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Friday, August 18, 2017

Once bitten - twice shy Bite - near bite job stress in veterinary medicine

I recently attended the American Veterinary Medical Association Convention in Indianapolis.   This was pretty exciting for me as I was selected as a poster presenter for my  survey " Once Bitten, Twice Shy - bite/near bite job stress in veterinary medicine".    In addition to the poster presentation,  I  was also selected to lead a round table discussion on the same topic.    
Me and my poster at  AVMA  convention

Last summer, I ran a 10 question survey to veterinary  groups.  This was an effort  to gather data on our job  stress due to bite and near bite injury in small animal  practice.  As a speaker, I was often  asked by attendees who had been bitten, how to be less nervous at work.  In my research I found few surveys or research on this subject so I ran my own, independent of any sponsors or affiliations.  I have presented the findings at the Midwest Veterinary Conference in Columbus Ohio Feb 2017, and at my  Low Stress Handling Ce days in Tuscola Sept 2016. 
It can happen in a second - facial bites often creates the most stress on the job 
Creating the poster was a little bit of a challenge since I had never done this before ( !)  and the guidelines were very broad from the AVMA. So I felt  a bit lost creating the  poster.   Dr Paul Eubig from the University of Illinois College of Veterinary medicine was a huge help.  I present a  behavior lecture in his pharmacology course, and he responded to my plea for help.  Paul sent me a template,  gave  constructive criticism on my draft.  Nancy Oliver in the design group at Vet Med U of I printed  my poster with short notice,  and helped tweak the lay out as well.  A huge thank you to both Paul and Nancy.  I could not have had my poster ready without you.
The round table event was fun.  There was food, drinks and 30 different experts at tables to present a topic for 10 minutes,  then  lead discussion with the participants.  There were 3 rotations of 20 minutes each for the hour and a half of the event.  I had a full table at each turn, with different input from each group.   I presented this  summary of the survey results  which are as follows - responders were DVM, licensed tech and on the job trained with  over 5 years of clinical experience.  The scenarios for bite/near bite injury were greeting the animal ( 29% of injury risk)   Blood draw,nails, feet handling( 40.1%)  rectal, ear, oral, or painful exam ( 29%)  transfer while sedated (14%)
75% claimed the bite came without warning, yet 70% indicated that there were signs of anxiety and early aggression before the bite which was not recognized for the bite risk.
Methods to reduce job related stress included asking help from a co worker ( 55.5%) requiring use of muzzle, sedation or other safety measures ( 58.2%), or avoidance of fractious animals ( 36.4%)
42% reported prolonged stress post bite/near bite with an additional 33.4% who indicated stress" just for the day".
12% of responders consider leaving the practice they are at due to injury risk, with 1.46% leaving practice  ( career change) due to job related stress.
feline bites are common to the hands and arms often requiring hospitalization
From the survey comments, taking courses in less stressful handling,  behavior and having the support of the DVM for sedation and pre exam  medications is what reduced job related stress the best.  
Towel Wrap technique from Low Stress Handling text book by Dr Sophia Yin

At the round table discussions, there was  a mix of experienced DVM's, practice managers, technicians and veterinary students.  Much of our discussions centered on how to improve staff awareness of bite risk.  As one DVM stated " It seems they need to get bitten in order to realize there is  bite risk."  many agreed with this statement.  Taking the time to train new staff in handling and recognizing the body language of stress is also a challenge.   When a new person has been added to the  staff, they are  handling animals  before they have a received this training.  Ideas for training and handling protocols, was discussed.
Other points of discussion were how approach to the animal  when it is agitated, reduce travel stress and reduce the intensity of handling. The seasoned DVM's had the most input about the importance of not pushing through care. Many stated that it seems there is a focus on getting the task done, without paying attention to the animal's response so fear build and becomes aggression.  The veterinary students brought up how they feel a lack of preparedness for knowing how to reduce stress in an animal.  As one student said " So I can tell this animal is a yellow or red for stress, but what do I do now?"  

 In discussing  the technician programs,  while some are including behavior and low stress handling in the curriculum,  few are addressing handling aggressive animals in a less stressful way.   Considering the number of aggressive animals adopted out of no kill shelters, preparation for the aggressive animal is important. 
We all agreed more surveys  are needed to dig deeper into this topic.  At my poster presentation, people would wince at the bite photos,  acknowledging that these injuries happen, and we must have  more knowledge to reduce this.
It was a great weekend. I learned a lot, gathering ideas to write and create products  to help veterinary care be less stressful for patients, owners, and staff.    On a personal note, I was able to meet up for brunch with two of my Purdue suite mates.   We had a great meeting and it was hard to believe it had been 37 years since our "suite life" at Earhart hall. 
Jo Anne and Kathy - 2 of my old Suite mates from Purdue!