Source: https://www.nysvms.org/general/custom.asp?page=practiceguidelinesp
Timestamp: 2018-05-23 01:22:23
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Practice Guidelines - New York State Veterinary Medical Society (NYSVMS)
Practice Acts for Veterinary Medicine and Veterinary Technology
Practice Guidelines For Veterinary Medicine and Veterinary Technology in New York State
(approved by the NYS Education Department in 2006)
In March 1999, Johanna Duncan-Poitier, then deputy commissioner for the professions, New York State Education Department, directed each State Board for the Professions (including the Board for Veterinary Medicine) to "provide guidance regarding the implementation of Rules of the New York State Board of Regents to practitioners for the promotion of good practice.”
Board members were advised that practice guidelines are "not a substitute for or have the authority of Education Law, Regents Rules, or Commissioner’s Regulations. They do not have the force of the law. ... In formal disciplinary hearings, a guideline may not be used in deliberations unless the Administrative Officer determines that it is admissible.”
The NYSVMS executive board understood that the Practice Guidelines would be used to measure proper professional conduct in disciplinary actions, and made the decision to become directly involved in the process of shaping the guidelines. NYSVMS members and board counsel, Barbara Ahern, attended every BVM meeting when the content of the guidelines was on the agenda to discuss our concerns and suggested changes to the draft Practice Guidelines.
The BVM draft of the guidelines was shared with the NYSVMS executive board, posted on the NYSVMS website, discussed in articles in the newsletter, and shared with regional presidents who discussed the draft at regional meetings. Guidelines were also discussed during a two-hour meeting at the NYSVMS annual meeting in 2001. While not every objection or suggestion for change proposed by the NYSVMS resulted in modifications to the guidelines document, the BVM made a good faith effort to address the concerns voiced by the practicing veterinary community.
The Practice Guidelines are the result of more than seven years of work by members of the Board for Veterinary Medicine with input from the NYSVMS. The practice guidelines were approved by the NYS Education Department's Office of the Professions and became effective October 6, 2006.
The NYSVMS’s involvement gave a voice to the practitioner, and our recommendations helped to determine the scope, terminology and content of the guidelines that govern the profession.
The Practice Guidelines for Veterinary Medicine and Veterinary Technology in New York State, combined with existing New York State law, regulation and rule, are intended to provide practitioners with valuable information on good veterinary medicine and veterinary technology practice. The practice guidelines may also be useful to consumers and others. The Practice Guidelines were developed by the New York State Board for Veterinary Medicine and the State Education Department.
The Practice Guidelines do not replace legal requirements for practice nor are they grounds for professional misconduct. Practice Guidelines do not carry the force of law or regulation. Practitioners must specifically become familiar with and observe the legal requirements associated with professional practice.
For specific legal requirements for the practice of veterinary medicine and veterinary technology in New York State, contact the State Board for Veterinary Medicine or refer to:
1. The law, or statute, authorizing the licensure of veterinarians and Veterinary Technicians is Article 135 of Education Law available at www.op.nysed.gov/article135.htm;
2. Part 62 of the Regulations of the Commissioner of Education in Title 8 of the New York Code of Rules and Regulations, i.e., NYCRR, Part 62 provides details regarding licensing regulations and educational requirements available at www.op.nysed.gov/part62.htm;
3. Education Law, Article 130, Sections 6509, 6510, and 6511 concerning professional misconduct available at www.op.nysed.gov/title8.htm; and
4. 8NYCRR, part 29.1, (General provisions) and 29.6,( Special provisions )for the profession of veterinary medicine of the Rules of the Board of Regents. Additional information concerning unprofessional conduct is found in sections of Part 29.2 of the Rules of the Board of Regents available at www.op.nysed.gov/part29.htm
We hope you find these practice guidelines useful. If in doubt about the appropriateness of specific practices, you should consult the actual laws, rules, or regulations. You may also access these guidelines at www.op.nysed.gov/vet.htm You may direct any questions and comments to Walter Ramos, Executive Secretary to the State Board for Veterinary Medicine at (518) 474-3817, ext. 560, at vetmedbd@mail.nysed.gov or by fax, (518) 487-4846.
GUIDELINES FOR PRACTICE OF VETERINARY MEDICINE AND VETERINARY TECHNOLOGY IN
2. Providing Professional Services
4. Continuing Professional Competence
Guideline 1: DEFINITION OF TERMS
1.1 An ambulatory facility is a mobile practice center where veterinary medicine services are performed.
1.2 An emergency facility is a practice where a veterinarian is on the premises to deliver emergency services during advertised hours.
1.3 Animal includes every living creature except a human being.
1.4 AVMA is an acronym for the American Veterinary Medical Association.
1.5 Board is a short form for the New York State Board for Veterinary Medicine.
1.6 Client is an entity, individual, group or corporation that has entered into an agreement with a veterinarian for the purpose of obtaining veterinary medical services.
1.7 Continuing Education is a program of professional education that is designed to contribute to the advancement, extension, enhancement or maintenance of competence in the practice of veterinary medicine (See guideline 4).
1.8 Patient is an animal that is receiving veterinary medical care;
1.9 General anesthesia is a condition caused by the administration of a drug or a combination of drugs sufficient to produce a state of unconsciousness or dissociation and blocked response to a given pain or alarming stimulus.
1.10 The practice of veterinary medicine is defined as diagnosing, treating, operating or prescribing for any animal disease, pain, injury, deformity or physical condition or the subcutaneous insertion of a microchip intended to be used to identify an animal.
1.11 Professional judgment includes any decision or conduct by the licensee pertaining to the practice of veterinary medicine as defined by Article 135, S. 6701, Title VIII of State Education Law.
1.12 Supervision
A. When an individual is practicing under the general supervision of a licensed veterinarian, the veterinarian must be readily available to communicate with the person under supervision.
B. When an individual is practicing under the direct supervision of a licensed veterinarian, the veterinarian must be on the same premises as the person under supervision.
C. When an individual is practicing under the immediate personal supervision of a licensed veterinarian, the veterinarian must be within audible or visual range of both the person under supervision and the animal patient and be able to intervene personally in the procedure, if necessary.
1.13 Surgery is the treatment through incision, excision or other structural alteration of animal tissue.
1.14 VCPR refers to the Veterinarian/Client/Patient/Relationship (See Guideline 5.11).
1.15 A veterinarian is a person who has received a professional degree from a college of veterinary medicine and is authorized to practice veterinary medicine under the laws, rules, and regulations of the State of New York.
1.16 A veterinarian on call means a veterinarian who is able to respond in a timely fashion to a request for veterinary service.
1.17 A veterinary facility is any fixed or mobile establishment, veterinary hospital, animal hospital, clinic or premises where veterinary medicine is practiced.
1.18 A veterinary technician is a person who has received a professional degree from a program of veterinary technology and/or is authorized to practice veterinary technology under the laws, rules, and regulations of the State of New York.
Citations of Pertinent Law, Rules, or Regulations:
Education Law, Section 6701 - Definition of practice of veterinary medicine
Education Law, Section 6703 - State board for veterinary medicine
Education Law, Section 6702 - Practice of veterinary medicine and use of title "veterinarian”
Education Law, Section 6708 - Definition of practice of veterinary technology
Education Law, Section 6709 - Practice of veterinary technology and use of title "veterinary
Education Law, Section 6711 - Requirements for a professional license as a
Guideline 2: PROVIDING PROFESSIONAL SERVICES
Before providing service it is important that a valid VCPR (see definition 1.14 and Guideline 5.11) is in place and you have obtained the informed consent from the client. In the course of providing professional services:
2.1 The veterinarian should:
A. provide professional services in a timely manner;
B. conduct a complete physical examination, including, but not limited to, weight (small companion animals), TPR, auscultation of heart and lungs, ocular and otic systems, integument, and musculoskeletal system, on every patient or a number of representative members of a herd or flock;
C. if providing small companion animal services, assure the availability of an appropriate waiting area for clients and their animals;
D. provide clients with direct contact information on how to obtain veterinary services in case of emergency, as well as who to contact for services in her/his absence. A sign should be displayed at the entrance of the veterinary facility with a telephone number and location where veterinary care is available when the veterinary facility is closed. An answering machine or service should notify the public of the business hours of the veterinary facility and when veterinary care is available;
E. assure that housing of in- patients is appropriate for the proper provision of veterinary care;
F. maintain an appropriate identification system for all animals admitted to the veterinary facility in which the veterinarian practices;
G. employ appropriately licensed staff;
H. provide written notice to client(s) should there not be appropriate personnel to assure proper veterinary care at any time while an animal is an in-patient in a veterinary facility. Such notice may be in the form of a clearly legible sign posted in a conspicuous place or a notification on a hospitalization consent form;
I. advise clients, as appropriate, of any diseases that currently pose an imminent danger to livestock, companion animals, and/or people within the locale;
J. perform or provide laboratory procedures, as appropriate, for diagnosis and monitoring of medical and/or surgical conditions, including, but not limited to:
1. urinalysis, including microscopic exam of sediment;
2. hematology, including CBC with differential WBC;
3. identification of external and internal parasites;
4. blood/plasma/serum chemistries;
5. necropsy and histopathology;
6. serology; and
K. perform or provide imaging procedures, as appropriate, for the diagnosis and monitoring of patients, in a manner that complies with all currently applicable rules and regulations for safe use of such modalities in the jurisdiction. Veterinarians and veterinary technicians should be familiar with and adhere to all rules of Section 16.54 of the New York State Health Code as it applies to veterinary radiology;
L. perform or provide access to appropriate diagnostic procedures to monitor cardiac health status; e.g., ECG and/or ultrasonography;
M. when offering disposal service, provide for proper storage of carcasses of animals (refrigeration or freezing) as well as disposal methods that meet all jurisdictional requirements.
Education Law, Section 6509 (9) - Unprofessional conduct
Education Law, Section 6713 - Special provisions
Education Law, Section 6705-a. Emergency veterinarian service
Title 8 NYCRR, Section 29.6 - Special provisions for the profession of veterinary medicine.
New York State Health Code, Section 16.54
Guideline 3: REFERRALS
3.1 As a New York State licensed veterinarian, you should refer the client to another qualified veterinarian under the following conditions:
A. when the attending veterinarian determines that he or she is not able or sufficiently qualified to meet a client’s or patient’s needs;
B. when additional or alternative services are required or requested that the attending veterinarian is unable or unwilling to provide; and/or
C. when an emergency situation exists where the attending veterinarian cannot
respond in a timely fashion as dictated by the described condition of the patient.
Guideline 4: CONTINUING PROFESSIONAL COMPETENCE
4.1 The veterinarian and veterinary technician should:
A. maintain and update professional knowledge and skills through continuing education and review of current literature, etc.;
B. complete appropriate professional training before performing any procedure or therapy;
C. have access to a library of current veterinary reference materials containing readily available textbooks and journals, internet databases, etc.
Regents Rules, Part29.1(b)(9) - Practicing beyond competency
Guideline 5: PROFESSIONAL PRACTICE
New York State licensed veterinarians and veterinary technicians:
5.1 should exercise the same care, skill and diligence in treating patients consistent with that of other members of the veterinary medical profession in good standing in the locality or community in which you practice, or in similar communities;
5.2 should conduct your practice on the highest plane of honesty, integrity and fairness in dealing with his or her clients and patients;
5.3 should disclose to clients any potential conflict of interest, (e.g., if you are providing services to both the buyer and the seller of the same animal);
5.4 should never make any attempt, directly or indirectly, to adversely influence the sound professional judgment of another veterinarian or veterinary technician;
5.5 should not render any services or advice that will deceive or betray the public;
5.6 should not issue a health certificate/certificate of veterinary inspection for any animal unless you have thorough knowledge, as a result of actual inspection and appropriate tests, that the animal meets the specifications and conditions certified;
5.7 should treat all animals entrusted to you in keeping with professional standards of humane care and treatment; this includes the use of chemical restraint, sedation and pain management, when appropriate;
5.8 should decide what medical or surgical cases you should accept in your professional practice; once you accept a patient, you should determine what course of treatment will be followed in consultation with the client;
5.9 should advise the client regarding any treatment to be provided to the patient without using undue influence;
5.10 should not allow any layperson, corporation, or other entity to control, influence, or exploit the relationship between the client/patient and the veterinarian;
5.11 should establish a veterinarian/client/patient relationship, VCPR except when the client is unavailable. The VCPR exists when:
A. you have sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal. This means that you have recently seen and are personally acquainted with the care of the animal by a physical examination of the animal and/or by medically appropriate and timely visits with the animal; and
B. you are readily available or have arranged for emergency coverage for follow-up evaluations in the event of adverse reactions or the failure of the treatment regimen.
5.12 should only prescribe, deliver, or have delivered prescription drugs when a VCPR has been established and you have determined that the prescription drug is therapeutically indicated for the health and/or well being of the animal. You cannot fill prescriptions from other veterinarians.
A. Written prescriptions can be filled at a pharmacy of the client’s choice. A written prescription for a drug must be provided upon request if a valid VCPR has been established. All written prescriptions should include the following information:
1. the name, address, telephone number, license number and signature of the prescribing veterinarian
3. the species and name, number or other identifying information for the animal;
4. The name, strength and quantity of the drug(s)
5. directions for use including, if applicable, withdrawal time
7. number of refills
8. Dispense-as-Written box.
B. Drugs dispensed from a veterinary pharmacy should be labeled with the following information:
C. Drugs should not be prescribed for a duration that is inconsistent with the patient’s medical condition. The drug should not be prescribed for more than one year from the date that you have examined the patient and prescribed the drug, unless you have conducted a subsequent examination of the patient and determined that there is a continued need for the prescribed drug.
D. Childproof containers should be used unless otherwise requested by the client (an exception would be a drug that is prepackaged, for example, and dispensed with appropriate labeling).
5.13 should not prescribe, dispense, deliver, or order any controlled substance unless you are currently registered with the Federal Drug Enforcement Administration (DEA). However, if you are not a veterinarian registered by the DEA but you are a DEA unregistered veterinarian employed by a DEA registered veterinarian you may dispense or administer controlled substances if the DEA registered veterinarian has knowledge that you are using the drugs in the usual course of your employment
5.14 should prepare a LEGIBLE individual record every time you provide professional services. The record can be written or computer generated, for each patient treated using accepted standard nomenclature (See Section 5.14E for food animal and colony practices).
A. Records should be maintained for at least three (3) years after the animal’s last visit. If controlled drugs were used to treat the animal, the record must be maintained for 5 years in accordance with DEA regulations.
B. All medical record entries should be signed, initialed or otherwise validated by the individual making the entry.
C. Adequate medical record should include all clinical information pertaining to the patient including sufficient information to justify the diagnosis and treatment. The medical record should include, but not be limited to, the following information:
1. Client identification (name, address, phone numbers)
2. patient identification (species, breed, age, gender, reproductive status, colors and distinguishing markings, tattoo, microchip, etc.)
3. patient history (past and recent history, current illness and chief complaint) which should include the dates of visits
4. results of physical examinations including weight, temperatures when possible, pulse rate, respiratory rate, mental status, conformation, hydration status, and complete systems review as appropriate to the circumstances
5. results of laboratory, imaging, and any other diagnostics performed as well as consulting specialist’s reports
6. assessment, differential or definitive diagnosis
7. recommended treatment plan, including diagnostic recommendations, surgical procedures, any medical alternative, or other therapy discussed
8. written documentation of client’s informed consent when appropriate for the treatment including acknowledgment of risk
9. treatments performed and therapy administered (including names, dosages, routes of administration of all drugs including anesthetics)
10. results of treatments performed, when available and in the case of hospitalized patients, daily narratives of the patient’s condition, assessment, changes in therapy and date of discharge
11. recommendations for outpatient care, follow up visits, postoperative instructions
12. all client communications either in person, via telephone or email
13. results of necropsies performed
14. all other pertinent veterinary information.
D. Daily treatment records, anesthesia logs, and surgical reports are all considered part of a patient’s medical record.
E. In a food animal or large colony practice where individual records might not be maintained, sufficient written information must be kept so that another veterinarian can continue veterinary services in a logical and professional manner.
F. Medical records also include, but are not limited to:
a. Original radiographs are the property of the veterinary facility that originally ordered them to be prepared.
b. Radiographs or copies should be released to the client or another veterinarian upon appropriate authorization of the client.
c. Original radiographs should be returned to the veterinary facility that prepared them within reasonable time.
d. Radiographs or copies of radiographs originating at an emergency hospital should become the property of the next attending veterinary facility upon receipt of the radiograph(s). Transfer of radiographs should be documented in the medical record.
e. All exposed radiographic films, except for intra-oral radiographs, should have a permanent identification legibly exposed in the film emulsion. This identification should include the following:
1. the hospital or clinic name and/or the veterinarian’s name
4. the date the radiograph was taken
5. positioning information if relevant
2. Laboratory data is also part of the medical record.
G. Emergency Clinic Medical Records - the client should be provided with a legible copy of the medical record when the patient is released following emergency clinic service. The medical record should include at least the following:
1. physical examination findings
2. dosages and time of administration of medications
3. copies of diagnostic data or procedure;
4. all radiographs, or copies of radiographs, for which the facility should obtain a signed-release when transferred
5. surgical summary
6. tentative diagnosis and prognosis if known
7. any follow-up instructions
H. Requests for copies of the medical record - upon request, the client is entitled to copies of all the medical records, provided in a timely manner. A reasonable fee may be charged.
5.15 Anesthesia and surgery. Veterinarians must use appropriate and humane methods of anesthesia (general or local), analgesia and sedation to minimize pain and distress during procedures. The veterinarian should comply with the standards listed below:
A. Every animal should be given a physical examination within 24 hours of the administration of an anesthetic or as dictated by the animal’s condition.. The results of the physical examination should be noted in the animal patient’s medical records.
B. Appropriate drugs and equipment to treat medical emergencies should be readily available.
C. Supplemental heat for intra-op, post-op and critical care patients should be available when appropriate.
D. Surgery should be conducted in an appropriate surgical environment at the level of practice commensurate with the practice of one’s peers.
5.16 Compliance with OSHA requirements is required and a notebook of Material Safety Sheets (MSDS) should be kept and be readily available to all employees.
Citations of Pertinent Law, Rules or Regulations
Education Law, Section 6706 - Corporate practice
Education Law, 6713. Special provisions
Education Law, 6714 Treatment Records
Education Law, 6807 Exempt persons: special provisions
NYCRR 29.1 - General provisions for all professions
6.1 willfully harass, abuse or intimidate a client or patient either physically or verbally;
6.2 fail to wear an identifying badge, that is conspicuously displayed and legible, indicating name and title;
6.3 fail to conspicuously post at the site of the practice the names and field of licensure of all the principal professional licensees engaged in practice at that site;
6.4 issue prescriptions for drugs that fail to contain the following information: the date written, prescriber’s name, address and telephone number, profession and registration number, client’s name, address, strength and quantity of the prescribed drug or device, as well as the directions for use by the patient;
6.5 fail to use scientifically accepted infection prevention techniques appropriate to the profession for the cleaning and sterilization or disinfection of instruments, devices, materials and work surfaces; and
6.6 fail to properly handle sharp instruments and utilize protective garb and covers for contamination prone equipment.
Additional information regarding Unprofessional Behavior can be found in the following Law, Rules or Regulations.
NYCRR Part 29 Unprofessional Conduct
NYCRR Part 29.1 General provisions for all professions
NYCRR Part 29.6 Special Provisions for Veterinary Medicine
Guideline 7: PHARMACEUTICALS
7.1 The following should not be held or offered for sale:
a. prescription medication that is returned by the client;
b. adulterated and/or misbranded drugs or devices;
c. drugs beyond their expiration date; and
d. drugs inappropriately stored.
7.2 Appropriate locked storage for controlled substances should be available in accordance with DEA regulations.
7.3 A separate refrigerator, with temperature monitoring, for proper storage of medications, laboratory kits and biologics based on the manufacturer’s recommendations (separate from staff food storage) should be available.
Guideline 8: FEES
8.1 Fee disputes can often lead to complaints of professional misconduct. The Office of the Professions does not negotiate or resolve fee disputes. However, other claims of professional misconduct may arise as a result. When investigated, many times these complaints are found to originate in disputes over fees, but the veterinarian as well as the Department will have had the burden of the investigation. To avoid these complaints, veterinarians should:
1. clarify the billing and payment conditions with clients at the outset of evaluation and treatment, and specify the financial arrangements in terms that the client can understand;
2. make the client aware of the cost involved for the recommended treatments so the client can make informed choices and not incur excessive expense.
DVM Licensure laws
Knowledge Center resources about becoming a licensed veterinarian
60-day grace period for new licensees Link Administration 8/21/2013
Knowledge Center articles related to veterinary medical records
Who owns patient records? Link Administration 12/12/2014
Best Practices - Medical Records Link Administration 8/22/2013
Veterinary Medical Records FAQ Link Administration 8/21/2013