SOP Pet Reaction Response...2015/12/18 · SOP_Pet Reaction Response 2014 SOP_Pet Reaction Response Rev 12/18/2015 GT Page 1 Effective Date: 12/8/14 Purpose: To outline the process

SOP_Pet Reaction Response 2014

SOP_Pet Reaction Response Rev 12/18/2015 GT Page 1

Effective Date: 12/8/14

Purpose: To outline the process by which our clinic field teams handle in-store reactions and subsequent necessary communication to all stakeholders. All field team members must be cross-trained to handle reaction situations at both the tech and CA stations. The process also includes the required communication content, direction for management personnel, and other applicable departments. Revision History

Date Rev. No. Summary of Changes

12/18/2015 2 Added Clinic Lead responsibilities. Removed requirement of calling Sev 1 into CS and restated reporting requirement/process. Removed SoluDelta Cortef from emergency drug list.

2/24/2015 1 Responsibility: Clinic Teams Clinic Lead (CL) Market Manager (MM) Customer Service (CS) Customer Service Manager (CSM) Regional Director (RD) Attending Veterinarian (DVM) Manager on Duty (MOD) Medical Director CUSTOMER SERVICE PHONE #: 855-844-8387 (VETS) Time Sensitivity: PET REACTIONS ARE #1 PRIORITY Severity 1 Incidents must be reported to MM, RD, and Store Management Immediately. When present at clinic, Clinic Lead is responsible for their team following the process outlined. If CL not present, clinic team needs to follow process. If you are unable to send an incident report immediately, all pertinent information should be relayed by phone our other communication method. MM/RD must report severity 1 incidents to Lisa Ellerhorst, Craig Niebur, and Garrett Trawick immediately. Contents: Overview Severity Levels and Reporting Reaction Incident Procedure Filling out Incident Report Crash Kit Contents

SOP# CS-RXNRPT



OVERVIEW Although rare, vaccine reactions of various severity can occur at any time. Reactions to vaccinated pets can occur immediately, within hours, or within several days of vaccination. If a vaccinated pet is experiencing any abnormal symptoms, notify the DVM IMMEDIATELY. The most common severe reactions:

• Collapsing/Weakness • Fever • Vomiting • Diarrhea • Facial Swelling/Hives/Severe Itching • Any Difficulty in Breathing

As part of the clinic field team, there may be times you are present when a pet experiences a reaction at the clinic. When this occurs, it is imperative that our team acts calm, professional and remember: PET REACTIONS ARE #1 PRIORITY! It is also important to stay organized, document the events via an incident report, and maintain communication with all parties involved. The following SOP defines types of reactions that can occur, how to handle a vaccine reaction situation at or after a clinic, the list of crash kit items the DVM may ask for during a reaction, and examples of ways to communicate with the Pet Parents at the clinic.



SEVERITY LEVELS AND REPORTING REACTIONS: Here is how we categorize the levels of severity for reactions (and incidents). This is important to know so the crew knows how, what, when, and where to report when reactions occur: SEVERITY DEFINITIONS and REPORTING:

1 – High: Pet death (during or immediately following service), escape (recovered and unrecovered), serious injury and or significant brand risk including media exposure. REPORT TO MM, RD, MOD. MM/RD report to VP Wellness, VP Operations, Customer Service Manager 2 – Medium: Vet treatment required but not a severity level 1 incident. All Social Media cases not a Severity level 1. REPORT TO MM, RD, MOD (verbal report only) 3 – Low: All others. REPORT TO MM, MOD (verbal report only)

ONSITE and OFFSITE REACTIONS:

On-Site Reactions that occur while pet is at the clinic/store Off-Site Reactions where the Pet Parent contacts the store after leaving the clinic to report they suspect their pet is having a reaction

COMMUNICATION PROCEDURE:

1. Clinic team and CL is responsible for communication with the Pet Parent until the Pet Parent leaves the store. Further communication will be handled by VETCO Customer Service and the VETCO Customer Service Manager

2. SEVERE 1 REACTIONS must be reported to Market Manager while at the clinic, and be reported to store MOD. Clinic Team gives Customer Service IR/VC details over the phone and should follow up with sending the IR/VC when back at office

3. IF SEVERE 1 REACTION Reported to the Store or Clinic Team after the Pet Parent has left store (OFFSITE), Report needs to be called in MM and RD IMMEDIATELY. MM should make attempt to reach Pet Parent and let them know CSM will be contacting them

4. SEVERE 1 REACTIONS - VETCO Customer Service Manager will schedule call with Animal Care Partners within 24hrs

5. SEVERE 2-3 Reactions – CL or Clinic team reports to MM. MM reports IR/VC to Regional Director by no later than Monday 10AM local time

SEE FLOW CHART BELOW





REACTION INCIDENT PROCEDURE DESCRIPTION:

On Site Reactions:

If a reaction occurs at a clinic/store, ensure the doctor is informed immediately and the life of the pet becomes TOP PRIORITY for the team until pet is stable enough to be transported to a local emergency hospital. Remember: No one except the DVM on duty can give medical advice to any Pet Parent regarding their pet. NOTE: If a pet experiencing a reaction is presented to DVM station during vaccine services being performed to another pet, the DVM and Tech should immediately tend to the pet experiencing the reaction! Make sure that the Pet Parent(s) are instructed to stay back from the table so that the DVM and vet assistant can address the pet’s needs. Make sure the CA informs anyone in line that the clinic is paused to deal with a pet need. Once the other Pet Parents have been notified of the pause in the clinic the CA should stay with the Pet Parent whose pet is experiencing the reaction, indicate this is a rare event and review the emergency sheet information with him/her. 1. Get crash kit, open it 2. Get calculator, drug dose chart, and emergency medications out of Crash Kit 3. Assist with any restraint/CPR/draw up meds/etc: WHATEVER DR. NEEDS! 4. Document process of care, medications, dosages, route of administration, communication. Tech

should ensure that DVM clearly describes symptoms, course of action taken, including any drugs administered, on the incident report. It is imperative that the incident report is filled out completely and the stickers of the vaccines administered are affixed to the VC. The emergency drugs, doses, and times administered must be written on VC

5. Recommend to the Pet Parent, pet should be taken to an Emergency or local hospital for follow-up observation and care.

“We recommend you take your pet to an Emergency or local hospital to make sure he/she fully recovers from the reaction.”

If the Pet Parent asks if we will reimburse for the expense of reaction treatment, inform them that we will and they will just need to contact CS. Making sure the pet is okay is the most important point to make.

“Please keep you invoice from the hospital and contact our customer service via the number on the VC/Flyer and we will help you out with expenses related to the reaction.”

If a Pet Parent refuses to go for follow-up care they must be informed that this is not recommended and must note this on the incident report.

6. Report to MOD Incident Report. Report to MM VC and IR post clinic 7. When Clinic resumes:

a. Apologize for delay, thank them for their understanding b. Reassure rarity of event c. If they can’t wait any longer, offer to hold VC & give 50% discount if return d. Take next customer as quickly as possible





O ON SITE - SEVERE 1 REACTION SSSSSS

1. Help Dr. until Dr. Call time of death/cease of resuscitation & document that time. Cover body of pet w/towel

2. DVM should speak with Pet Parent, but it’s important to also console Pet Parent/reassure rarity of event. Try to be as empathetic as possible. Consoling the Pet Parent is most important step.

“We are so sorry for your loss and the DVM did as much as possible. Please let me know if there is

anything we can do to help…?”

3. Keep other Pet Parents away. Let them know we will be cancelling the clinic and provide 50% discount card. Refund anyone who may have already paid but not received services.

4. Let Pet Parent know that we will reimburse for body care at emergency hospital. We also report these reactions to manufacturer. Our CSM will contact them as soon as they are made aware of the reaction to help with any reimbursement. Do not tell the Pet Parent that CS will call them back within a specific timeframe.

“We can help with your pets final arrangements. Our Customer Service Manager will contact you to

assist you and your family during the grieving process...”

5. Offer to assist the Pet Parent in transporting the pet out of the store. Use a back entrance if possible – offer body care options: Option 1 - Let the Pet Parent know we will go to the nearest Emergency hospital to assist in checking them in and providing details of the reaction. We contact the E Clinic to inform of Pet Parent and pet are in route:

“I can’t imagine how hard this is for you. Would you like us to go with you to the hospital to

assist you in checking in?”

Option 2 - Pet Parent will take body to alternative location of their choice

6. Use towel provided to cover and/or carry pet to Pet Parent’s car. Please be aware that a deceased pet can lose bodily fluids while transporting. Try to be as discreet as possible.

7. Pack clinic 8. In addition to the incident report the CL/tech fills out, have DVM fill out separate incident report

with instructions to provide as much detail as possible in what occurred and exactly what was communicated to Pet Parent

9. Report to MOD, MM, and RD IMMEDIATELY. Provide MM AND RD with as much detail from IR as possible

10. Notify next store and CS that the next clinic(s) for the rig run are cancelled due to severity of a reaction. Crew and DVM will still be compensated for the day.



Off Site Reactions:



If a reaction occurs after the pet has left the clinic, our instructions to the Pet Parent will be to take the pet to the nearest ER or full service clinic listed on the Emergency sheet. Instruct them NOT to bring the pet back to the store. Additional steps are listed below for situations where the crew is still at the store OR the store manager notifies our MM of a reaction that has been reported to them. Pet Parent Calls Store: If a reaction occurs after the pet has left a clinic (call-in to the store). The Clinic Lead or crew (if CL not available) will speak to the Pet Parent if they are still at the store OR the Store MOD will contact our MM who will contact the Pet Parent: 1. Instruct the Pet Parent to take the pet to the nearest ER or hospital (refer to the Emergency sheet)

If the Pet Parent asks if we will reimburse for the expense of reaction treatment, inform them that we will and they will just need to contact CS. Making sure the pet is okay is the most important point to make.

If the Pet Parent refuses to take their pet to the hospital, please be sure to note this in the incident report. No one except a DVM can give medical advice to any Pet Parent regarding their pet.

2. Acquire the Pet Parent’s name, pet name, and write up incident report with any information that can be obtained on the phone call.

3. Report to MM - full report includes VC (w/lot #s) and Incident Report –including communication notes with the Pet Parent

4. MM reports to RD, who will report to CSM for follow-up. MM should also let the store MOD that the Pet Parent was contacted and referred to emergency clinic

O OFF SITE - SEVERE 1 REACTION SSS If the Pet Parent calls and indicates their pet has died, the store MOD will either have the Clinic Lead or crew (if CL not available) speak to the Pet Parent if the crew is still at the store OR the MOD will contact our MM to call the Pet Parent: Console the Pet Parent over the phone, but also collect the following information: 1. Pet Parent’s name and Pets name 2. Description of signs pet exhibited prior to passing away. 3. Refer to the list of E Clinics and hospitals on the Emergency sheet for body care 4. Let Pet Parent know that we will reimburse for body care at emergency hospital. Our CSM will

contact them “Soon” to help with any reimbursement. Do not tell the Pet Parent that CS will call them back within a specific timeframe.

“We can help with your pets final arrangements. Our Customer Service Manager contact you soon to help with reimbursing you...”

5. Report to Retailer - Incident Report 6. Report to MM and CS IMMEDIATELY MM will report to RD IMMEDIATELY 7. CSM will follow-up with Pet Parent



FILLING OUT INCIDENT REPORT:



The following portions (except for Vendor Case #, filled out by CS) of the Incident Report should be filled out in their entirety for ALL On Site and Off- Site Reactions, being sure to mark the checkbox for “Reaction”:

Field teams need to fill out this portion as well. For field teams, please use the back of the page if there is not enough room for all details necessary. Lot numbers are found on the vaccine vial/label. If Pet Parent has indicated they will not take their pet to a hospital, please note “Hospital follow-up declined by Pet Parent” under Hospital Name. If FATAL REACTION, DVM must fill out a separate IR with detailed information on treatment, times, doses, and all communication with Pet Parent:

CRASH KIT CONTENTS AND DESCRIPTIONS



It is mandatory that all field team employees are familiar with all contents of the crash kit. Each team member should know the name of each item, where it is located, and how it is typically utilized/administered. The DVM at the clinic will ultimately be responsible for requesting the item(s) in the crash kit they need to treat a pet experiencing a reaction and the necessary dosage required. Emergency Medicines (all in glass bottles) *Atropine 100 ml - Increases heart rate, decreases secretions of the respiratory tract dose cat and dog 0.02 – 0.04 mg/Kg SQ, IM, or IV *Dexamethasone Sodium phosphate 4 mg 100ml - short acting steroid dose cat and dog 0.1-0.5 mg/kg IV, IM, SC q6-24h *Diphenhydramine 50 mg/ 1 ml - antihistamine used to stop histamine release during allergic reactions. Dose for dogs and cats 1 mg/kg q8–12h IM, SC, IV *Epinephrine 30 ml - adrenaline used when the heart stops to help start it again dose Cat and Dog 1) 0.01-0.02 mg/kg IV q3-5min prn 2) 0.8-2 mg/kg diluted in 3-10 ml saline given intra-tracheally *Dopram – Stimulates breathing- a couple drops on the tongue stimulates breathing. This is used in humans also, especially those with drug overdose. This drug would be used when a pet is not breathing at all, or breathing too slowly. This can’t help if the airway is blocked because of swollen tissues from an allergy. Dextrose - sugar water. This is for small pets (mainly dogs) whose blood sugar drops too low due to the stress of the clinic. They would most likely be seizing, which is not a common sign of a dog-allergic reaction, so that helps differentiate what is going on. *FIRST LINE ITEMS TO HAVE READY IMMEDIATELY UPON REACTION IV Supplies Lactated Ringers bag - Intravenous fluid to replace blood volume displaced during shock (anaphylactic) *Heparin - Anticoagulant used to keep intravenous catheter from becoming blocked with a blood clot Extension set - attaches to intravenous fluid bag to administer fluid from bag to intravenous catheter in patient 1”Gauze tape - keeps intravenous catheter in place 1” roll Vetwrap - keeps intravenous catheter in place Bandage Scissors - cuts gauze tape and Vetwrap IV Catheters 20, 22, 24 g (2) - small cannula (tube) placed inside blood vein to allow instant access to bloodstream for fast delivery of emergency medications Port Ends (2) - caps used to close intravenous catheter, preserve catheter for later use, or allow injection via needle Other *Calculator - used to calculate emergency drug doses & concentrations *Dosage chart – Lists weight and dosage amounts for emergency drugs *Stethoscope - used to monitor heart & respiratory rate & sounds Sterile lube jelly - lubricates rectal thermometers Digital/Rectal thermometer and probe covers- used to take basal/core body temperature *Resuscitation Bag - creates positive pressure air flow when attached to an endotracheal tube *ET tubes (endotracheal tubes) 3-10MM - tubes placed into trachea to allow positive airflow and prevent obstruction from swelling



Gauze sponges 3”x3” - These come in many sizes and generic brands. These do not have to be sterile. These are in case of bleeding for whatever reason. 12cc and 20 cc syringes - The 20cc syringes are for drawing IV fluids out of the bag and giving in fast slugs to pets. INJ Cap Luer Lock Plug Web Tear 2” *FIRST LINE ITEMS TO HAVE READY IMMEDIATELY UPON REACTION Human First Aid Gloves (1 box) - protection from animal waste, biologic agents, other contaminants. Must be used when administering first aid which involves human blood. Also recommended when picking up waste from pets Tweezers - to remove small items such as ticks, fleas, sutures, among other items Pen Lite - to view dilation of pupils & papillary light reflexes Instant Cold Pack - prevents swelling or used to help with heat exhaustion Bandaids (20 regular, 10 large, 10 small, 5 various shapes) - covers skin abrasions to protect wound from contaminants Gauze pads (2 each of 3 sizes) - covers skin abrasions & protects wound from contaminants Antiseptic cleansing wipes (10-20) - used to clean scratch, scrape or any other open minor wound to the skin Triple antibiotic (packets or tube) - used to prevent bacterial infection of small open wound Kept Elsewhere on Rig *Scale - used to accurately obtain pet’s weight *1 ml, 3 ml, 6 ml syringes - 1 ml are used for small doses of more potent drugs, 3 ml can be used to administer larger doses of drugs or more volume *FIRST LINE ITEMS TO HAVE READY IMMEDIATELY UPON REACTION

Documents

SOP Pet Reaction Response...2015/12/18 · SOP_Pet Reaction Response 2014 SOP_Pet Reaction Response Rev 12/18/2015 GT Page 1 Effective Date: 12/8/14 Purpose: To outline the process