SELF-EVALUATION FORM FOR REGISTRATION OF VETERINARY FACILITIES Minimum Standards as described in Rules 23 – 33 of rules relating to practicing of veterinary professions VETERINARY FACILITY EVALUATED: ____________________________________________________ 1. General structural requirements for veterinary facilities (Rule 23) 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 A permanent structure add pre-fab, wendy house, containers allowed Adequate lighting to complete procedure in progress Fire extinguishing apparatus move to CO2 perhaps-Requirement ito Occupational Health & Safety Act Constructed to minimise the escape prevent escape of animals Hygienic disposal of wastes New Waste Management Act promulgated – please take note A reception / office area A waiting room for clients with access to toilets One or more examination rooms Walls, floors, shelves, tables impervious for cleaning and disinfecting Drainage and washing water runs into a sewer and/or septic tank No public entrance through another business to be re-looked at when discussing Rule 8 (Covering) Storage and disposal of carcasses to prevent decomposition-see new Waste Management Act Hygienic storage of therapeutic and nutritional requirements Adequate facilities for preparation of food and washing of equipment Adequate ventilation in all facilities Compliance Yes Category No A B C A B B A A B B B B B B B 2. General procedural requirements (Rule 24) 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Personnel trained in basics of aseptic technique. The veterinarian remains responsible. Training must be relevant to scope of practice and be more specific re training requirements. Personnel responsible for operation of sophisticated equipment adequately trained and available Relevant to scope of practice, what measurement used? The definition of “adequate training” is to be added. Veterinarians attend to animals in facility at least daily if animals are hospitalised, and observations are to be recorded Adequate health and safety precautions within practice Staffed by a veterinarian during specified consulting hours Telephones answered at all times with telephone answering service stating normal consulting hours with an emergency contact number given Telephone capacity sufficient for facility – answered promptly/professionally B B A B A B B 3. General requirements at veterinary facilities (Rule 23 & 25) 3.1 3.2 3.3 3.4 3.5 3.6 Facility clean, tidy and in good repair Area surrounding facility clean and tidy Sufficient parking for clients and staff Free of offensive odours Weighing facilities/methods of determining mass of patients Services provided in a competent and humane manner B C B B A B 2 3.7 3.8 3.9 3.10 3.11 IF YES: Professional approach towards clients Staff dress code, cleanliness and appearance good Library present, relevant reference material, Code of Conduct and Practice A laboratory service for own requirements B B C B B a. A centrifuge b. A refractometer C C a. Reasonable access to such laboratory services A Microscope Emergency and intensive care service rendered to stabilise patients in an emergency. Intensive care is to be referred during normal operating hours. This includes referrals if the veterinarian is unable to attend to the emergency. Dispensing of medicine administered in accordance with legislation Post mortem examinations can be performed or access to such a service, or must have access to a laboratory Appropriate sterilising equipment Efficacy of sterilisation and expiry Facility where advanced surgical procedures are performed has alternate power supply B A A A diagnostic service, including imaging diagnostics or access to such IF NO: 3.12 3.13 3.14 3.15 3.16 3.17 3.18 A B A A A 4. Records at veterinary facilities (Rule 26) 4.1 Legible, accurate records of each animal and client 4.2 Records contain patient’s name, species, breed, gender, age and other forms of ID. Large animals cannot be regulated under the same rules 4.3 Records contain: The name of the veterinarian who treated the patient Clinical information Vaccination records Special procedures Diagnosis Treatment Discharge instructions. Veterinarian must keep records in order to protect him/herself 4.4 In the case of veterinarians attending to horses registered with the National Horseracing Authority: Veterinary case sheet in duplicate Premise identification Patient identification Diagnosis Treatment Horses must be micro-chipped 4.5 All records (including diagnostic images, laboratory and pathology results) retained for three years 4.6 Proper security to protect records from loss, fire or unauthorised access 4.7 Record kept of diagnostic images handed over to owner 5. Identification of veterinary facilities (Rule 19).These guidelines may change as the veterinarians may now advertise as they like A A A A A A A A A A A A A A A C C 3 5.1 5.2 5.3 5.4 5.5 5.6 Direction Board Direction Board comply with rules Identification Board Identification Board comply with rules Sign Board Sign Board comply with rules C B C B C B 6. Diagnostic imaging (Rule 27) Use what is applicable and practical. 6.1, 6.2 and 6.4 to be kept, the rest to implode 6.1 Imaging facilities suitable and adequate for the needs of the type of practice or access thereto B 6.2 Maintenance of imaging facilities and equipment done regularly 6.3 Equipment capable of producing diagnostic quality images appropriate to the range of animals seen in the practice Structural requirements and safety precautions for use of radiation equipment comply with relevant legislation Imaging logbook (ID of animal and owner, numerical number, exposure factors and anatomical position and diagnosis). No logbook is required if you have electronic data, and data is to be backed up monthly on an external hard drive Suitable range of cassettes, screens grids and contrast materials Suitable facilities for processing, recording, viewing, filing and storage of diagnostic images, including but not limited to x-rays, ultra sound, sonar equipment Permanent identification exposed in film emulsion (ID of animal and owner, practice ID, date and left/right indicator) B B 6.4 6.5 6.6 6.7 6.8 B C B C C 7. General requirements for anaesthesia (Rule 28) Some veterinarians move away from using gas, 7.1 Equipment for anaesthesia and facilities adequate and appropriate for the needs of the relevant practice: a. Inhalation, or b. Parenteral 7.2 Appropriate range of endotracheal tubes 7.3 Oxygen available 7.4 A means to provide artificial ventilation 7.5 I/V fluids, administration sets and drugs for cardiopulmonary resuscitation 7.6 Lock-up facilities available for schedule medicines and lock-up safe for highly scheduled medicines 7.7 Equipment for the control of body temperature 7.8 Monitoring to ensure safe anaesthesia 7.9 Anaesthetic equipment for variation in body mass within the specie range 7.10 Active or passive anaesthetic gas scavenging equipment 7.11 All persons administering anaesthesia must be properly trained, registered or exempted. Para-veterinarians may administer anaesthesia on instruction. Wildlife veterinarians – only the veterinarian may administer anaesthesia 7.12 Anaesthetic equipment serviced regularly 7.13 Monitoring, maintenance and recovery from anaesthesia effected by registered personnel or trained non-registered personnel under supervision of a veterinarian 7.11 and 7.13 to be combined, and 7.13 to be more specific. 7.14 All animals are not discharged until adequately recovered from anaesthesia 7.15 Adequate (to be specified) facilities for safe induction and recovery (more specified)from anaesthesia Surgery at Consulting Rooms Is surgery performed at the consulting room? NO/YES A A B A B A A B B A B A C A B A 4 If YES, please refer to the requirements of an Operating Room, under item 8, that have to be met. (rule 25(4)) ADDITIONAL MINIMUM REQUIREMENTS FOR HOSPITALS/CLINICS 8 Small Animal Hospital/Clinics (Rule 31) The difference between a clinic, hospital and consulting room (no invasive surgery may be performed there) to be explained. The definition currently: (4) Only routine surgery that is not complicated abdominal, orthopaedic or cardiovascular surgery may be performed at a consulting room. If such routine surgery is performed at a consulting room, the provisions of rule 31(1)(b) shall be complied with. Records 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 One or more rooms for the treatment and pre-operative preparation of patients Preparation room convenient to the operating room Operating Room. A separate suitably equipped operating room/theatre: Adequate lighting Impervious operating table Gas anaesthetic apparatus Adequate oxygen supply Radiographic viewer screen Adequate ventilation Adequate size Sufficient instruments No thoroughfare Not used as storage facility Only final preparation of patient done in theatre Suitable scrubbing up facility Adequate water supply Soap dispenser Sterilised:Sterile o gowns; o drapes; o gloves; and masks and caps Ward. A ward for hospitalising patients: Separate cages of adequate size for each patient Proper identification of each patient Adequate lighting, ventilation, heating and cooling Are animals with contagious diseases hospitalised Isolation facility for patients with contagious diseases Exercise area. An indoor or outdoor exercise area: Constructed to minimise prevent escape Constructed that it can be kept clean/hygienic Supervision. Animals are monitored after hours. To be discussed by the Review Committee. Does monitoring include that the para-veterinarian can phone veterinarian? B A A A A A B B B B B B B A A A A B B B B B A A A A A A B B B 9 Equine hospitals/clinics (Rule 32) 9.1 One or more examination rooms or undercover areas: Hand washing facilities Equipment for physical examination of patients Endoscopic equipment Ophthalmoscopic equipment A A A B A 5 9.2 9.3 9.4 9.5 Cardiographic equipment Crush pen with impervious floor Adequate facilities for safe induction and recovery from anaesthesia (Impervious, padded material easily cleansed and disinfected, covering the entire floor area and wall up to a height of 2 metres) Transportation system to and from induction area and operating room A separate suitably equipped operating room/theatre: 9.6 Adequate lighting Impervious suitably padded operating table Gas anaesthetic apparatus Adequate oxygen supply Radiographic viewer Adequate size Sufficient instruments No thoroughfare Adequate ventilation Not used as storage facility Only final preparation of patient done in theatre Suitable scrubbing-up facility Adequate water supply Soap dispenser Sterilised: Sterile o Gowns o Drapes o gloves; and o masks and caps Loading Area. An area for safe loading and off loading of patients 9.7 Stables. Stables in which patients are kept: 9.9 9.10 9.11 B A Operating Room 9.8 A C A Patients kept individually in stables Stables adequately ventilated Are animals with contagious diseases hospitalised Isolation facility Exercise Area. An exercise area: Constructed to prevent escape Constructed that it can be kept clean/hygienic Flammable material stored away from stables If flammable material stored in adjoining room to stables, is such room separated by a fire partition wall Supervision. Animals are monitored after hours A A A A B B B B B B A A A A B B B B A A B A A B B A A B 10 Production Animal hospital/Clinic (Rule 33) Reproductive work? Limited specialised services? Sonar apparatus required, also for small stock. New Category – will refer to embryo transfer group. 10.1 10.2 One or more examination rooms or undercover areas: Hand washing facilities Equipment for physical examination of patients Crush pen with impervious floor Equipment to perform standing surgical procedures Adequate facilities for safe induction and recovery from anaesthesia Transportation system to and from induction area and operating room Operating Room. A separate suitably equipped operating room/theatre: Adequate lighting Impervious suitably padded operating table Relevant anaesthetic apparatus A A A A A A B A A A C 6 10.3 10.4 10.5 10.6 10.7 10.8 A B B B B B B A A A Adequate oxygen supply Radiographic viewer Adequate size Sufficient instruments Adequate ventilation No thoroughfare Not used as storage facility Suitable scrubbing-up facility Adequate water supply Soap dispenser Sterilised o gowns; o drapes; o gloves; and B B B B Masks and caps. Loading ramp. A loading ramp for safe loading and off-loading of patients Stalls. Stalls in which patients are kept A Patients kept separately Stalls adequately ventilated Are animals with contagious diseases hospitalised Isolation facility Flammable materials stored away from stalls If flammable materials stored in adjoining room to stalls, is such a room separated by a fire partition wall Exercise Area. An exercise area: Constructed to prevent escape Constructed that it can be kept clean/hygienic Supervision. Animals are monitored after hours B B A A A A B B B GENERAL COMMENTS 11 Minimum standards for mobile theatre/animal services Decision- Yes No Category Mobile services not stand alone, must have fully equipped back up physical facility, extension of and operate under same name as that of back up facility. 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 Operated by SAVC registered personnel Mobile animal service: part and parcel of base facility, but visit bona fide clients Necessity of accessible records – must get it from facility- Requirement ito veterinary rules and Act 101/1965 Fully equipped back-up facility Communication with back-up facility Acceptable standard of construction and appearance Constructed of impervious material that can be cleaned/disinfected Own water supply Adequate lighting Secure storage of scheduled drugs A A B A B A A A 7 11.11 11.12 11.13 11.14 11.15 11.16 Refrigeration/cooling facilities for storage of biologicals/pharmaceuticals Equipment for disposal of wastes including carcasses Appropriate equipment and drugs for species serviced Appropriate protective clothing Mobile theatre complies with relevant regulations for animal theatres Proposal to: register mobile facility. A B A C A GENERAL COMMENTS 12 Minimum standards for house/farm calls is like mobile services Perhaps to implode 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 Fully equipped back-up facility Communication with back-up facility If NO to 12.1, Has exemption been granted by Council? An office where clients can be received, with a neat internal and external appearance? Storeroom for pharmaceuticals Vehicle used maintained in a clean and sanitary condition Vehicle contains equipment necessary for the veterinarian to perform physical examinations and emergency treatment consistent with standards for the particular service required Sterile surgical instruments and suture materials Protective clothing, boots and the means to change or sanitise them between visits Current pharmaceuticals/Biologicals protected from overheating A B A B A A B A A GENERAL COMMENTS Pig Farmer forum input: Dr Tom Spencer reported that they work as consultants and liaise and communicate with the local veterinarians when they visit farmers. A new category in terms of facility registration must be formalised: CONSULTANCY The naming guidelines must change to include “Consultancy, Services, etc. Already approved at a previous Council meeting, must be communicated to members. Herd Health feedback: Dr C Marwick said that there are direct communication between the herd health practitioners and other mixed practitioners in area, and a report is given to the local veterinarian. Changes to the self evaluation form must not make the completion more difficult for rural vets. Changes to the application form for exemption must be considered. Good guidelines on veterinary practices are needed, and the rights of specialists must be specified. Ruminant (large animal practices). The Review Committee to discuss this issue, and Mobile standards to be clarified. The “Bakkie” practices are actually also “mobile facilities. They MUST have a physical facility (requirement of Act 101/1965), they MUST have a referral practice/back-up facility, and transparency is needed for this whole process. Rural mixed veterinary practice is not defined – should be Wildlife Group feedback. Must have an office to store records, medicines etc, according to requirements of Act 101/1965. The vehicle must be able to reach the client They do not want to comply to requirements of general practice, or 8 Having to ask for exemption (Why?) To have back-up facility must be added to the application form. Post mortems – disposal of carcasses on farm – burn or bury. – please note there is a new Act and members should adhere to it Veterinary Physiotherapists. Not yet on board, but requirements will be the same as for a consulting room. The practice will have to be registered with Council Animal research facilities. A new type of practice? No feedback from DAFF received. Dr Bert Mohr submitted input from SAALAS. Tertiary research institutions have own ethics committees controlling and applying quality standards. DAFF and Prof Vinny Naidoo to be involved. ISO standards-Not a legal requirement (implementation is voluntary), but it is a useful tool to apply in respect of quality control. Sterilisation only facilities? Spays are invasive surgery and cannot be done from Consulting Room. Should have registered a clinic which complies with all minimum requirements. The veterinarian must also provide emergency services to deal with any emergency/ complications resulting from the surgery. Limited services? – What about special interest i.e. equine, wildlife? This must be further investigated – see Competition Commission ruling. As a general principle veterinarians should be allowed to offer a limited service, provided that all minimum standards are complied with and emergencies are adequately dealt with by arranging to refer those to a referral practice (by agreement with such practice) or by supplying an after-hours emergency service Rule 8 (Covering- sharing of premises and/or fees)-The rule regarding the non-sharing of premises with non-registered persons was created to minimise the effect of zoonoses on human health and to ensure adequate quarantine facilities. Sharing of fees is prohibited to ensure that the veterinarian always takes decisions in the interest of the patient and is not influenced by outside factors such as pressure from non-registered persons with a vested interest in either the procedure or medication prescribed. In the UK a model existed where a nonregistered entity could set up and manage a veterinary facility, but the veterinarian remained in control of all decisions relating to patient care and also remained responsible for his/her own professional conduct. The rule as it currently reads may be anti-competitive and/or outdated. Business models should be considered so as to ensure compliance with the requirements of the Competition Act, 1998, provided that health concerns relating to humans and pressure from non-registered persons in patient care are adequately addressed. Further input on different business models is to be obtained. RECOMMENDATION FROM EVALUATOR I hereby certify that I have evaluated the veterinary facility named above. I recommend to the SA Veterinary Council that: 1. As the minimum standards and requirements of a veterinary hospital/consulting room/mobile facility are met the facility should be registered/continued to be registered as a veterinary hospital/consulting room/mobile facility. 2. As the standards and requirements of a veterinary hospital/consulting room/mobile facility are adequately met the facility should be registered/ continued to be registered as a veterinary hospital/consulting room/mobile facility provided that the outstanding requirement/s reflected on the report are addressed within the stated time period/s. A re-evaluation is/ is not necessary to confirm that the work has been completed 3. The facility should not be registered as a veterinary hospital/consulting room/mobile facility due to the deficiencies reflected on the report. 4. Additional comments:_____________________________________________________________________ __________________________________________________________________________________________ 9 __________________________________________________________________________________________ __________________________________________________________________________________________ 5. Overall impression: Excellent/ Good/ Fair/ Requires attention Notes in relation to the completion of the above recommendation: i. ii. Paragraphs 1, 2, or 3 should be deleted as appropriate If only minor matters require attention, paragraph 2 should be completed. Please indicate whether a reevaluation will be required. Name of Evaluator ___________________________ Signature ___________________________ Date of Evaluation ___________________________ MINIMUM STANDARDS OF VETERINARY FACILITIES REGISTERED WITH THE SOUTH ARICAN VETERINARY COUNCIL - EVALUATION The rules relating to the practicing of a veterinary profession in terms of the Veterinary and Para-Veterinary Professions Act, no 19 of 1982 refers. The aim of the evaluation of facilities is to: Enhance the ability of veterinarians to provide quality veterinary care to animals; To enable veterinarians to successfully conduct their practice and maintain their facilities with high standards of excellence; and Meet the public’s needs as they relate to the delivery of veterinary medicine. The evaluator performing the evaluation will emphasize education, consultation and on-site assistance. Evaluation should be seen as a positive step in ensuring that South Africa maintains the high level of veterinary care in facilities that are designed and equipped to ensure this. Owners of practices will receive notification that their facilities will be evaluated at least 60 days in advance or at a pre-arranged time. It is recommended that the principal veterinarian be actively involved throughout the entire evaluation. The evaluation form directly reflects the Rules and the Code of Conduct and Practice in that the questions are phrased from them, Compliance with, or not will be noted for each rule under various headings on the evaluation form. If certain rules have not been complied with, the evaluator will indicate by when the practitioner needs to comply to be able to maintain his/her registration of the facility with the South African Veterinary Council. Council in its discretion will decide if a facility complies sufficiently with the Rules to enable continued registration, however, adequate time will be given to practitioners to enable them to attain to minimum standards. 10 The symbols A, B and C have been used to denote whether non-compliance of the particular requirement is deemed as a very serious, serious or minor infringement. Inspectors will be required to take photographs of deficiencies under symbols B and C and the Inspections Committee may accept photographs as proof once the deficiency has been addressed. Please note that an accreditation and registration of the facility do not absolve members from compliance with any other legislation relevant to veterinary practice. A. Very serious It is imperative to obtain, build, institute or acquire within the time specified. A re- inspection of the facility could be scheduled within a 30 – 60 day period after the required date. B. Serious Important to obtain, build, institute or acquire within the time specified. Confirmation, in writing, will be required that the outstanding matters have been addressed by the required date. If no satisfactory reply is received a re-inspection of the facility may follow. C. Minor Must obtain, build, institute or acquire within the time specified. Confirmation, in writing, will be required that the outstanding matters have been addressed by the required date.