Training in a veterinary practice setting has been notorious for throwing new employees out onto the floor and hoping for the best in terms of sinking or swimming with the rest of the team. Using checklists can help organize and streamline this process into a much more pleasant experience for new team members.

Imagine a new veterinary technician has just been hired after searching for one for months amidst the technician shortage. Hallelujah! This individual has finally arrived to save the day. However, their first day is filled with patients getting treatments missed, no communication between team members on who is doing what, and the only person who knew how to open the clinic called in sick, so everything has just been a mess since the start of the business day.

Do you think that new team member had a good or bad first impression of their new work environment? Do you think they will stay in this kind of inefficient and chaotic environment long term?

When a veterinary clinic is looking into improved profitability, efficiency should always come into the conversation. A general definition of efficiency can be simply explained as completing a job with as little expenditure as possible, leading to increased productivity. When connecting this to veterinary medicine, we can create efficient teams by using checklists in a variety of ways. Using checklists in day-to-day operations, training practices, and patient care are important because they:

Offer fail-safe methods by providing a dependable safety net
Help ensure safer pet care by preventing errors
Spread out responsibilities and makes delegation easier
Motivate team members to complete tasks¹

Why do checklists improve efficiency? Above all, it improves communication between all team members within the veterinary practice. When used correctly and being made an important part of clinic success, checklists will never let you down.

Daily checklists

Checklists in day-to-day operations highly depend on the type of facility you are working in. For general practices, an opening and closing checklist are vital in ensuring the clinic opens and closes the same way daily. For opening and closing, I have seen checklists incorporate:

Equipment start up and shut down
Computer systems logged into and shut down/backed up appropriately
Stocking drawers before or after clients arrive
Verifying money counts before and after the business day
Identifying and confirming charts for each business day
Setting up or breaking down surgery suites, exam rooms, and dental tables
Assigning team member roles for the day
Daily, weekly, and monthly cleaning assignments

For more specialized facilities or hospitals with multiple departments, operations checklists can also include communication between departments and setting up your specialized areas for patient care. For example, in surgery departments that I have worked in previously, detailed checklists for setting up a surgery suite include setting up equipment needed for the day, pulling packs and individuals instruments for each surgery, identifying and leak testing anesthesia equipment for the day, and preparing individualized anesthetic protocols for each surgical case. The checklists can be lengthy and detailed depending on your needs and should displayed clearly for all team members to see. When displayed clearly, delegation and what has or has not been done can be communicated to all.

In training

Training in a veterinary practice setting has been notorious for throwing new employees out onto the floor and hoping for the best in terms of sinking or swimming with the rest of the team. Using checklists can help organize and streamline this process into a much more pleasant experience for new team members. Checklists for training can include:

A list of job duties, how many times they have been successful with that duty, and an official completion date
Job duties listed into levels or tiers for incremental training
Duties they are doing well with
Duties they need to improve upon
Job duties coupled with a mentor or “go-to” person to help complete training

Creating checklists for training, within my experience, can take a large amount of preparation before implementation. Job descriptions, duties team members can and cannot do, mentor buy-in, and organization all must be prepared before implementing a final checklist into your training program. While this extra effort into training upfront will be arduous, a smooth training process within your facility will lead to increased communication and higher efficiency.

Daily checklists can also be a large part of your training program. By using these checklists, every new team member will be trained the same way, every time. Long ago are the days of “That’s what the last person told me, but she quit three years ago.” Modern times call for, “We have a checklist for that! Let’s go over it together in detail.”

In-patient care

When a patient enters a veterinary clinic for anything ranging between wellness care, an illness, and a procedure needing done, each should have their own checklist for gold standard patient care. To name a few:

Medical records entries for the doctor and the technician/assistant
Treatments needed
Contact with the owner
Medications filled or prescriptions
Invoice completion

As the patient moves along through their stay within the hospital, each team member (or a dedicated team member) can check off what has been completed and can see and communicate what still needs to be done. For patients having surgery, I have experienced these checklists:

Anesthesia protocol checklists
Pre-op patient checklists
World Health Organization (WHO) surgical safety checklist²
Post-op patient checklists
In-hospital treatment checklists
Invoice checklists
Instrument pack checklists
Surgery room setup checklists

While these are just checklist titles and do not go into detail, I hope this gives you a list to reflect upon and consider where a checklist of this nature could be helpful in your practice’s surgical routine.

Another aspect of veterinary patient care that checklists are vital to employ are hospitalized patient care checklists. Veterinarians are in charge of creating a treatment plan, which veterinary technicians and assistants have the ability to utilize nursing care checklists. For nursing care checklists, Kirby’s Rule of 20 must be at the heart of how this checklist is created and implemented,3 Team members in charge of hospitalized patients must assess for each patient:

Fluid balance
Albumin and oncotic pull
Electrolyte and acid–base
Mentation
Heart rate, rhythm, and contractility
Blood pressure
Body temperature
Oxygenation and ventilation
Red blood cells (RBCs) and hemoglobin
Coagulation cascade
Renal function
Gastrointestinal (GI) motility and integrity
Nutrition
Glucose
Immune status and antibiotics
Wound healing and bandages
Drug dosage and metabolism
Pain control
Nursing care
Tender loving care

Once gold standard patient care has been implemented to hospitalized patients, shift communication can also benefit from a rounding checklist. The main purpose of a rounding checklist is to standardize how each shift rounds to the next shift taking over patient care. A rounding checklist can include:

Changes in patient status
Recent treatment plan changes
Diagnostic results
Client communication
Patient preferences
Invoice update

Ultimately, using Kirby’s Rule of 20 checklist improves communication between the medical team member and the veterinarian, and the rounding checklist improves communication between team shifts. Improved communication, as said above, can lead to improved efficiency and improved profitability of the practice.

Conclusion

The Checklist Manifesto highlights the importance of checklists used throughout the world. Ranging from pre-flight checklists, emergency response, to investment banking, checklists have shown over and over how important they are in every aspect of life. A quote from the book explains quality checklists further:
“Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professional using them could miss. Good checklists are, above all, practical.”⁴
Whether one or 10 checklists become commonplace within your practice, you are well on your way to improved team communication, higher quality patient care, and higher profitability through efficiency and quality veterinary care.

Mariel Hendricks graduated with her bachelor’s degree in 2010 from the Purdue University’s Veterinary Technology Program and spent the majority of her career in small animal specialty surgery and anesthesia. She transitioned into veterinary technician development with Noah’s Animal Hospitals. Hendricks is a director on the NAVTA executive board and is also an active member with Indiana’s vet tech association and the Association of Veterinary Technician Educators (AVTE). She is also obtaining her master’s degree in Veterinary Education through Lincoln Memorial University’s online platform.

References

Vetstoria. (2021, January 4). How veterinary checklists can save you hours every week. Vetstoria. https://www.vetstoria.com/blog/how-veterinary-checklists-can-save-your-hours-every-week/
Jain, D., Sharma, R., & Reddy, S. (2018). Who safe surgery checklist: Barriers to universal acceptance. Journal of Anaesthesiology Clinical Pharmacology, 34(1), 7–10. https://doi.org/10.4103/joacp.joacp_307_16
Waxman, C. (2020, July 2). Kirby’s rule of 20: The Veterinary Nurse’s Critical Patient Checklist part 1. The Veterinary Nurse. https://www.theveterinarynurse.com/review/article/kirby-s-rule-of-20-the-veterinary-nurse-s-critical-patient-checklist-part-1
Gawande, A. (2010). The Checklist Manifesto. Profile Books Ltd.