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1) If you are transferring a patient we would ask that case histories be provided by email rather than providing paper copies

2) We will screen calls to check clients do not have symptoms, aren’t self-isolating or are not in the “at risk” or shielding category. If yes to any of these, we will ask them not to visit the clinic themselves but request that the patient is brought to the clinic by someone other than the self-isolated individual or anyone from their household.

3) We will ensure that only essential emergencies are advised to attend the clinic to limit the number of people attending. More information about this messaging to pet owners can be found here.

4) We have launched our new video consultation service, Video Vet. The service provides clients with the option of having an online video consult with a vet as an alternative to calling the contact centre. Full details can be found here.

It should now be the exception, rather than the norm, that clients enter the building with their pet. If the duty vet decides there is a need for a client to enter the building the following applies:

• In all but the most exceptional of circumstances, only allow one person is allowed to enter the building with the animal.
• All clients will be directed to wash or sanitise their hands-on arrival.
• Strict social distancing of 2m apart will be maintained.
• Contact time with the owner will be minimised as much as possible.
• After the pet has been triaged the clients will be asked to wait in the car. The pet will be left with the Vets Now team.
• The vet will speak to the client by telephone during the examination to take the history and discuss treatment options, they should also gain consent for any treatment required.
• Good hand hygiene will be practiced at all times.

If the patient is discharged, payment will be taken over the phone and the pet will be safely delivered back to the owner at the door.

Where a patient needs ongoing hospitalisation, in order to minimise movement of people and animals we will need to consider retaining more cases at our Host Practices. This will need to be balanced against capacity of the Host Practice.

To minimise journeys for clients, we will generally prescribe a minimum of 5 -7 days’ worth of medication. More specifically:

• We will prescribe full courses of antimicrobials.
• If a patient is to be on long-term medication we will consider prescribing a longer course if safe to do so.

• Until further notice, no ashes will be returned, all ashes will be retained and safely stored by CPC at their crematoria.
• Once movement restrictions are lifted, all ashes will be returned to the clinics at which point the clinic will need to contact the client to arrange collection of the ashes.
• Any ashes due from the last 7-10 days may also be retained at the crematoria, we will need to advise clients expecting ashes of this.

Will there be any changes to CPC collections?

• It is likely that the frequency of collections will be reduced, which could potentially lead to storage issues, therefore no cadavers should be stored awaiting a cremation decision, the cremation decision should be made during the consultation or at the very latest by the end of the shift.

• Try to maintain safe social distancing guidance of 2m apart where practicable
• Telephone handovers may seem attractive but without scrupulous surface disinfection carry a similar risk
• Consider the location handover takes place, avoid confined wards – be aware that a focus on social distancing and risk reduction may detract from the quality of handover and essential information may be missed
• If handover is performed away from the patients, make notes and do a quick walk-round immediately afterwards to check nothing has been omitted

• Normal hygiene measures apply (using IVC Evidensia Hygiene Guidelines)

• It is not excluded that virus particles can be transmitted through animal fur, skin and mucous membranes. However, it is considered that this is a theoretical pathway of little significance.
• Barrier nursing (see Appendix 1) should be implemented for animals admitted from a household with a self-isolating or infected individual. More stringent (e.g. air space) isolation of these patients if they require hospitalisation is not deemed necessary at this stage.
• Please be aware our understanding of how animals may act as fomites is in its early stages – the IVCEvidensia Group Veterinary Medical Board will review new evidence regularly so guidance in this area may be updated

What should I do if a pet is ill or injured within a household where one or more people advise they are self-isolating?

• The veterinary surgeon should triage the patient to assess clinical need and urgency over the phone.
• It may be that the patient is able to be treated or monitored at home safely without compromising the patient’s welfare. If your recommendation is that the patient does not need to attend the clinic please follow our usual process of advising the pet owners to call back if there are any changes to the patient’s condition.
• If the patient requires veterinary attention request that the patient is brought to the clinic by someone other than the self-isolated individual, or the individual hands over the patient without entering the premises – use telephone contact for history, consent and payments.

• Follow the usual Vets Now house visit process.
• We would not expect staff to perform a house visit which was not clinically necessary.
• Follow our normal process of supporting the client through overcoming barriers to transporting the animal to the clinic setting.
• In the exceptionally unlikely scenario that you judge a patient’s clinical situation justifies a home visit, and it is unable to be moved to the clinic, then you should make your decision whether to attend based on all known risk factors, including the risks associated with Covid-19. Please document these clearly in the clinical notes; remember human medical information should not be recorded due to GDPR but stating that “In this case my clinical judgement was applied in the context of guidance in place relating to the Covid-19 pandemic” is sufficient
• If the case is outside of the home (e.g. impaled on railings) you should request that any people present who are concerned they may be infected, or self-isolating remove themselves from the scene. If this is not possible you should maintain a distance of at least 2m from anyone who is infected or self-isolating
• It is likely that taxi services may become harder to access, or staff may consider the risk of using taxis to be unacceptable. However, where possible:
  • Use Hackney Carriage type cabs as they have a screen barrier in place between the driver and passengers, follow hand hygiene guidelines.
  • Use of personal vehicles – only if the driver has adequate Class 1, or higher, business insurance covering (confirm with your individual insurer):
    • Transit between multiple places of work
    • Transport of medication
    • Transport of live and deceased pets.
  • If you are collecting a pet from the home as the owner has no options to arrange transport safely themselves whilst adhering to Government guidance relating to human movement, then ideally the pet should be collected from outside the house:
    • A small/medium pet should be placed in a suitably sized and secure pet carrier
    • The owner should leave the pet carrier outside the house in a secure location and inform you this is about to occur by telephone
    • Staff collecting the pet should bring a clean large towel or blanket and use this to cover and lift the carrier into the building
    • If a dog is too large to fit into a carrier, leave a crate outside the house for the owner to place the dog into, OR if this is not possible, advise the owner to securely attach a lead/well-fitted collar
    • Staff should wear PPE including gloves, so they do not touch the lead directly
    • Pass the lead through a crack in the door, ensure the receiving person has a secure grip on the lead
    • Place 2 clean slip leads onto the dog, before removing the existing collar and lead and placing in a sealed plastic bag
    • Place pet carriers of admitted patients into a plastic bag, reverse the process on discharge of the patient
    • Clean and disinfect crates as normal
    • Observe strict hand hygiene for anyone who may have come into contact with potentially contaminated leads or carriers

• If the patient is at the home of an infected or self-isolating owner, cannot be moved to the clinic and cannot be collected by a member of veterinary staff following the guidance above due to the animal’s clinical condition then you may decide to enter the house. If so you should take the following precautions:
  • use personal protective equipment
  • follow usual hygiene processes associated when barrier nursing any patient as far as practicable
  • ensure all occupants of the house are in another room at all times
  • ensure minimal contact with any persons present at the scene – use telephone/video contact for history, consent and payments
  • remove the patient from the house as soon as practicable and treat them as potentially contaminated
  • treat the lead/collar/basket as contaminated, place in a sealed plastic bag or disinfect
  • Transfer the patient to the clinic/hospital. Continue to barrier nurse the patient and follow practice hygiene guidelines

You will have available support in your decision from District on call/On Call Hospital Manager.

• If a member of your team or a client develop symptoms in the building, or advises they are from a self-isolating household they should be asked to leave immediately.
• All surfaces should be thoroughly cleaned as per hygiene guidance below – full PPE should be worn.
• Further guidance can be found here: https://www.gov.uk/government/publications/covid-19-decontamination-in-non-healthcare-settings/covid-19-decontamination-in-non-healthcare-settings (in this instance non-healthcare refers to non-human-healthcare)
• People Services should be informed if this relates to staff illness.
• Treatment of the pet should continue as clinically necessary/agreed with the pet owner.

• In these exceptional circumstances, prescribing medicines following a telephone consult may be appropriate and in the best interests of animal welfare, if there are no other options available. This is in line with RCVS FAQs.
• In this scenario a note should be made in the record how this decision was reached in the context of RCVS guidance related to the Covid-19 pandemic, and other options which were discussed with the owner.
• Plan how medications required will be made available for clients, and offer appropriate options:
  • a member of staff could leave the medications on the car bonnet whilst the owner remains in the car, for example.
• A strong recommendation to contact their usual veterinary practice during the day for follow up advice must be recorded in the clinical record.

How much medication should we prescribe to patients?

Generally, you should prescribe a minimum of 5 -7 days’ worth of medication. More specifically:

• Prescribe full courses of antimicrobials.
• If a patient is to be on long-term medication consider prescribing a longer course if safe to do so.

We should be moving to minimise oxygen usage (see below).

• Use oxygen generators/concentrators where they are available.
• Titrate to an SpO2 of 96-99%
• Use nasal oxygen prongs instead of flow by/oxygen tents where possible.

This link has detailed information, you may want to print the poster to display in the prep room https://ava.eu.com/how-to-use-less-oxygen/

Can we maintain physical distancing whilst performing euthanasia to enable a client to be present?

• Many pet owners would find it highly distressing not to be present when a pet is euthanased, decisions around clients being present should be made at the discretion of the duty vet
• We can use long drip lines to enable recommended social distancing of a 2m distance between staff and pet owners.

What do we do about ashes for individual cremations?

• Until further notice, no ashes will be returned, all ashes will be retained and safely stored by CPC at their crematoria.
• Once movement restrictions are lifted, all ashes will be returned to the clinics at which point the clinic will need to contact the client to arrange collection of the ashes.
• Any ashes due from the last 7-10 days may also be retained at the crematoria, we will need to advise clients expecting ashes of this.

Will there be any changes to CPC collections?

• It is likely that the frequency of collections will be reduced, which could potentially lead to storage issues, therefore no cadavers should be stored awaiting a cremation decision, the cremation decision should be made during the consultation or at the very latest by the end of the shift.