Quality doesn’t stop at the door: Supporting treatment compliance

The importance of compliance

As discussed  previously, I define quality as safe, reliable and effective healthcare that puts pets and their families first. I have discussed some strategies for improving quality  and safety  within veterinary hospitals.

However, quality care does not stop at the door.  Compliance with at home recommendations is often crucial to cure or manage disease.  The role of hospital staff in improving compliance was brought home to me when I had to take my own son to the ER.

The story

My son was 19 months old, had an infection, and was prescribed antibiotics.  The ER pediatrician emphasized how important it was that he received all of the antibiotics at the right time and for the entire course.

It was a good thing he promoted medication compliance because my son was tougher to medicate than most cats!  It started out as an adventure three times a day to give him the “good tasting” liquid.

As  I gave him the medication, I thought about the very sick animals I treat. I sometimes dispensed not one medication but four or even five.  I wondered how many owners gave up because of the difficulty of medicating their pets.  I wondered if I did as well as the pediatrician in emphasizing how important medications are for the recovery of their pet.

I’m pretty good at medicating dogs, cats, and even rabbits. However, medicating my son was a humbling experience.  He zipped his lips and shook his head when he saw the liquid.  He was under two so explanation of why didn’t work. He spit it out in any food we tried to mix it with.  No way could we burrito him like a cat and force it down.  We finally discovered the wonders of chocolate bribery after each dose.

Somehow, the pediatrician must have known that my son was going to be a challenge. He surprised me 24 hours after the visit with a phone call.  He wanted to check in, see how my son was doing, and make sure we were indeed giving the medication.

Medication demonstrations and discharge instructions matter

After this experience, I watched how we discharged pets with medication from the ER and how we followed up.  We didn’t always ask, “Do you know how to medicate your pet?”  Many people took the medication, had no idea how to give it, but did not ask for help until after they got home. I realized that a follow up phone call was a big deal.

We created a consistent discharge protocol. It became an important part of training for our staff. When we discharged pets, we asked every owner if they knew how to give the medications or if they would like a demo.  We created medication administration handouts with pictures and provided links to you tube videos for both dogs and cats.  Pill poppers and pill pockets were offerred when appropriate. We provided written discharges for every patient.

In addition, we showed every owner the medication, read the label to them, and told them WHY they were giving the medication.  With pets on multiple medications, we would send them home with an at home treatment sheet with times and boxes to check off.  We also emphasized that if they were still having problems, they should call us.

Thorough discharges also add safety

An added benefit of this procedure is medication safety.  By matching the labels to the discharge instructions, we avoided sending home the wrong pet’s medication. With medication like chewable carprofen, we emphasized  why it needs to be stored up high (dogs will eat through their pill vials to get the flavored tablets).

We were also able to use our EMR to create a phone call reminder system to check in on patients after an ER visit.  This call has been valuable in ensuring medication compliance and catching issues early.

Quality requires a proactive commitment to ensure that pets get the care they need.  How we discharge patients and our willingness to teach owners can make a huge difference in outcome.  The extra couple of minutes of a medication demo and explaining why compliance matters can be the difference between a resolved infection and one that becomes life-threatening.

Do you have a great video for at home medication or treatment compliance you share with owners?  Please share in the comments!