The Board is aware of the degree of community concern about SARS-Cov-2 (the novel coronavirus) and COVID-19 (the disease caused by the novel coronavirus) (Coronavirus) and the dynamic nature of the information that is emerging about this outbreak.
There are many important aspects to consider regarding this outbreak including:
- Communication with clients
- Human health and managing risk
- Obligations under veterinary practice legislation
Communication with clients
Veterinarians and veterinary staff may receive enquiries from clients and members of the public about the risk posed by coronavirus to pets and other animals and the risk animals may pose to humans.
There is no evidence that animals can be infected by or infect humans with Coronavirus (OIE, WHO). AAHL and IDEXX have confirmed that no dog, cat or horse has tested positive to Coronavirus during this outbreak.
The Board encourages veterinary practitioners to familiarise themselves with the most up to date information about Coronavirus and animals so they can inform their clients and the community to diffuse any unnecessary worry.
The World Small Animal Veterinary Association (WSAVA) has provided helpful advice for veterinarians when communicating with clients about Coronavirus.
Human health and managing risk
Your own personal safety as well as the safety of fellow staff and clients is a priority. It is important that you make yourself aware of and adhere to the following advice from NSW Health, the Australian Government Department of Health and SafeWork NSW.
The Australian Veterinary Association (AVA) has also created several excellent veterinary specific resources regarding Coronavirus. These resources include detailed information about WHS, workplace relations (including leave and pay arrangements during periods of isolation, in order to care for children if schools close or during periods of forced closure of businesses) and infection prevention and control in the workplace.
Veterinary hospitals are encouraged to develop policies and procedures aimed at reducing the number of people who attend the premises and limiting contact with clients. This may include measures such as limiting the number of people who may attend a consultation or conducting consultations over the phone once an animal has been delivered to the veterinary hospital for examination.
Plans should also be made about how emergency cases for patients cared for by Coronavirus infected clients, those who are self-isolating, or in the event of practice closures are dealt with in order to minimise interaction with clients and environmental contamination whilst still providing care to animals in need. Algorithms such as the one developed by Dr Weese of the University of Guelph may assist.
These plans should include restricting access to the hospital by infected persons or those self-isolating, using appropriate PPE and quarantining animals from affected households away from other pets within the hospital.
Clients should be informed that routine treatments and consults for pets belonging to people who are self-isolating should be delayed.
Obligations under veterinary practice legislation
The Board acknowledges that veterinarians may feel anxious about ensuring compliance with their obligations under veterinary practice legislation during this period of uncertainty.
The Board always considers complaints regarding potential breaches of the Code and legislation on the specific facts, taking into account the context in which decisions were made, together with other relevant factors.
The Board is acutely aware that these are difficult times for the profession and its priority is always to regulate the profession in order to promote animal welfare and protect the public.
The Veterinary Practitioners Code of Professional Conduct (the Code) and Veterinary Practice Regulation 2013 (Regulation) include a number of provisions that may become important considerations during this outbreak:
- availability to care for an animal
- access to records
- telemedicine including prescriptions and supply of medication
- practice standards
- record keeping
- client confidentiality
1. Availability to care for an animal
The Code (clause 8) sets out that a veterinary practitioner must, when accepting an animal for diagnosis or treatment, ensure that they are available for the ongoing care of the animal or if they will not be so available, to make arrangements for another veterinary practitioner to take over care of the animal.
The Board encourages the veterinary profession to work together both within workplaces and regions to coordinate the best care available for animals.
If a veterinary hospital is forced to close or limit its operations (if for example, a staff member tests positive for Coronavirus and all staff are required to self-isolate or there is a government imposed shut-down), a veterinarian’s availability to care for an animal will be compromised. In such circumstances, effective communication will be essential. The Board recommends that you take the following steps in such a situation:
- notify your clients that the hospital is closed or its services are limited and, if possible, the anticipated duration of the closure/limitation of services
- provide direction about where clients can seek assistance in your absence
- ensure your telephone system is appropriately diverted and provide a recorded message that informs clients about where they can obtain veterinary assistance during the hospital’s closure or service limitation
- notify the Board if your hospital will be closed so that our online database provides accurate information to the public (the licence will be suspended and a simple notification to us when re-opening will lift this suspension).
Consideration should also be given to after-hours arrangements if a hospital usually provides an emergency service. For those hospitals that utilise a separate provider such as a referral centre for after-hours care, veterinarians should seek confirmation from those providers that they are still available to provide after-hours care.
2. Access to clinical records
In the event that a veterinary hospital is required to scale back its operations or close, there may be circumstances where another practice takes over the care of a patient.
In accordance with the Code, a veterinarian who has previously treated an animal must, when requested to do so, and with the consent of the person responsible for the care of the animal, provide all relevant case history records directly to another veterinary veterinarian who has taken over the treatment of the animal.
It is possible that physical access to a veterinary hospital may be restricted and this could interfere with the sharing of records. Appropriate phone diversions will be necessary to ensure hospitals can continue to contact one another should these circumstances arise.
The Board also recommends that plans are made regarding how records can be shared between clinics in the event of hospital closures, which may include arranging for staff to have remote access to electronic records. Veterinarians should consider what arrangements can be put in place to facilitate access to paper records during a possible shut-down.
The Board has received enquiries regarding what veterinary care can be provided to patients remotely and is aware of AVA policy in this area.
Telemedicine may provide an opportunity for the delivery of ongoing care to patients. The Board’s guideline, Technology-based patient consultations, sets out requirements under the Code in detail. This includes prescribing and supplying medications to patients based on a technology-based patient consultation.
If the criteria set out in the Guideline can be met by a veterinarian, telemedicine may provide a helpful way that veterinarians can continue to provide veterinary assistance to clients and patients in the event of increased social-distancing measures or business shut-downs.
4. Practice standards
It is possible that hospitals may have to reduce or limit the services they offer due to staff or materials shortages. The Board recommends that services that have the greatest impact on animal health and welfare are prioritised, such as emergency care. Again, communication with clients about this if it occurs will be essential. It is also recommended that clients are kept informed that waiting times may be longer for non-urgent appointments if increased social-distancing measures are implemented.
Veterinarians should also consider variations to normal practice that may need to occur in the event of stock shortages such as access to some forms of PPE like surgical masks and gloves and some medications.
5. Record keeping
If your management of a case is compromised because of circumstances created by this outbreak it is important that the record includes contemporaneous notes regarding your concerns and decision-making processes. The Board encourages veterinarians to consider taking extra time and care in relation to clinical record keeping during this period.
6. Client confidentiality
Veterinarians are reminded that it is it is a requirement under the Code and is not considered a breach of confidentiality under the Veterinary Practice Act 2003 to share a patient’s medical records with another veterinarian who has taken over care of an animal provided you have consent of the person responsible for the care of the animal to do so.
Coronavirus has been declared a notifiable condition under the NSW Public Health Act 2010. It is feasible during this outbreak that another party (such as the NSW Health or the Australian Government Department of Health) may request access to confidential client information such as your appointment diary in relation to Coronavirus contact tracing exercises. The Board is of the opinion it would be appropriate to release information under these circumstances and as such this would not be in breach of confidentiality provisions in the Code.
7. Continuing professional development
The Board is also conscious that conferences, seminars and other face to face continuing professional development (CPD) opportunities are being cancelled in the wake of the outbreak.
Many providers are making additional online CPD opportunities available during this period of uncertainty. Again, should you be unable to meet your CPD requirements the Board will seek further information from you regarding your individual circumstances during this outbreak.
The Board wishes to extend well wishes to all in the veterinary profession during this uncertain time. The following resources are available to you for support during this difficult period:
- Doctors’ Health Advisory Service (02) 9437 6552
- AVA Counselling Service 1300 687 327
- Lifeline 131 114
- Beyond Blue 1300 224 636