Implementing a strategic deworming program in your practice

Preventive health care is an important component of veterinary practice. Pet owners rely on veterinarians to provide optimum health care for their pets. Veterinarians are in a unique position of trust with our clients and they expect us to look out for their pet's best interest. This is accomplished through education about all aspects of preventive health care. Good veterinary practice also includes giving clients advice on the prevention of transmission of zoonotic disease agents from their pets to human family members.

A veterinary nurse should regularly review strategic deworming guidelines with clients. By offering a comprehensive training program for the staff, employees will gain confidence and can then easily talk with clients about their questions.

Traditionally, some practitioners have been reluctant to talk about intestinal parasites and the human health risk for fear that this may lead some clients to give up their pets. It has been our experience that this is not the case. People are bonded to their pets more than ever, with more pets sleeping in our beds, having birthday parties and having their names appear along side our own when sending greeting cards. The likelihood that the pet would be removed from the home is remote. The likelihood that clients will comply with your recommendation is high, especially when the client is properly educated.

Health threat to humans, animals

Human infection with roundworms of dogs and cats is considered by many to be the most common zoonotic infection associated with pets in the United States and other industrialized countries. Veterinarians should not ignore statistics produced by the Centers for Disease Control and Prevention (CDC) and the mounting pressure on our profession to be leaders in not only animal health but also public health. In order to help deal with this problem the American Association of Veterinary Parasitologists (AAVP) and CDC have prepared recommendations for veterinarians on the treatment of roundworms and hookworms for dogs and cats. These are strategically timed, preventive anthelmintic treatment recommendations for dogs and cats.

Practice Tips

It is important to take this information and modify it if necessary to suit the geographic location and risk factors of your practice area, take the steps to train support personnel, then educate your clients what their role is in this part of their pet's preventive health care program (Table 1, p. 34).

Training support personnel

In order for your hospital personnel to be able to speak knowledgably to clients about your strategic deworming program they must first have a basic knowledge of intestinal parasite life cycles, mode of infection, how to decrease exposure, diagnostic testing, consequences of infection and the human health risk. Before you can train your personnel on strategic deworming recommendations, all staff members need to at least learn the basic life cycle and impact parasites can have on humans, if infected. The veterinary nurses who do the majority of client education are trained in much more detail than a receptionist. The goal is eventually to have all support staff trained to the same level of comprehension, however, depending on existing levels of animal health care knowledge this is a good starting point.

Table 1

Once your staff has mastered the basics then they can graduate to a more comprehensive version of the same material. It is important to train the complexities of a topic so that your staff can confidently answer clients' questions, not so that they may deluge clients with everything they know! Your staff wants to be empowered with knowledge. This gives them more confidence when dealing with clients and ultimately much more job satisfaction. Increased job satisfaction means less staff turnover. This is a win-win situation for your staff and for the hospital since it is well recognized that staff turnover has a dramatic effect on hospital morale and revenue.

Centrifugation does not require the most high-tech centrifuge available, merely something reliable.

Learning curve

Whenever a hospital embarks on a staff education program it is important not to train by intimidation but to support those with lesser knowledge and realize that these people may need to be trained on a more simplified version. Keep in mind that not everybody will understand a topic the first time it is taught, so be patient. Some people will need to hear the same thing several times before they have full comprehension and some will require different training techniques. Remember, your staff will learn more effectively if the information has relevance to them. The same is true for our clients. It is our job to make complex subject matter simple for our clients to understand. We need to communicate to them at a very basic level while imparting the important and relevant information for their pet's needs. The average client has a very short attention span for new information, so, we need to train our staff how to do this in less than 30 seconds.

Diagnostic testing

Our chief diagnostic tool to detect intestinal parasites in pets is the in-house fecal examination. We recommend that clients bring one entire bowel movement if possible since the eggs are not evenly distributed in the stool. When a client arrives with a fresh fecal sample the staff member who receives it completes a form with pertinent information and gives the stool to one of the nurses for testing. All fecal tests are run by the veterinary nursing staff and the process involves completely mixing the sample then viewing a fresh mount and a fecal flotation under the microscope. Results are recorded in the medical record and abnormal values are brought to the attention of the attending veterinarian (see Fecal Diagnostics, p. 35). Although many practices perform passive fecal flotation exams, most every veterinary practice has the capability of using the centrifuge technique for fecal examinations. This procedure actually takes about the same amount of time as a simple flotation, except the results are much more accurate. (See related story p. 8.) It is also critical that solutions for performing fecal examinations have the proper specific gravity. Since most parasite eggs have a specific gravity of 1.1-1.2, it is imperative that the fecal solution's specific gravity be at least 1.2-1.25. If the specific gravity is off even by 0.1 from the ascribed values, most eggs will be missed.

Client education

Client education should be part of every contact with your hospital and involves all staff members. The first contact is often with the reception staff, and with the appropriate training they can relay the importance to clients about bringing in their pet's stool sample when booking the appointment. Educating clients about the importance of fecal examinations and regular deworming is reinforced by the veterinary nursing staff as part of all patient visits. A copy of our hospital's strategic deworming guideline is placed in the patient's medical record while the record is being prepared by the reception staff prior to the patient's arrival. These recommendations are reviewed by the nursing staff and the appropriate deworming medication is prepared and dispensed.

Preparing a fecal exam properly is important for an accurate diagnosis.If a passive feal flotation is performed, it involves mixing the fresh stool sample, setting up the fecal flotation and having the veterinary nurse examine a fresh mount and fecal flotation.

Conclusion

What does all of this mean to your practice? First, it means that if you are not already leveraging your nursing staff then this is a great time to start. This is common subject matter that the staff can readily learn and start to implement in a short period of time with some training and guidance.

Your clients will appreciate your guidance and will happily comply with your hospital's recommendations. Your staff will amaze you at their willingness to learn and accept more responsibility. A nursing staff empowered with knowledge has the unique ability and the patience required to educate the public. Clients and their pets win and so does your support staff.

Suggested Reading

In 2002, using this process , our hospital saw a 38 percent increase in fecal examinations and an more than 200 percent increase in worm medication dispensed. Your hospital wins by providing excellent preventive health care with increased profitability.