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POLICY
UNDERSTANDING THE VCPR— INSIDE AND OUT
It is well known that the veterinarian-clientpatient relationship( VCPR) is one of the foundations of effective veterinary care. A veterinarian must establish a VCPR prior to providing any veterinary services.
When the College published the updated Professional Practice Standard: Telemedicine earlier this year, stating a VCPR can be established via telemedicine( at a distance), questions arose about what a VCPR actually entails. The finer features of the VCPR did not appear well understood. It seemed some assistance is needed for the profession to better understand this fundamental pillar of veterinary medicine.
The VCPR, as defined in Regulation 1093, is established in a conversation with a client when three things occur. The veterinarian:
• Has been retained by the owner of the animal( s), groups of animals, or herd( s), an authorized representative of the owner, or an individual who the member
PRESCRIBING & DISPENSING WORKING GROUP RECONVENES
At its September meeting, Council received an update on the ongoing work of the Prescribing and Dispensing Working Group. In recent years, Council has developed new and separate standards on prescribing and dispensing. These draft standards have been circulated for consultation and revised as a result of the feedback received.
At Council’ s request, the working group reconvened this spring to once more review the drafts and prepare recommendations for Council’ s consideration prior to final approval and publication. The following comments represent current suggestions of the working group.
Prescribing Drugs
The current Canadian Veterinary Medical Association Therapeutic Decision Cascade for prescribing medication has had limited uptake. As a result, the draft standard, now in words only, outlines expectations related to prescribing choices of veterinary drugs,
reasonably determines is acting in the interest of the animal( s), groups of animals, or herd( s);
• Has reached an agreement with the client as to the scope of the services to be provided by the member; and
• Has advised the client that services will only be provided in accordance with the standards of practice of the profession.
However, working within a VCPR to deliver any particular course of treatment, whether medical, surgical, or medication-related, requires other elements inclusive of a history, inquiry, physical examination, diagnostics, and / or anything else a veterinarian deems necessary in his / her professional judgment. This is where the terminology“ recent and sufficient” comes into play. What constitutes recent and sufficient knowledge of an animal or group of animals depends on the circumstances of a specific case. This is particularly necessary for prescribing drugs.
approved human drugs, or compounded products. The working group is also suggesting that prescribing a compounded product instead of an approved drug should not be done solely for economic reasons of the veterinarian.
Dispensing Drugs
In the draft standard on dispensing, the working group is suggesting a revision to state a veterinarian may not return to stock, administer, re-sell, or re-dispense a drug. Also proposed is a list of restricted drugs that may not be dispensed due to risk to the public and animals. These measures increase the safe management of medications.
Compounding
In the area of compounding, the working group is recommending Council maintain the standard for compounding and introduce a new standard for extra-label drug use to clarify compounding as a subset of extra-label drug use. The working group is proposing
Guidance on all of these components can be found in the Guide to the Professional Practice Standard: Veterinarian-Client-Patient Relationship.
Once a VCPR is established, a veterinarian must obtain the client’ s informed consent for each service or group of services provided.
There are some exceptions to the need for a VCPR, including a situation where a veterinarian, acting reasonably, determines that there is an emergency situation and that an animal or animals require( s) immediate veterinary services. For a full list of exceptions, consult the VCPR standard.
The VCPR is a cornerstone to safe, quality care. Understanding all of its component parts is important for every veterinarian.
Guide to the Professional Practice Standard: Veterinarian-Client- Patient Relationship
revisions to the compounding standard in keeping with the Health Products and Food Branch Inspectorate Policy on Manufacturing and Compounding Drug Products in Canada. In particular, the changes clarify expectations relating to in-office use.
Dispensing outside VCPR
Consideration is also being given to those substances that may be dispensed outside a veterinarian-client-patient relationship( VCPR). The broad issues, for Council’ s debate, are whether veterinarians should be permitted to dispense certain substances outside a VCPR and, if so, which substances should be permitted.
The Working Group includes representatives from the Ontario Veterinary Medical Association, Toronto Academy of Veterinary Medicine, Ontario College of Pharmacists, and a registered pharmacist with experience in veterinary medicine.
Fall 2017 / 3