open the autoclave and pull out the trays to allow the packs to air dry.
50
8. Do not touch the packs while they are wet. Do not place wet packs on tables. The wet material will wick microorganisms from the immediate environment into the interior of the pack and contaminate the pack. (This guideline should be adhered to whenever possible.) CLEANING ENDOTRACHEAL TUBES 1. Allow all tubes to soak in a dilute chlorhexidine solution for at least 10 minutes. It is helpful to take tubes from OR or soak for 10 minutes at pack area since you may not know when the last tube was placed in the bucket. 2. Remove tubes and inflate each one. Inflate enough to remove all creases in the cuff but do not over inflate. Over inflation leads to unnecessary stressing of the plastic and will decrease the useful lifetime of the cuff/tube. 3. Using either a soapy chlorhex solution or dish soap clean the outside of the tube and ensure all mucous etc is removed from the cuff and the hole near the end of the tube. 4. Use the special tube brushes to clean the inside of the tube. Insert brush into both ends to ensure the entire tube has been cleaned. Do not use the instrument brushes on tubes - it negates the effect of disinfecting them before cleaning. 5. RINSE WELL with clean water. 6. REMEMBER YOUR PATIENT BREATHES THROUGH THESE TUBES! 7. Hang to dry and deflate before sorting into appropriate bins. 8. If water has collected inside the cuff, throw the tube out. 9. If the cuff does not hold air, throw the tube out. 10. This is the best time to test all ET tubes for defects. MISCELLANEOUS Remember when making hot water bottles that Wet is not Warm. This means you should dry the outside of the bottles off before placing them next to a patient. Also ensure that the bottle does not have direct contact with patient to ensure against burns. Blades can be opened en masse onto the needles pack prior to surgery following standard sterile technique.
Disease Control Procedures

The first priority of disease control is to keep the patients that are in our care in clean and tidy cages. This also means keeping their surroundings clean and cleaning previously used cages to prevent cross-contamination. The daily duties of the disease control person include (but are not limited to) the following: Daily Tasks 1. Clean and disinfect all cages. 2. Wash, dry, and fold all laundry. 3. Sweep, mop, and disinfect the kennel area and cat room (this includes under all cage banks). 4. Clean bathrooms. 5. Empty all trash (kennel, cat room, waiting area, and front office). 6. Clean all windows and doors. 7. Sweep, mop, and disinfect the waiting area (this needs to be done as soon as receiving is complete). 8. Clean the front office. First impressions are very important, so make sure this area is always clean and tidy.
51
9. Periodically check occupied cages and clean if necessary. 10. Clean kennel dishes. Weekly Tasks 1. Dust the mini blinds in the front office. 2. Sweep, mop and straighten laundry room(s). 3. Straighten all newspaper boxes. 4. Run errands for clinic. 5. Purchase kennel inventory items. Cage Cleaning Dog Cages Remove all newspapers, blankets, and organic debris. Spray all surfaces with dilute clorox 1:32 (this includes all sides, top, bottom, and cage doors). Let sit for 10 minutes. Scrub cage door with brush and wipe out all cages back to front. Clean clipboard and cage card holder. Place clean newspaper in cage. Cat Cages Remove all newspapers, blankets, and organic debris. Spray all surfaces with Trifectant (this includes all sides, top, bottom, and cage doors). Let sit for 10 minutes. Scrub cage door with brush and wipe out all cages back to front. Clean clipboard and cage card holder. Place clean newspaper in cage. Cleaning the Runs 1. Remove all newspapers and blankets. 2. Scrub all surfaces with a solution of dilute clorox 1:32. 3. Let sit for 10 minutes. 4. Rinse thoroughly and wipe dry. 5. Place clean sheet in run. Crate Cleaning Dog Crates Cat Crates
Remove all blankets and organic debris. Spray all surfaces with dilute clorox 1:32. Let sit for 10 minutes. Wipe all surfaces front to back. Place clean newspaper in crate. Remove all blankets and organic debris. Spray all surfaces with Trifectant. Let sit for 10 minutes. Wipe all surfaces front to back. Place clean newspaper in crate.
CANINE DISEASES/VACCINES Canine Distemper This potentially fatal disease is caused by a virus and is spread through contact with the bodily
52
secretions of infected puppies or dogs. Signs may include diarrhea, fever, upper respiratory signs including runny eyes and nose, and neurological signs including muscle tremors and seizures. The distemper vaccine provides good protection when given appropriately to puppies older than six weeks of age. The distemper vaccine is acombination vaccine, which also provides protection against Parvo virus, infectious canine hepatitis, para influenza virus and other diseases depending on the product. Parvo Viral Enteritis This is a commonly occurring viral disease that primarily affects unvaccinated puppies and is often fatal without treatment. Affected canines usually present with large amounts of watery or bloody diarrhea, vomiting and severe dehydration. Parvo virus is highly contagious. It is spread by contact with the feces of infected patients and can live in the environment for months to years. Again, appropriate vaccination of puppies is very effective in preventing this disease. Infectious Canine Hepatitis Another disease caused by a virus, hepatitis is generally spread through contact with infected urine or feces. The virus enters the tonsils and lymph nodes where it reproduces before attacking the liver and intestine. Signs include fever, tonsillitis, ocular and nasal discharge, depression and occasionally sudden death, especially in puppies. In patients that recover, a bluish discoloration may be noted on the surface of the eye. This disease may affect whole litters of puppies. Canine Para Influenza This is one of several viruses that contribute to infectious tracheobronchitis, also known as kennel cough. Dogs affected have a dry hacking cough and ocular and nasal discharge. Although the para influenza portion of the distemper vaccine cannot prevent kennel cough, it can decrease the severity of clinical signs in dogs that are infected. Rabies This very serious viral disease affects most warm-blooded animals including cats, dogs and humans. The virus is present in the saliva of infected animals and is transmitted through bite wounds. Once inside the body, the virus attacks the nervous system, eventually causing death. Once clinical signs occur, the disease is almost always fatal. Since rabies is maintained in populations of wildlife, such as skunks, foxes, bats and raccoons, it is a persistent danger to unvaccinated companion animals. For this reason, most states require, by law, regular routine vaccinations against rabies for all dogs and cats. Any person who is bitten by a strange animal should seek medical attention immediately. Leptospirosis Causes a bacterial infection that affects several parts of the body. Domestic animals transmit the bacteria through urine to both animals and humans. The illness occurs most commonly in the tropics and can be treated with antibiotics. FELINE DISEASES/VACCINES Feline Distemper This disease, also known as panleukopenia, is caused by a virus that spreads easily in groups of unvaccinated cats, affecting young kittens most severely. The virus can enter the body by being inhaled or swallowed, or it may enter through flea bites. It then attacks the intestine, causing vomiting and diarrhea. It can also enter the bone marrow, causing decreased numbers of white blood cells in the blood stream and as a result decreasing the cats ability to fight infection. This disease can progress rapidly to shock and death. The feline distemper vaccine is very effective in preventing this disease. Like the canine distemper vaccine, the feline distemper vaccine is a combination vaccine and includes vaccines against Feline Viral Rhinotracheitis and
53
Sample Operations Manual Calicivirus.
Feline Viral Rhinotracheitis and Calicivirus These viruses cause diseases of the upper respiratory system of cats. FVR causes sneezing, runny eyes and nose and may cause pneumonia and death in kittens. Calicivirus causes ulcerations in the mouth and nose. Both of these viruses may cause chronic, recurring disease. Feline Leukemia (FELV) This viral disease can present with many different signs including runny eyes and nose, difficulty breathing, weight loss, lack of appetite and depression. Though often fatal, cats may be infected for long periods of time without showing signs of illness. The virus may be detected easily using a readily available blood test. Though vaccinations provide good protection against FELV, they are not 100% effective at this time. FELV positive cats should not be housed with healthy cats, even if they have been vaccinated against FELV. Because FELV affects a cats immune system, FELV positive cats often develop opportunistic infections to which healthy cats are resistant. It should be noted that an FELV-positive cat may not be protected against other infectious diseases, including rabies, by vaccinations. Rabies This very serious viral disease affects most warm-blooded animals including cats, dogs and humans. The virus is present in the saliva of infected animals and is transmitted through bite wounds. Once inside the body, the virus attacks the nervous system, eventually causing death. Once clinical signs occur, the disease is almost always fatal. Since rabies is maintained in populations of wildlife, such as skunks, foxes, bats and raccoons, it is a persistent danger to unvaccinated companion animals. For this reason, most states require, by law, regular routine vaccinations against rabies for all dogs and cats. Any person who is bitten by a strange animal should seek medical attention immediately. PARASITES Roundworms may stunt growth 1. Transmission contact with soil contaminated with infected feces or ingesting host with larvae in tissues (often transplacental transmission from mother) 2. Typical patient puppies/kittens, thin with potbellies, anemia 3. Signs diarrhea, poor hair/coat, pot-belly, if infection is severe may enter stomach where they may be vomited 4. Method of detection fecal float 5. Treatment Pyrantel 6. Environmental control preventative de-worming and remove infected fecal material Whipworms may cause colonic inflammation, bleeding and intestinal protein loss 1. Transmission feces or soil (fecal-oral) 2. Typical patient dog 3. Signs sometimes none, bloody mucus, greenish diarrhea, CNS signs 4. Method of detection fecal float 5. Treatment Panacur or Drontal Plus 6. Environmental control difficult to eliminate, remove dog from infected environment Hookworms may cause life threatening blood loss or iron-deficiency anemia, may stunt growth 1. Transmission fecal-oral (soil or feces) or direct penetration in pads of animal 2. Typical patient dogs and cats (dogs more affected than cats) 3. Signs frank fecal blood, diarrhea, anemia, failure to thrive, very thin animal with potbelly 4. Method of detection fecal float
54
5. Treatment Pyrantel 6. Environmental control preventative de-worming, remove animal from infected area Tapeworms rarely pathogenic in small animals 1. Transmission ingestion of infected flea 2. Typical patient dogs or cats with fleas 3. Signs see tapeworm segments on feces or the perineal area 4. Method of detection visible segments 5. Treatment Drontal 6. Environmental control flea prevention Coccidia (protozoa) 1. Transmission fecal-oral 2. Typical patient puppies/kittens 3. Signs mild to severe diarrhea, sometimes with blood 4. Method of detection fecal float 5. Treatment Albon 6. Environmental control remove infected feces Giardia (protozoa) 1. Transmission ingest giardia cysts shed from infected animals (beavers) often via water 2. Typical patient dogs that live near streams, hiking, or on farms 3. Signs- cow patty diarrhea without blood or mucus, may experience weight loss 4. Method of detection smear, snap test 5. Treatment Panacur/ Metronidazole 6. Environmental control dont allow animal to drink from streams or standing water
Budget Process & Financial Guidelines

Designing a Budget Reference the Humane Alliance budget Financial Controls Develop an accounting control system to reduce errors. Areas to focus include: cash receipts cash disbursements, petty cash, payroll, grants, fixed assets, check issuance, deposits, and transfers. Also, you will want to set up a policy for salary levels, vacation, overtime, compensatory time, benefits, grievance procedures, severance pay, evaluation, and other personnel matters. As your organization changes, you will want to review your budgeting procedures and update your financial controls. Basic Financial Reports Financial reports should be performed monthly, quarterly, and annually. Three commonly implemented reports are balance sheets, income statements, and cash flows. In a small nonprofit organization the board treasurer or outside accountant would work closely to the clinic director and prepare the financial information. The clinic director should review all reports prior to presenting them to the board members. Audits The purpose of audits is to test the accuracy and completeness of the organizations financial statements. Audits must be performed by a certified public accountant (CPA). The auditor will request information including: bank balances, contribution amounts, conditions and restrictions,
55
contractual obligations, and monies owed to and by your organization. Some non-profit organizations are legally required to obtain audits. You will need to contact your Secretary of State for regulations on raising money; since some states require an audit once you hit a specific amount. Outsourcing We recommend getting a bookkeeper/ accountant. Outsourcing your financial information will save you time. Accountants will help with financial statements, annual audit reports, cash flow, taxes, reporting, and loan or capital requirements.
Important Phone Number, Websites, & Resources

Insert phone numbers, websites, & resources here
56
Risk Management
Risk Management
57
Risk Management
Insurance Guidelines
Creating a 501(c)(3) Nonprofit in North Carolina (state guidelines vary) Establish a Board of Directors. If you are sure a new organization is really needed, the next step is to establish a Board of Directors. North Carolina law requires only one board member, but best practices recommend that you have at least five; a minimum of seven is preferable. o As you recruit board members, make sure they are aware of their roles and responsibilities. These include but are not limited to: selecting and reviewing the performance of the chief executive; recruiting new board members; ensuring effective organizational planning; evaluating organizational performance; providing financial oversight; and ensuring legal and ethical integrity. A first priority for the board of directors is to clarify the organizations mission and purpose. The board must realistically determine both its short- and long-term goals by identifying who the organization will serve, clarifying what values will drive the organization, and planning for how the organizations mission may evolve over time.
Steps to Establish Your Nonprofit Before applying for tax-exempt status, you need to create organizational bylaws. Its helpful to review those of existing nonprofits and to have a lawyer review them before theyre finalized. Incorporate as a nonprofit corporation by registering with the N.C. Department of the Secretary of State. For forms and free information, including guidelines for incorporating, call 888/246-7636 or 919/807-2225, or visit www.secretary.state.nc.us/corporations. Apply for a Federal Employer Identification Number (FEIN). File Form SS-4 (available at www.irs.gov/pub/irs- pdf/fss4.pdf) with the IRS -- even if your nonprofit doesnt have any employees. The IRS uses this number to track reports and your tax-exempt application. The next step is to apply to the IRS for tax-exempt status as a 501(c)(3) nonprofit by filing Form 1023. The form and instructions are available at www.irs.gov/charities/index.html or by calling 800/829-3676. We strongly recommend you have an attorney or CPA familiar with nonprofit tax law review your application before final submission. You will hear from the IRS in 3-24 months after submitting Form 1023. Ordinarily, there is no need for a new nonprofit to apply for an exemption from the state income and corporate franchise taxes. Rather, the N.C. Secretary of State will notify the N.C. Department of Revenue after an organization registers as a nonprofit. The Department. of Revenue will then contact the nonprofit to obtain additional information and begin the process. While nonprofits must pay sales and use taxes at the point of purchase, most can obtain a semi-annual refund by filing a Form E-585 with the Department of Revenue. For more information or to obtain Form E-585, visit www.dornc.com or call 877/252-3052. You are required to carry workers compensation insurance once you have three full- or parttime employees and/or corporate officers. Contact the N.C. Industrial Commission (919/8072500, (www.comp.state.nc.us) for information on how to obtain coverage. File with the N.C. Employment Security Commission (919/733-7156, www.ncesc.com) for unemployment taxes when you have at least four full- or part-time employees working a total of 20 weeks in one calendar year. Apply for an Unemployment Tax Number and then file the Employers Quarterly Tax and Wage Report.
58
Risk Management
Apply for local property tax exemption by contacting your local County Tax Office. Even if property tax exemption is granted, it is still necessary to file a complete property listing by January 31. Finally, make sure you apply for a Charitable Solicitation License through the Solicitation Licensing Branch of the N.C. Department of the Secretary of State (888/830-4989 or 919/8072214, www.secretary.state.nc.us/csl) if you will be raising $25,000 or more in one calendar year.
Ongoing Legal Requirements File Form 8734. The initial letter you receive detailing your 501(c)(3) status is an advanced ruling only. To maintain this status, your organization must submit Form 8734 to the IRS within 90 days of the end of your advanced ruling period (this date will be listed on your IRS determination letter). File IRS Form 990. Any nonprofit with annual gross receipts of $25,000 or more must file a Form 990. You must refile Form 990 annually within 4.5 months after your fiscal year ends. Beginning in 2008, nonprofits with receipts under $25,000 are required to electronically file form 990-N. The forms are available on the IRS website, www.irs.gov/charities/index.html. Call 877/8295500 or your CPA for details. Renew your organizations Charitable Solicitation License. The license must be renewed annually, within 4.5 months after the end of your fiscal year. Collect sales tax on items sold. If your nonprofit sells retail items, register with the N.C. Department of Revenue for a Certificate of Registration, file the returns, and pay the tax due on a quarterly or monthly basis, depending on your volume of sales. Contact the Taxpayer Assistance Division, 877/252-3052 or www.dornc.com. When needed, update your principal office address and registered agent with the N.C. Secretary of State. For a Change of Registered Office/Agent form, call the N.C. Department of the Secretary of State (919/807-2225). Follow all state and federal laws related to employment, including I-9, W-2, and W-4 forms; withholding taxes; and posting all compliance posters. For free compliance posters, call 800/625-2267 (N.C. Department of Labor), 866/487-2365 (U.S. Department of Labor), and 800/688-8349 (N.C. Industrial Commission).
Crisis Response Procedures

Emergency Evacuation Plan (Animals) Emergencies may include, but are not limited to, natural disasters such as tornados or floods, gas leaks, fire, chemical hazards. Staff must be prepared to safely manage each type of emergency. ADVANCE PREPAREDNESS The following documents and equipment should be easily accessible in case of an emergency. Transport vehicle Employee phone and emergency contact list laminated and ready for safe travel (Phone Tree)
59
Sample Operations Manual AFTER HOURS PREPAREDNESS Phone tree activated Contact info for families of all animals at clinic
Risk Management
RESPONSE Responsibilities of Clinic Director and Executive Director in emergency 1. Makes decision to evacuate and leads evacuation 2. Communicates with RVTs and veterinarian to determine status of animal evacuation, allowing a decision to be made about staff evacuation 3. Monitors the condition of staff and other responders on scene All animals will be loaded into their carriers or crates and loaded into the [CLINIC NAME] van. From there staff will evaluate the need. Owners will be contacted to meet the van at the clinic location or a safe location determined by staff. If alternative housing to the clinic is needed, animals will be taken to the following locations: If during business hours (8am-5pm M-F) Contact Person: If after hours: Contact Person:
Phone Number: Phone Number:
*Animals will be boarded until their owners can be contacted and retrieve the animals. Responsibilities of Vet Techs and Veterinarians 1. Manage the internal movement of animals to outside the building 2. Manage the external evacuation site (i.e. parking lot) ensuring that animals vacate the property to an off-site location Responsibilities of Office staff 1. Follow orders of Clinic Director 2. If moving animals, listen to RVTs and Veterinarians and do so in a quick and orderly manner 3. Ensure that materials necessary to provide temporary care get out of evacuation site and reach temporary staging location including crates/carriers and two week supply of dog and cat food to feed all animals in our care. Emergency Numbers Fire, Medical, City Police 911 Police Department Direct: 828-252-1110 Fire Department Direct: 828-259-5636 Health Department: 828-250-5000 Animal Control: 828-253-1195
Code of Conduct
Reference the HR Manual
60
Forms
Forms
Visit our website www.humanealliance.org for form examples
61

Sample Operations Manual 2010

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Sample Operations Manual 2010

Diunggah oleh

Hak Cipta:

Format Tersedia

Sample Operations Manual