Partner Hospital Clinical Reference Manual

Clinical Standards

IndeVets Code of Conduct  

We believe the best way to promote a healthy work environment is to set clear expectations for our Associate IndeVets. We’ve developed a set of guidelines – A Code of Conduct – that we ask our doctors and members of our headquarters (HQ) team to follow. We consider these baseline requirements for clinical and interpersonal behavior and expect many of our Partner Hospitals already exceed these with their own operating protocols. 

We ask that you review the policies below and agree to follow them when working with IndeVets doctors and HQ staff. 

Associate IndeVets and HQ staff are asked to bring concerns about Partner Hospital actions related to our Code of Conduct to their managers. We ask our Partner Hospitals to do the same regarding actions by our Associate IndeVets or HQ staff by emailing  [email protected] or [email protected] or by calling us at 833-INDEVETS (option 5). We will reach out and discuss any concerns, following our internal guidelines.  

Our Clinical and Interpersonal Guidelines 

We follow these clinical policies: 

  • Federal, State, and Local clinical and non-clinical laws 
  • State practice acts 
  • Radiation safety regulations 
  • DEA law/controlled substance handling, including (1) how and where drugs are stored; (2) how drugs are logged for use, and (3) how drugs are ordered
  • OSHA safety standards 
  • Minimum appropriate staffing – (1) At least one technical staff member and one customer service representative on with each Associate IndeVet; and (2) At least two Partner Hospital staff to complete radiographs as Associate IndeVets are not allowed to take radiographs

We follow these internal IndeVets policies 

Click here to view these full policies on our website.  

Minimum Clinical Standards for Associate IndeVets Working in Partner Hospitals 

Our Associate IndeVets follow minimum equipment and clinical policies when they work in Partner Hospitals. We adjust our standards based on the type of veterinary hospital and clinic we work with. 

Equipment Standards
Type of Partner Hospital and Shift Minimum equipment
Vaccine clinics Gloves
Working scale and thermometer
Different sizes of needles and syringes
Access to disinfectants - alcohol, hydrogen peroxide, surface disinfectant that is bactericidal/fungicidal/virucidal
Low-cost clinics All minimum equipment above for vaccine clinics
Otoscope and ophthalmoscope
Full-service general/emergency practices All minimum equipment required above for vaccine and low-cost clinics
Cytologic slides and diff-quick stain
Centrifuge and microhematocrit tubes for PCV/TS
Refractometer
Gloves (sterile and nonsterile)
Working microscope
Access to diagnostic imaging
Surgery/Dentistry shifts in full-service practices All the above under full-service general/emergency practices minimum equipment required
See our policy: If a Partner Hospital Wants to Request Surgery Shifts from an Associate IndeVet (available for review on our website or in your onboarding email from IndeVets) for additional minimum surgery and dentistry requirements
General Clinical Standards 
Type of Partner Hospital and Shift Minimum Clinical Standards
Vaccine/low-cost clinics No use of expired medications/vaccinations
Access to life-saving medications (epinephrine, atropine, diphenhydramine, and dexamethasone at minimum)
Full-service general/emergency practices All minimum standards listed above for vaccine/low-cost clinics
Vaccines stored in refrigerator and drawn up at time they are given
Access to life-saving medications (epinephrine, atropine, diphenhydramine, dexamethasone, and furosemide, at minimum)
Access to appropriate sedatives: Opioids, alpha-2 receptor agonists, tranquilizers
Access to appropriate analgesics: An opioid at least as strong as buprenorphine, and at least one NSAID option and one non-NSAID analgesic
Access to euthanasia solution (DEA license)
Access to an appropriate range of antibiotics
Surgery/Dentistry shifts in full-service practices See our policy: If a Partner Hospital Wants to Request Surgery Shifts from an Associate IndeVet (available for review on our website or in your onboarding email from IndeVets) for our minimum surgery and dentistry requirements

Surgery/Dentistry Procedure Shifts

Because anesthetic procedures carry an increased risk and require more detailed protocols, Partner Hospitals must complete an additional profile before an Associate IndeVet can perform surgery or dentistry procedures. 

 

General information 

  1. An Associate IndeVet must perform at least two exam-only shifts prior to accepting a surgery/dentistry shift. This ensures our doctors know your staff, protocols, medications, equipment, and space. 
  2. Once this protocol is completed, an Associate IndeVet can select procedure shifts at your hospital.

 

Process

  1. First review the standards below to determine if your hospital can support an Associate IndeVet performing anesthetic procedures (surgery or dentistry procedures). 
  2. Then, please complete this form that outlines your hospital’s processes and procedures in more detail surrounding anesthetic procedures.
  3. Once our clinical leadership team reviews your completed form, our scheduling manager or a member of our clinical leadership team will alert you to the ability to post surgery/dentistry shifts through our online scheduling system.
  4. Completing this process doesn’t guarantee an Associate IndeVet will sign up for procedure shifts at your hospital, but we do make every attempt to match hospitals with Associate IndeVets who want to perform surgery and/or dentistry.  

 

Standards 

Pre-anesthetic Procedures

All anesthetic patients will have: 

  1. A valid VCPR with the Partner Hospital prior to being scheduled for a procedure with an Associate IndeVet. The Associate IndeVet will perform a pre-anesthetic exam the day of surgery and has the right to refuse an anesthetic patient based on the results of that exam (new heart murmur, etc.) 
  2. A consent form signed by the owner that explains anesthetic risks, covers a treatment plan for services, has an emergency contact number and ideally a DNR.  
  3. Pre-anesthetic bloodwork completed within 12 weeks of the procedure. Bloodwork includes a minimum of a small chemistry screen and a complete blood count. Older animals undergoing procedures will have additional diagnostics based on the individual case. 

 

Peri-anesthetic Procedures

All animals must have: 

  1.  An intravenous catheter placed prior to induction of general anesthesia with the exception of cat neuters.
  2. An anesthetic chart completed for each patient’s procedure, including drugs, doses, and monitoring parameters. 
  3. Multi-modal anesthesia providing adequate analgesia and sedation.  
  4. Pre-medications, induction, and surgical clipping take place outside of the surgical room with the final surgical scrub being completed in the surgery room. 
  5. The option for intravenous induction. 

 

Surgical Anesthetic Procedure Requirements

  1. Surgical equipment and machines adhere to safety/regulatory guidelines. 
  2. Associate IndeVets will cap, mask, sterilely glove and gown for procedures.  
  3. Exceptions include cat neuters (cap, mask, and sterile gloves) and dental procedures (cap, mask/face shield, non-sterile gloves, non-sterile covering to protect clothing). 
  4. All animals under general anesthesia will be intubated. 
  5. The use of intravenous fluids unless an underlying medical condition prohibits this. 
  6. The minimal level of monitoring includes SpO2, EKG, non-invasive blood pressure and temperature recorded every 5 minutes. Heat support is also required if needed and is defined as forced air warmers, warm water blankets, or another veterinary-approved heating device.   
  7. Anesthetic monitoring by a dedicated technician trained in emergency procedures. 
  8. An Associate IndeVet may refer any procedures they have not been adequately trained to perform and/or do not feel comfortable performing. This referral could be to a specialist or to another veterinarian in the same practice with additional training/expertise. 
  9. Surgery will take place in a dedicated surgery room. 

 

Dental Procedures

  1. Dental procedures will not take place in the surgery room.
  2. Only licensed veterinarians may extract teeth  (unless a specific state practice act allows licensed technicians to extract specific types of teeth).
  3. Associate IndeVets require access to a high-speed drill, dental radiography, and appropriate analgesics to administer local nerve blocks. 

 

Post-anesthetic Procedures 

  1. Patients will have immediate supervision until they are extubated and are then monitored routinely until their temperature is above 99F and they are responsive. 
  2. A surgical report will be completed for each procedure performed and the entire anesthetic record added to the patient’s chart. 
  3. Patients will be discharged with appropriate bandaging and/or an Elizabethan collar (if appropriate), written discharge instructions, and properly labeled medication vials.