Developing an effective staff training program for surgery

Any good training program starts with standardization of procedures so they can be taught and readily duplicated by staff members. Consistency of process is an asset anywhere in your practice but especially in the prep room and surgery.

Using staff in this area is one of the most common forms of staff leveraging and is already widely done in many hospitals. Many of the tasks are technical and can be taught readily to a veterinary nurse and veterinary assistant. This frees up the veterinarian to do what we do best in this area - perform surgery.

Identifying roles

When creating training materials you must first identify what needs to be trained and then write it down. The first training documents that need to be created are what we call "service sequences" in our hospital. These explain how a service is to be delivered, in chronological order. For example, when a patient is admitted for a surgical procedure it needs to be outlined who greets the client, who admits the pet, who sets up the kennel, who premedicates the pet and sets up the surgery, who places the intravenous catheter, who monitors the anesthesia and recovers the pet, who calls the client once their pet is recovered and who does the discharge.

When a patient is admitted for surgery, everything should be outlined in advance, including who pre-medicates the pet.

Standardizing and writing service sequences for these procedures will remove confusion and miscommunication in your hospital and leaves the veterinarian available to do the surgery. Similar service sequences need to be prepared for day-admit patients and patients that are hospitalized.

Once these service sequences have been created so that everyone understands the workflow, then identify all duties that need to be trained and prepare written protocols.

Set up protocols for:

• Supplemental heat

• IV set up

• Drug mixtures

• Kennel set-up and cleaning

• Anesthetic machines

• Endotracheal tube selection and cleaning.

• Surgical site preparation

• Set-up for routine surgeries

• Anesthetic monitoring

• Postoperative patient care

• Pain management protocols.

• Dental prophy set-up and clean-up.

• Surgical instrument care and cleaning.

• Autoclave use and cleaning

• Radiology set-up and maintenance

• Anything else that applies to your hospital.

In multi-doctor practices, establish a consensus on the standardized service sequences and other protocols. This may be your biggest hurdle. However, the benefit to the practice far exceeds the effort required to get a collective agreement for training. Staff will be first to celebrate standardization since it alleviates their need to adjust based on what veterinarian they are working with on any given day.

Involve staff in the process

Before you decide that you will never have time to write all these training documents, take time to identify the people in your hospital who perform such duties and have them help prepare the documents. Who better to prepare training materials than those who are already doing it well. These protocols should be concise and useable as a quick reference for staff. Once the necessary documents have been written in a simplified, understandable form, assemble the material into a manual and begin training. Once again, remember those people in your practice who excel at these duties and recruit them to help with training. This manual should be available in the prep room of your hospital at all times so it can be used as a quick reference for your staff. Keep in mind when you are training that everyone has a different learning approach. Once you train the written word it may be useful to run an in-hospital "wet lab" where all trainees can apply the training hands on.

Fig. 1: Anesthesia Admitting Form and Fig. 2: Anesthesia Monitoring.

Practice makes perfect

Once your staff has the necessary training, they need to be scheduled to work in this area on a regular basis to hone their skills. This may mean a rotating work schedule that buddies a more experienced staff member with a less experienced one. Remember, the only way we get good at a technical skill is to practice. It is very difficult to watch a nurse blow a vein while taking blood or placing an intravenous catheter, but it is an essential part of learning. Let them do it.

A well-trained nursing staff is an empowered nursing staff creating increased job satisfaction that results in increased staff retention. All the while your nursing staff is generating revenue by freeing up your time to see more patients or work on other practice priorities while they are billing for services that you previously performed.

Develop a plan

Planning is an essential part of working efficiently to complete daily surgeries and back office procedures. It is beneficial to have an early morning meeting with staff working in this area to plan the day and create a clear outline of how the day needs to flow. Identify one nurse as the leader in the prep room on that day. It is that nurse's job to coordinate daily activities and plan the work flow in order to achieve an efficient completion of all tasks. In many single veterinarian practices morning appointments precede the day's surgeries and day-admits procedures. The nurse in charge, with the assistance of a veterinary assistant, can be performing pre-anesthetic physical examinations on surgical patients, completing blood draws and pre-anesthetic blood testing, placing intravenous catheters in patients, premedicating and setting up the surgery for the day's procedures so that when the veterinarian has finished appointments they can walk into the surgery and start procedures. If all procedures have been standardized then it is easy for the nursing staff to follow established protocols with minimal assistance from the veterinarian.

The nursing staff is perfect to discharge pets since they are the ones providing nursing care during the pet's hospital stay.

It may also be that nurse's responsibility to admit all in-patients for that day. Our hospital uses an admitting form that is completed prior to patients receiving an anesthetic while in our care (Figure 1). This form is completed by the nurse at the time of admitting while obtaining consent for services to be performed. Then the back of the form is used to record the anesthetic monitoring (Figure 2).

Once the daily procedures have been completed there are still opportunities to leverage your staff by training them on the client education required to discharge hospitalized patients. Once again, standardization is essential so that all clients receive the same comprehensive discharge instructions. Discharge instructions for routine procedures can be prepared ahead on standard forms, with room to write individualized comments pertaining to the pet and any homecare instructions that are unique to that pet. These forms should proudly display your hospital logo and contact numbers. They can be personalized with cute pet and seasonal stickers.

Using staff effectively

The members of the nursing staff are the perfect people to perform pet discharges since they are the ones providing nursing care during the pet's hospital stay. Train your staff on what information you want conveyed to the client, arm them with a discharge form that they customize for each patient and watch them work their magic with the client. Once again when you empower your staff with knowledge they are more confident to take on new responsibilities, which ultimately leads to increased job satisfaction. It also creates an opportunity for your nursing staff to build relationships with clients, strengthening their bond to your hospital.

Surgery follow-up

Your nurses should also conduct telephone follow-ups to complete the surgical patient service cycle. Our nurses contact clients whose pets have had a general anesthetic within two to four hours after discharge to address any immediate concerns and hopefully avoid a panicked call to the veterinarian after hours. This call is followed by a telephone recheck two days later to ensure the pet's well being and address any new client concerns. Not only does this avoid unnecessary calls to the veterinarian, but it is also great client service. Your nursing team will require training on how to handle common post-anesthetic client concerns and when these concerns warrant advice from the veterinarian.

Continued training

This discussion has focused on in-hospital training, which is an essential part of efficient work flow but don't ignore outside opportunities of staff training. Equipment companies often have very knowledgeable representatives that will educate your staff on how to properly use and maintain surgical instruments and equipment, and they will do it for free. The results of financial investment in your staff will often benefit the practice many times over. For instance, there are many veterinary conferences that provide a host of support staff training sessions. We recently took two staff members to the Central Veterinary Conference in Kansas City (we are located in Central Ontario). These nurses had the opportunity to sit in on lectures about pain management, anesthetic monitoring and many other topics not related to surgery. Continuing education for staff at this level validates their importance to your practice and creates renewed job excitement and rejuvenation.

Invest in training your staff and then sit back and enjoy the free time you have created for yourself because you are no longer needed to perform technical duties within your practice. And relax knowing that your nurses are not only educating your clients but they are providing them with excellent client service.