Can We Talk? Ensuring Owner Compliance
A 2009 compliance study by the American Animal Hospital Association found only 55% of dogs get year-round heartworm preventives, while only 30% of practices send any reminders to refill chronic medications.1 Obviously, there’s a connection between owner noncompliance and lack of communication on the part of the veterinary team.
We veterinary nurses enter the field because we love animals, yet we spend a great deal of time talking to the animals’ human owners.2 It’s true that one of our most important roles is to be an advocate for animal patients, but that role means we have a responsibility to educate owners on how they can best care for their pets.
Most pet owners want to do the right thing, so we simply need to educate them regarding what that is. The only way to accomplish this collective goal is for the veterinary team and the pet owner to work together as a team. This teamwork, however, does not end when the patient leaves the hospital. Although we cannot follow the owner home to remind them of when or how to follow through with recommendations, here are some guidelines and tips for promoting owner compliance in your practice.
Aftercare directions can be overwhelming for owners, especially following a stressful procedure or diagnosis. Providing clients with written instructions that review everything discussed with them prior to discharging the patient can be crucial in ensuring that no details are forgotten. These instructions can highlight a brief description of the diagnosis and prescribed medications or diet, along with other recommendations, such as drain maintenance, warm compressing, e-collar compliance, and if or when a recheck exam is advised. Not only will this promote compliance but it can also help to minimize the number of phone calls that the hospital receives with owner inquiries about aftercare.
To avoid spending excessive time writing discharge directions for each patient, I recommend using a template (BOX 1) for generic instructions, which can be edited and customized for each case. For example, generic instructions for “abdominal surgery aftercare” can be edited to accommodate a post-op spay, splenectomy, enterotomy, cryptorchid neuter, etc. Diabetes mellitus, renal disease, growth removal, and laceration repair aftercare are a few more scenarios that can provoke much stress and many questions. Brainstorm with your team to determine the most common procedures or diagnoses seen in your hospital; and then create a template for each.
These written directions should not be used as a replacement for speaking with owners, but as a complement to the instructions and a reference for when the patient is home. Discharge instructions maximize compliance only if they are accompanied by verbal directions. Simply handing the owner this valuable sheet of paper for them to review on their own could result in zero compliance if they set it aside when they arrive home. My recommendation is to sit down with the owner and read through the discharge instructions together prior to reuniting the owner with their pet. The owner can then ask any questions that may come up and bring the literature home to refer to later. Another crucial piece that cannot be missed is to ensure that all instructions to the owner (written and verbal) are written into the medical record.
Teaching an owner how to medicate a pet, give subcutaneous fluids, or place an e-collar on the pet can greatly contribute to compliance.
It wasn’t until I started medicating my own cat (she was diagnosed with small cell lymphoma nearly 2 years ago) that I discovered just how many modalities are out there for any given medication—suspension, caplets, transdermal, solution, soft chews, capsules, and tablets. Prior to this discovery, I felt like most clients—I was frustrated to tears after chasing my ailing cat around the house only to end up covered in fish-flavored suspension. It honestly occurred to me at one point that I might have to choose between having a good relationship with my pet and treating her cancer. Then, as a last resort, I brought home tablets and a few Feline GREENIES® Pill Pockets® (greenies.com). “My cat is way too smart for this,” I kept thinking, but she proved me wrong and gobbled it right up. Now, every morning and evening, we have a routine: she sits on the counter, watches me put her pill in the pouch, then takes her medicine. This is in no way meant to be a product endorsement; I simply wanted to share this tale to provoke discussion about options. All pets are individuals and what works for one may not be best
One simple but significant way to ensure compliance with medication administration is confirming that the owner can actually medicate their pet. Initiate the conversation by asking the client if they have ever medicated the patient: “What form of medication did you use? Was the administration successful?” This is vital information that the veterinary nurse can collect in order to advocate for your patient. “The medication that the doctor would like to prescribe comes in a suspension, pill, capsule, or long-lasting injectable form—which would be easiest for you to give Gandalf at home?”
Together, as a team with the pet owner and veterinarian, you can help choose the best option for each individual patient. The client will also feel more confident with the treatment plan as he or she has been part of the decision-making process.
Although some individuals may be auditory learners, most find information more retainable if they are shown exactly how to perform a task rather than simply having it described. Teaching an owner how to medicate a pet, give subcutaneous fluids, or place an e-collar on the pet can greatly contribute to compliance. Remember, each patient is an individual and may require a different technique than your go-to method or the method that the pet owner used for their last pet. My recommendation is to take it one step further and have the owner perform the task after you demonstrate the proper technique. Utilizing the “see one, do one, teach one” concept can make both the owner more confident in performing the task as well as promoting confidence in the veterinary team that it will be carried out successfully.
In a fast-paced, high-caseload hospital, it is easy to focus on the patients that are right in front of you rather than the ones already treated and at home. Making time to perform daily or weekly callbacks to check in with clients will aid in promoting compliance and allow them to ask any forgotten questions. Ideally any patient who is seen for a procedure or prescribed new medication should be scheduled for an update call to confirm that things are going as planned. Utilizing the knowledgeable veterinary nursing staff for patient update calls not only promotes pride and confidence in the veterinary nurses but also alleviates the veterinarian’s workload.
Avoid the “no news is good news” mentality, which is especially easy to fall into in a busy hospital. Although this may be appropriate in some cases, I propose celebrating negative tests and the owners who are compliant with preventive medicine. Let’s take heartworm testing, for example. One type of conversation may go as follows: “Congratulations! Arwen’s heartworm test was negative! Great job with the year-round prevention. Keep up the good work and we will see you both in one year to retest.” This owner feels rewarded for doing the right thing for his or her pet.
Another conversation that can be just as impactful is the following: “Phew, Gollum’s heartworm test was negative today. This was a close call as you did miss a few doses. We recommend year-round prevention to ensure that he is protected against heartworm disease.” This owner now understands the impact of prevention and is more likely to follow recommendations than if you did not follow up with a call notifying him or her of the negative result.
Working with pet owners to find the best fit for their lifestyle as well as for the patients is vital in ensuring that the treatment plan will be executed as outlined.
Everyone is connected to social media these days, even our clients. One of my favorite methods for promoting compliance with monthly preventive medicine is posting a reminder on the hospital’s Facebook, Instagram, and Twitter accounts on the first day of the month. All that’s needed is a simple suggestion worded this way: “It’s the first of the month! Have you given your dog their heartworm prevention today?” These posts can be beneficial to even the most organized owner. Try this with reminders for tooth brushing, heartworm testing, routine annual bloodwork, and other topics of your choice. The internet does not have to be the enemy; rather, it can be an excellent tool for educating our owners!
Although you may cringe at the thought of speaking with another human being, please be assured that both you and the pet owner have the same common goal. We must work together as a team to protect our patients and help our clients be the best pet owners they can be. Working with pet owners to find the best fit for their lifestyle as well as for the patients is vital in ensuring that the treatment plan will be executed as outlined. As a veterinary nurse, you are an invaluable resource in promoting owner compliance and ensuring the best care for your patient.
1. AAHA. 2009 AAHA compliance follow-up study. In: Albers J, Hardesty C, eds. Compliance: Taking Quality Care to the Next Level. Lakewood, CO: AAHA; 2009:1-17.
2. Dobbs K. Pros and Cons of Becoming a Veterinary Assistant. Veterinary Practice News. veterinarypracticenews.com/pros-and-cons-of-becoming-a-veterinary-assistant. Accessed May 3, 2019.