Ahhh...Making Mistakes on the Job!

[vetwardbound]

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I recently took my first job as a a vet tech at a really short-staffed, chaotic, overloaded hospital. I've seen a number of mistakes made by other techs and the doctor (aka pre-meding a dog twice for surgery due to poor communication, giving shots to a dog with a fever, etc.) but today I made my first big mistake and I'm completely stressed about it -- I misread the shots a puppy was due for and gave it a distemper booster two whole weeks early (we do boosters every three weeks). The puppy was fine as of eight hours later (fortunately, I know the owner and called to check on it), just a little sore at the injection site. In the grand scheme, I know that I will probably make larger mistakes at some point as a vet, but since this is my first real tech job (second week), I'm terrified of going to work tomorrow/making another mistake. Am I overreacting?? How have you guys bounced back from mistakes? How does everyone keep all of the patients straight when they are responsible for so many at a time? (We have one doctor and two nurses who see about 25-30 pets a day and 2-5 surgeries a day). I'm really doubting myself right now! Help!!

 

[critterfixer]

I'm kind of confused. How did you come to be the person to determine which shots should be given, and when, as the veterinarian is the only one who is legally allowed to make that decision?

Outside of that, I'd say this is not a major error, from a health standpoint. A stray puppy brought into a shelter would have a chance of being re-vaccinated, and really the reason puppies are vaccinated so often is so that one will "take" as passive immunity wears off.

You're right, you will make bigger blunders over the life of your career--as will we all. Owning up to it (this is the biggie--be sure you told the veterinarian about this), checking on the puppy, and taking steps to insure you won't make the same mistake again are the steps you can take. But even then, sometimes you just have to allow time to pass until you are ready to let yourself off the hook.

 

[ShelterGirl]

Hey, it happens. Best thing you can do is own up to your mistake (sounds like you did, so good) and get it corrected if at all possible.

I've found that I tend to make more mistakes when I am rushing, and that I tend to rush when I feel overwhelmed. I work in a 20-doctor practice in the ICU and believe me, it gets very chaotic when you have only 3-4 people working on 2-3 DOZEN pets requiring hourly treatments! Sometimes I have to force myself to slow down a little, even if we are a little behind on treatments, because it is better for a pet to get its meds or tests delayed slightly than to get a double dose, wrong meds, jug stick on a pet with a clotting problem, etc.

 

[Wolf Vet]

Sorry for the long answer, but it's actually been a hot topic at my work lately and I think I'm still wired up about it. 😳

As far as early vaccines, it's not that bad (not saying it wasn't very stressful!) but here's two points to consider. Some "stupid" breeders vaccinate every 1-2 weeks, this usually only causes major problems after it's happened a few times. Second, if a stray dog/pup comes in, we'll start vaccines right away (it may have just recieved them a few days ago for all we know). It still sucks as it was a mistake, but I have seen a dog recieve way too much insulin, a dog that got out of its cage and pulled his own IV out because the door didn't get shut properly - those are the calls to clients that roll ones stomach.

As far as keeping it straight in a busy hospital (my hosp has 7+ doctors, 1 office manager, 3 supervisors, 9-11 RVTs, 10-12 receptionists, 12-14 vet assistants, 3 groomers and 4 kennel help) it helps to have an organized flow, such as patient flow sheets, etc. (I'm assuming your hosp is paper charts?). Of course, being the new guy makes implementing it hard. You may personally keep a tiny notepad, etc, some people at my hosp do. But what seems to help the most at my hosp it the "checkbox". Everything we do is written on the surgery/treatment, etc board, followed by a box, when you give, say pre-meds, it is initialled immediately so it doesn't get doubled up.

Lastly, you asked how to carry on? Try to remember (not trying to be too philisophical here), we've ALL made mistakes, it happens in human medicine too. The important thing is to first admit it (yes, I've seen many who tried to hide the fact, sadly) and obvious try to be more careful in the future. Learn, but don't dwell on it. If you do, you'll be distracted from your current patient and you'll make another mistake. (get home, have hard liqour on the rocks, and THEN dwell on it 😀)

 

[david594]

It really sounds like you guys need some better organization.

The pre-surgical med issue can be pretty much entirely avoided by having all the meds prepped beforehand or at the very least marking each animals chart when a med is given so they don't get double dosed. If your only doing 2-5 surgeries in a morning, then its fairly easy to just lay out all 5 records and draw up all the pre-surgical, anesthetics, pain meds, antibiotics, etc for each record before hand and just place them with each record. Give an injection, mark the time and initials in the record and you are all set. Someone asks you to give an injection and its not already prepped in the record, then you know something is amiss and then you just need to figure out if it was already given, or if it was somehow never drawn up to begin with.

Just some thoughts because I am always the guy giving the pre-surgical meds and post surgical pain meds.

 

[vetwardbound]

Thank you guys for all the really great replies. You certainly made me feel better about the mistake itself (medically speaking). I told the doctor when it happened and he said the dog would be okay, but the doctor tends to write off mistakes very quickly (by any of the staff) and keep them quiet, so I wasn't sure if he was downplaying the dog's risk of getting sick from the injection. Probably because, as critterfixer said, he should be the one deciding which vaccines and when. He simply doesn't have the time to do everything he should be doing, so a lot of responsibilities fall on the techs that shouldn't. He examines every pet and tells us if its okay to vaccinate in general, but it's up to us to draw up the right stuff. It's a lot of pressure for someone who is still figuring out what's going on in general to all of the sudden have all of these extra responsibilities on top of what I should be doing.

I'm pretty grateful that this was my first big mistake (not life threatening) because I'm going to feel much more comfortable walking in today and saying no to things and slowing down, even when the pace is rushed and we're behind (good advice, sheltergirl 🙂 thank you). I'm also taking in a little notepad like wolfvet recommended to see how it helps today. Maybe if I have my notes written down and I can worry about keeping less information in my short term memory I can really focus on the tasks at hand and not make stupid mistakes.

This is definitely not a great clinic by any standards, but it is inexpensive and therefore very busy no matter how poor the medicine is. Can I ask another random survery question? How many regular appointments do your vets see each day? I think thirty is way too many for a one doctor staff. My last hospital where I worked as a kennel assistant and receptionist saw about 20 per doctor and things were busy enough there! What number do you guys think is best?

 

[theunraveler]

I'm kind of confused. How did you come to be the person to determine which shots should be given, and when, as the veterinarian is the only one who is legally allowed to make that decision?

real life practice and the law dont always go hand in hand. in singapore by law, when the drugs are not used by their expiry date, they are supposed to be destroyed but in reality alot of vet clinics still use expired drugs.

alot of funny things happen behind closed doors...

 

[HeartSong]

I think it is good that you are upset about making a mistake. Of course you don't want to let it eat away at you or keep you from doing your job in the future for fear of making another mistake. But at the same time you don't want to brush off mistakes as easily as it seems your vet and others working at that clinic do. Everyone makes mistakes, but not everyone handles their mistakes properly. That's what I've learned separates good workers from those who are going to be sued. It sounds to me like you fall into the first category. You are learning from your mistake and taking advice on how to improve in the future. Great for you! I think you are going to be awesome in this field.

 

[rachroo]

Everyone makes mistakes, but not everyone handles their mistakes properly.

Wow, that quote needs to be framed or something! Very, very true.

Don't forget, we're all human and therefore we all make mistakes (even the Dr's). All you can do is try your best, be as organized, alert, and focused as possible. Also, try to learn from mistakes (made be yourself and/or others) when they are made.

 

[Kat0303]

To respond to the question of why the OP was deciding what vaccines to give... At the clinic I work at, the techs are allowed to decide which vaccines to give, because there are guidelines to what age each vaccine is given. We just follow the age guidelines and give what the client is willing to pay for. We often give vaccines on days that the Dr. isn't even in the office. So I can see how there is the potential for mix-up in this type of situation.

 

[critterfixer]

To respond to the question of why the OP was deciding what vaccines to give... At the clinic I work at, the techs are allowed to decide which vaccines to give, because there are guidelines to what age each vaccine is given. We just follow the age guidelines and give what the client is willing to pay for. We often give vaccines on days that the Dr. isn't even in the office. So I can see how there is the potential for mix-up in this type of situation.

But that's still illegal. I would advise you to refuse to give vaccinations the doctor doesn't order and caution you that giving vaccines when the doctor is not on the premises can be a very risky thing to do.

 

[chordy4]

isn't rabies TECHNICALLY the only vaccine that's required to be given by a licensed vet?

i'm not saying it's a good idea to be giving vaccines when there isn't even a doctor in the office though.

we'll have techs give boosters for lepto, or bordetella if they're been seen in the office relatively recently(last month or two)...other than that though, exam is always required for vaccines and the vet always gives them. they may be drawn up by a tech, but in the end, it is the vet who is responsible for looking over what we've pulled up.

 

[Wolf Vet]

Can I ask another random survery question? How many regular appointments do your vets see each day? I think thirty is way too many for a one doctor staff. My last hospital where I worked as a kennel assistant and receptionist saw about 20 per doctor and things were busy enough there! What number do you guys think is best?

First, is it all walk in basis or appointment? It sounds like walkins, which or course will increase the number you see. My Dr's usually take 15-20 minutes per appointment, so 3-4 ish an hour. But we REALLY thourough exams (a "check ear" appointment gets examined head to toe regardless). This seems reasonable to me, so unless your Dr's are pulling 9-10 hours lunchless shifts, 30 seems pretty high.

 

[critterfixer]

isn't rabies TECHNICALLY the only vaccine that's required to be given by a licensed vet?

i'm not saying it's a good idea to be giving vaccines when there isn't even a doctor in the office though.

we'll have techs give boosters for lepto, or bordetella if they're been seen in the office relatively recently(last month or two)...other than that though, exam is always required for vaccines and the vet always gives them. they may be drawn up by a tech, but in the end, it is the vet who is responsible for looking over what we've pulled up.

Vaccinations other than rabies can be administered by a licensed technician (this is Tennessee law, I don't know about other states), if that technician is working under the direct supervision of a licensed veterinarian. However, the technician cannot prescribe or diagnose, as those are undelegatable tasks per our Veterinary Practice Act, so determining which vaccines should be administered is the responsibility of the veterinarian, and only the veterinarian.

An unlicensed (OTJ trained) "technician" cannot even administer the vaccinations. And "direct supervision", in my understanding, means the veterinarian must be on the premises, so I would refuse to give a vaccination if the veterinarian did not personally prescribe it and was not on the premises.

The only part of this that I think might vary state to state is whether or not a technician must be licensed. But prescribing and diagnosing are never legally allowed by a veterinary technician

 

[HeartSong]

Wow, Tennessee has some strict vaccine laws. Here anyone can give vaccines to their animals except rabies. I know farmers especially will design their own vaccine protocols and carry them out fully without direct contact with a veterinarian. Dog breeders, also, are well-known for designing and performing their own vaccination procedures on their litters. Also, I know that anyone, no matter their qualifications, can perform many veterinary procedures as long as they are directly supervised by a licensed veterinarian. Now how someone interprets "directly supervised" may vary. And then if anything happens, it's the licensed veterinarian who is responsible. So then even rabies vaccines can be given by an assistant as long as the vet is there.

 

[critterfixer]

Wow, Tennessee has some strict vaccine laws. Here anyone can give vaccines to their animals except rabies. I know farmers especially will design their own vaccine protocols and carry them out fully without direct contact with a veterinarian. Dog breeders, also, are well-known for designing and performing their own vaccination procedures on their litters. Also, I know that anyone, no matter their qualifications, can perform many veterinary procedures as long as they are directly supervised by a licensed veterinarian. Now how someone interprets "directly supervised" may vary. And then if anything happens, it's the licensed veterinarian who is responsible. So then even rabies vaccines can be given by an assistant as long as the vet is there.

Giving care to your own animals is not construed as practicing veterinary medicine. I could go to the co-op and purchase medicines (and I guess vaccines?) and then come home and give them to my own animals, no problem. What I cannot do, is give them to my neighbor's animals.

 

[lailanni]

I read the Banfield horror story on the vet board -- makes me want to do everything super legal to the max when I'm finally a vet. Legal issues are nasty and you'll want to avoid them like the plague. Whatever state you're in, you'll want to find out the laws and stick to them best you can. It could get messy if you don't. (Go read that thread if you haven't already, very spooky)

As for the OP, we all make mistakes. Don't worry. Sounds like you handled it well 🙂 and learned from it. Don't beat yourself up, it happens to everyone. I feel that my clinic is excellent, but from time to time we do make a mistake too.

 

[david594]

Dog breeders, also, are well-known for designing and performing their own vaccination procedures on their litters.

If you ever get your hands on a copy of the USDA breeder application packet you will realize that is not actually how it works for a licensed breeder. The breeders can give the vaccines, but the vet is responsible for establishing the protocol.