Hospital Onboarding

This is a supplement to the IndeVets Code of Conduct that outlines minimum equipment and clinical policies required for our veterinarians that work in Partner Hospitals. Adhering to these standards allows our Associate IndeVets to provide your hospital with the best possible service and care.

Please see our minimum standards below:

Equipment Standards

• Gloves
• Working scale and thermometer
• Different sizes of needles and syringes
• Access to disinfectants – alcohol, hydrogen peroxide, surface disinfectant that is bactericidal/fungicidal/virucidal

• All minimum equipment above for vaccine clinics
• Otoscope and ophthalmoscope

• 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

• All the above under full-service general/emergency practices minimum equipment required
• And please see our policy: If a Partner Hospital Wants to Request Surgery Shifts from an IndeVet for additional minimum surgery and dentistry requirements

General Clinical Standards

• No use of expired medications/vaccinations
• Access to life-saving medications (epinephrine, atropine, diphenhydramine, and dexamethasone at minimum)

• 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

• See our policy: If a Partner Hospital Wants to Request Surgery Shifts from an Associate IndeVet for our minimum surgery and dentistry requirements

IndeVets endeavors to maintain a positive work environment. Our partner hospitals, along with our team of doctors, play an important role in fostering this environment. We’ve developed a set of guidelines – A Code of Conduct – that we ask our Associate IndeVets and Partner Hospitals to follow.

We believe good working relationships start with eliminating unwanted and unneeded distractions such as unprofessional, disrespectful, or aggressive language or behavior.

Associate IndeVets working in our Partner Hospitals are asked to bring violations to our Code of Conduct to our attention. We ask our Partner Hospitals to do the same by emailing [email protected] or [email protected] or by calling us at 833-INDEVETS. If we conclude that a violation has occurred, we will follow the guidelines in the IndeVets Response to Code of Conduct Violations policy.

Our Clinical and Interpersonal Guidelines

We follow these clinical policies:

• State practice acts
• Radiation safety regulations
• DEA law/controlled substance handling
  • How and where drugs are stored
  • How drugs are logged for use
  • How drugs are ordered
• OSHA safety standards
• Minimum appropriate staffing
  • At least one technical staff member and one customer service representative on with each Associate IndeVet
  • At least two Partner Hospital staff to complete radiographs (Associate IndeVets are not allowed to take radiographs)

We follow these internal IndeVets’ policies:

• Harassment-Free Environment Policy
• Minimum Clinical Requirements for IndeVets Working in Partner Hospitals
• Always communicate in a professional, respectful way. Don’t use aggressive language or behavior.
• Always follow Federal, State, and Local clinical and non-clinical laws and regulations.

Because Associate IndeVets cannot have a dosimetry badge at every hospital where they work, they are legally not allowed to be in the radiology room when a radiograph is being exposed. Exemptions exist if you have an Associate IndeVet work routinely at your hospital and you purchase an individual dosimetry badge for that Associate to monitor radiation exposure as required by law. Please see the full policy below.

• All states have their own radiation control divisions that regulate people’s exposure to radiation.
• The states’ regulations incorporate the federal standards of the United States Nuclear Regulatory Commission -10 CFR Part 20.
• If people are exposed to radiation as part of their employment, that exposure must be monitored and measured to ensure the exposure stays under a certain limit.
• In a typical hospital setting, veterinarians must wear a specific dosimetry badge when they are exposed to radiation while taking radiographs.
• It is impossible for an IndeVet to have one dosimetry badge for all hospitals in which he/she works because the badges are unable to distinguish between location and amount of radiation exposure. Exposure limits are linked to the specific machine in a specific hospital location.
• To limit an IndeVet’s radiation exposure and follow the state and federation regulations, veterinarians working for IndeVets are not allowed to take radiographs or be in the room while radiographs are being taken in client hospitals.
• An exception to the above protocol involves dental radiographs. IndeVets can participate in professional dental cleanings but can’t hold or stand next to the radiation source while it is being used. IndeVets must stand 6 feet or more away from the dental x-ray source when in use.
• If an IndeVet is asked to take radiographs while working in a client hospital, he/she should reference this protocol and direct any client questions or concerns to a member of the IndeVet’s leadership team.

Not all Associate IndeVets take shifts at emergency hospitals. Those that do are interested in the answers to more detailed emergency and critical care policies and procedures at your hospital.

If you are an emergency Partner Hospital, please fill out this additional questionnaire for our Associate IndeVets here.

In many cases, Associate IndeVets are available to perform surgeries/dentals. Because anesthetic procedures carry an increased risk and require more detailed protocols, surgery and dentistry procedures must be requested separately.

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.

Once this protocol is completed, an Associate IndeVet can select procedure shifts at your hospital. They may only select a few shifts to start; this ensures it is a great match between the Associate IndeVet and partner hospital.

• First review the standards below to determine if your hospital can support an Associate IndeVet performing anesthetic procedures.
• Then, please complete the following form that outlines your hospital’s processes and procedures in more detail surrounding anesthetic procedures: https://forms.gle/jbtxqDqFnCgH8sNb7.
• Once our medical leadership reviews your completed form, our scheduling manager will alert you to the ability to post surgery/dentistry shifts through our online scheduling system.
• Completing this process doesn’t guarantee an 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 or dentistry.

Pre-anesthetic Procedures – All anesthetic patients will have:

• 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.)
• 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.
• 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:

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

Surgical Anesthetic Procedures

• Surgical equipment and machines must adhere to safety/regulatory guidelines.
• Associate IndeVets must cap, mask, sterilely glove and gown for procedures. Exceptions include cat neuters (cap, mask and sterile gloves) and dental procedures (cap, mask/face shield, non-sterile gloves, nonsterile covering to protect clothing).
• All animals under general anesthesia must be intubated.
• Intravenous fluids must be used unless an underlying medical condition prohibits this.
• 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.
• Anesthetic monitoring requires a dedicated technician trained in emergency procedures.
• 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.
• Surgery must take place in a dedicated surgery room.

Dental Procedures

• Dental procedures must not take place in the surgery room.
• Only licensed veterinarians may extract teeth.
• Associate IndeVets require access to a high-speed drill, dental radiography and appropriate analgesics to administer local nerve blocks.

Post-anesthetic Procedures

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

View our surgery requirements as a PDF.