Writing treatment protocols, on-farm training, and records-making it a seamless system (Proceedings)

The request for a written treatment protocol is made frequently and easily by people that don't have to accomplish the task. This request is made with the best intentions and it is necessary that we accomplish this, but it is not quite as simple as it sounds. Simply defining mastitis as abnormal milk and leaving instructions to infuse the quarter with an intramammary tube does not meet our obligation to the cows, the consumers who have a stake in what products they purchase, ourselves, the regulatory agencies administering drug usage laws, and the dairies workers; either the responsible manager or the first touch worker, nor the ownership of the dairy.

Treatment protocols are prepared based on being able to define an expected condition and then leaving instructions about what to do when what was defined is found. The laws regulating drug usage include a requirement for a valid veterinarian client patient relationship (VCPR).

The valid VCPR exists when:

      1. "The veterinarian has assumed responsibility for making clinical judgments regarding the health of the animal(s) and the need medical treatment, and the client has agreed to follow the veterinarian's instructions.

      2. The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of an examination of the animal(s), or by medically appropriate and timely visits to the premises where the animal(s) are kept.

      3. The veterinarian is readily available, or has arranged for emergency coverage, for follow evaluation in the event of adverse reactions or the failure of the treatment regimen."

When we keep the cow's welfare as the priority, the process becomes much simpler. As you work your way through your own protocol writing it is interesting to note that when our decisions favor the cows welfare they always seem to be in the best interest of the workers, the consumers, and business interests of the farm also.

As practitioners, the law that had the greatest impact on the protocol writing was the Animal Medical Drug Usage Clarification Act (AMDUCA), meeting the letter of the law isn't always easy but meeting the intent of the law is. This law is the lynch pin for the papers that follow and the organization of a plan that needs to be very comprehensive yet remain simple and easy to accomplish.

To get started we need to know how the client defines conditions treated currently and the drug protocols currently being used for each management group.

Management group (Fresh cows)

Starting where the dairy is offers several very important pieces of information:

     •      We find conditions that need no redefining or adjustments in drug plan

     •      We find conditions where a superior treatment plan can be written

     •      We find conditions where something about the current drug plan is not medically appropriate

     •      Find if conditions severities that could be served by different treatments

The complexity of the written protocol does need to be considered first if we are going to keep the entire process transparent, simple, and easy. We need to give thought to the simple definitions used to describe what we expect to have caretakers find and clear instructions about what to do when they find what was defined.

Depending on the level of knowledge and decision making ability of the people that will carry out the protocols there may be two levels of protocols to write. The simplest is the top down protocol which defines a condition, states what to do for a defined condition, and what to record to a cows' permanent record. Severity is an easy differentiation defined with a corresponding treatment plan and a recording plan can match clearly and exactly. The records should be available to access response and they should be easily interpreted as to what was found and what was done.

Table 1 is an example a top down protocol for metritis defining the levels of severity with an accompanying treatment plan and instruction about what to record.

This example of a top down protocol carries with it the need to train the first touch person to detect, to develop the technician skills needed to do the job, and record the information that will have value for him or her. This training can be cow side as a demonstration of following the written definitions.

On all of our dairies there is also a person who is responsible for the animal that needs a deeper understanding of the condition. The dairy and this person can use a more complex set of instructions in order to train them to think past the mild, simple cases to managing the group and/or the severe and treatment failures. The treatment protocol for owner/ responsible person includes information in many more areas.

In Wisconsin a program named Best Practices Wisconsin included a software template for organizing the information for upper level management was developed. The plan has spaces for detailed instructions and understanding of:

     •     Condition definition

     •     Defining severities with instructions for different condition scenarios

     •     Instructions for assessment of clinical progress during therapy

     •     Definitions for problem cases and the recognition of treatment failures

     •     Reminders about the records to keep and where and when to record them

     •     Defining how treatments of this condition will be measured and monitored

     •     Drug protocols that match treatment decisions recommended with withdrawal information

     •     For this level of responsibility the written treatment protocol is also a lesson plan for a deeper level of understanding and explains part of why we do things so on-farm supervision of the work can happen, so that we can detail the convalescence we expect, for on-farm supervisors and set the stage for our own supervision of drug usage. We can define a treatment failure and what we want to have happen at that point and include recordings that meet the letter of the law for the treatment records required by our practice acts and AMDUCA which we did not include in the simple cow side recording. We can also leave instructions about routine surveillance diagnostics when we would like additional diagnostics.

Table 2 Protocol form in the WVMA Best Practices

Cow side treatment included instructions for recording the condition, severity, and the treatment protocols used which we are going to see is enough information for treatment assessment, supervision of drug usage, determining epidemiology, and monitoring treatment outcomes. However, when you look at the letter of the law for AMDUCA, the record requirement is ID, species, number treated, condition, drug, dosage, duration, withdrawal times for meat and milk. Therefore in order to meet the letter of the law the more extensive protocol written and the drug protocols that accompany the treatment plan allow us to meet this obligation.

The simply recording cow side of ID, date, condition, and its severity and the protocol used establishes the information needed to:

     •      Assess progress for the individual animal

     •      Have a list of animals currently under treatment for supervision of treatments

     •      Assess the skill level of personnel for identifying conditions

     •      Measure compliance and protocol drift by the personnel

     •      Measure patterns of conditions in the herd

     •      Assess outcomes of treatments

Next, can we use the records to be accountable for the level of welfare we are delivering, our judicious use of drugs and the clinical and economic effectiveness of our plan.

Conclusion

     •      Determine the current condition definitions, drug plan, records being kept, and the definition of a satisfactory outcome first.

     •      Develop two levels of written protocol

           o Top down protocol for the first touch person

           o Complete protocol for the person with the authority to make individual cow decisions

           o Define the conditions expected in a simple manner

           o Prescribe a treatment plan for each condition defined

     •      Establish the record keeping plan

           o What gets recorded cow side

           o How does it get to the cows' permanent record