Peripheral vein IV Catheter & IV line – Patency Maintenance

Versus Maintenance

Saline-flush Versus Heparinised-saline flush

What I’ve been doing to-date:

1. My ‘go to’ primary protocol: no regularly timed flushing protocol observed – react as required only

2.Use a heparinised-saline flush (HSF) if the catheter or IV line becomes blocked and after initial placement of catheter-only placements



Catheter only (e.g. for IV access intra/post surgery or repeat blood-sampling)

After placement of the bung; introduce a small amount of HSF into the bung ‘hub’ to help maintain patency. React with further HSF as required

Catheter and giving-set (e.g. for a surgical or hospitalised patient)

  • Undertake checks that the catheter, the giving-set, bandaging, the vein and patient remain uncompromised – either at regulated times or when alerted (e.g. by a monitor alarm)
  • If there are no abnormalities: no further action taken
  • If there is a blocked IV catheter or line: use an HSF to clear the obstruction and flush through afterwards with an appropriate sterile fluid

The latest research and guidelines


For the majority of purposes (peripheral vein)
Regular flushing of the catheter with 0.9% sterile NaCl is as effective as 10 IU/mL HSF in maintaining patency for up to 42 hours.

Continuous fluids administration (peripheral vein)
Q4hr sterile NaCl flush is advised

Serial blood sampling (peripheral vein)
Regular use of HSF is generally indicated to aid on-going patency

I’m changing my methods!

Thanks Alison – RVN 

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Our Planet needs Plants and Pollinators!

Plants are the very basis of our world’s food-chain.

What’s a pollinator?

Pollinators are insects or animals that, through their daily activities, move pollen from the anthers (male) to the stigma (female) of the same plant species and so fertilises the flower’s eggs. The flower can then make seeds and create a new generation of plants.

Our bees are an endangered pollinator; subject to dangers such as viruses, fungi, parasites and attacks and competition from non-native invading insect species and our human inclination to avoid planting pollen-producing flowers in favour of unwelcoming species, put down astro-turf, composite (plastic) paving or decking or, as sadly featured in the news recently people maliciously destroying vibrant hives!

How you can help

  • Don’t use weed-killer
  • Don’t kill wild-flowers and, (thanks Elsa), ahem – “Let it Grow”!
  • Do plant some pots with herbs – you can use them and so can the bees
  • Do allow dandelions to flower – They are one of the bees first port-of-calls in the early spring. You can pull the heads off the dandelions after the pollen has been harvested, if you wish. Alternatively, go really hippy up-market and cultivate them for a food source for yourself as well 
  • Do put bee-friendly plants in your garden

Here’s a list of a few easy to grow flowers to attract our buzzy sisters…
Bee Balm – Lavender – Clover – Mint – Cotoneaster – Poppies – Geranium – Russian Sage -Honeysuckle – Sunflowers – Ivy  – Wildflowers – Marigolds and many more. 

Thirsty bees? Yes, bees drink (hic!)
A year-round dependable supply of water is essential for a honey-bee colony. They use water for cooling the hive by evaporation, for thinning honey to be fed to larva and de-crystallizing the honey in the winter months. They collect it as they need it as they don’t store it.

They prefer a safe place to land and then stand while drinking as they can’t swim and will drown. Avoid steep-sided containers. They also have habitual places to visit so you may find it a little while before your drinking station is discovered, (the bee waggle-dance of delight), enjoyed and thereafter visited frequently.

Your bee water-station tips:

  • An old saucepan filled with stones and sticks. Please ensure the pebbles/stones/marbles are pre-washed in hot water to remove any chemical contaminants before using them
  • A shallow saucer-type plant pot, a bowl, or similar and fill it with (pre-washed) marbles or stones/pebbles
  • A bucket with floating corks bobbing about on the water surface

Your bee water-source tips:
Bees don’t like clean tap-water and prefer a mineral-rich water source. They are attracted to the water source by scent rather than sight, so it’s okay to leave algae to form and allow fallen leaves to float around/sink into the bow

  • Add a little salt to your water
  • Use water from a water-butt, a pond or other natural sources
  • Create a scent by putting ground-down oyster shells into the water – Where from? I asked at my local sea-food shop and they were more than happy to help when I told them what it was for – or treat yourself to some!

Thanks Alison – RVN 

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Veterinary Fridge Pharmacy Thermometers


What equipment, checking and warning systems does your practice use to ensure vaccines and sensitive drugs are kept at optimum temperature?

Are the systems doing their job correctly, to help you avoid spoilage?

With the recent hot-spell of weather it is highly likely that your ‘fridge temperature has

hit new highs not to mention those in your pharmacy area (and vet car boot!)

What can you do? What can you use? 

Firstly, get to know your product temperature storage needs (and whilst you’re at it, their exposure to light restrictions as well). Don’t assume and always spot-check (doesn’t take a second at stock take or when you are putting orders away) as things can change…

Maximum and minimum manual thermometer. This is the cheapest piece of kit at your disposal. However, it does not come with an alert function to warn you of exceeded temperature parameters. All too easy to miss until after the fact and, importantly, you may never know it happened and use spoiled drugs as a result.

Electronic data recorder. The simplest data recorders are just an ‘up-market’ manual thermometer and still require manual checks. Though they are compact and easy to use.

Electronic data logger. The data logger produces a print-out, or records onto a USB stick or onto a linked computer – as many times a day/night as you program it to do. However, unless it has an alarm function, any temperature parameters that have been exceeded are historic. Nevertheless, you WILL at some point, KNOW that the temperature parameter has been exceeded and can decide what to do about the (potentially) spoiled drugs.

Posh fridge. All singing-all dancing specialised and dedicated ‘pharmacy fridge’ with all the bells and whistles. If you have one of these, you lucky thing, then it does almost everything for you. Even screams out loud if someone has the left door open… and makes a cup of tea. (Joking, I’m joking…).

Tips and wrinkles
The air temperature in fridges varies enormously every time the door is opened. Measuring the AIR temperature is the standard methodology however this doesn’t necessarily reflect the average temperature of the LIQUID elements contained within a fridge Therefore, for a more realistic recording of the temperature of liquid contents in the fridge, use the following tip…

Tip: put the thermometer probe in a bottle, preferably filled with water, if it will take it, or, if it won’t, filled with paper towel. This will better represent the average temperature of the other liquids in bottles/vials in the fridge rather than relying on an AIR temperature recording (which will probably be different and may affect your decision about spoilage).

Tight for space? Want to use electronic means? Think an alarm would be a great idea?
If a standard thermometer is too bulky for your fridge then consider the following pieces of equipment instead.

Tip: an electronic min/max recording device is designed for small spaces. It can also be used for pharmacy space, a separate vaccine fridge or many other spaces, as well.

Tip: a USB data logger monitors the temperature as often as you set it to. You can check precisely how warm or cold the temperature has reached.

Example: lab-facility EL-USB-1. –

Tip: use of a separate fridge alarm is a sensible idea to complement your temperature recording.

Frequency of recording
The least is twice daily, the most would be consistently and with a reasonable middle-ground of several times daily and overnight.

Warning! Potentially forgotten areas…
Do you measure the temperature of the area wherever you store repeat prescription medications when they are bagged up and waiting for collection? What about your crash kit? The home visit kit?

No? You need to!


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‘Bed & Breakfast’ for a Street Paw

Free veterinary care to animals owned by people who are homeless, vulnerably housed or other vulnerable groups severely affected by poverty
Registered Charity No. 1178826

  • What’s one of the worst things to lose?
  • Your pal and constant companion
  • Just imagine it (my stomach is in knots already…)


To abandon your companion is unthinkable

What do you do if you live on the streets, but your overnight accommodation refuses to allow you to keep your pal with you?

You stay on the streets, is what you do.

What do you do if you need to go to hospital and cannot take your companion with you?
You stay on the streets, ill, is what you do.

What do you do if you are offered permanent accommodation but it’s at the cost of giving away your fur-kid?

You stay on the streets is what you do.

Can we give shelter from the storms of life? Yes, we can!
Street Paws provides bedding, food & veterinary support to a dedicated & secure kennel

  • The kennel is funded by ‘Beacon Pathways’
  • The kennel is for pets requiring shelter for a short-term period; to give their owners the chance to get off the streets.
  • The fur-kids stay safe and sound and are ready for pick-up by their loving owners the following morning (or shortly after).
  • It’s a Win-WIN (Woof-Woof) all round!!

What a marvellous solution! I’m feeling all happy & woofunderful!

  • Of course, keeping the shelter in clean bedding, good food and excellent veterinary support costs money.
  • So, Street Paws is asking for your donations.
  • One-off or regular donations are happily accepted, thank you!
  • Ah, go on, go on, go on; it’ll definitely do good and you’ll feel good!!!!
  • Your Pounds and Your Penny’s make the magic happen


To help Street Paws please donate to:
Thank you; you’re a wonderful human being!

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Street Paws

Vet Seekers are proud to announce that we will be supporting Street Paws as our main 2019 charity of the year. We will be providing volunteer dates, information, support and offering ongoing awareness for the charity.

About Street Paws:

  • Street Paws is a charity providing free veterinary care for animals owned by people who are homeless.
  • They run outreach services in 18 locations; Manchester, Newcastle, Sunderland, Stockton, Leeds, Wakefield, Bradford, Blackpool, Morecambe, York, Cardiff, Lancaster, Belfast, Blackpool, Wigan and Leigh, Salford, Hull and Sheffield.
  • Street Paws has nearly 200 vets, vet nurses and behaviourists who volunteer to care for the animals, most of whom are dogs but there are a number of cats.
  • Each month, animals can receive a health check and, when needed, flea and worming treatments and vaccinations. If an animal is ill or injured they can provide funding for medication and surgery.
  • Street Paws was founded by Michelle Southern in 2016. At the time, Michelle was working as a practice manager for Vets4Pets and volunteering at a soup kitchen.
  • Whilst there, she saw a homeless man with a dog and recognised that while there were services to help people living on the streets, there wasn’t the same support for their pets.
  • She rallied support from colleagues and Street Paws volunteers hit the streets with backpacks filled with treatments, plus practical items like food, bowls, collars and coats for the dogs.
  • Their work began in Newcastle and thanks to huge support from the veterinary community and via social media, they’ve been able to expand across the North of England.
  • Currently, less than 10 per cent of hostels in the UK accept dogs according to research by Homeless Link and Dogs Trust and 63 per cent of owners said they had been asked to give their dog up to get into accommodation.


Michelle says:

“For people living on the street their dog or cat is their constant companion. Often, they lived together in homes before sadly finding themselves homeless.

The bond they share is so strong. The pet provides emotional support and is often their only source of unconditional love.

Homeless people who own pets feed them before themselves and sadly have to choose between being with their pet or being in a shelter or hostel.

They remain on the street because they can’t bear to be parted from them. The animal is their world, their reason to carry on.

By providing outreach services, owners have the reassurance that their pet can have a health check and if they need anything more, they can come to us for help.

Our aim is to work with hostels and shelters to encourage them to support people with pets and provide kennel care for them so their owners can find permanent accommodation.”

In addition to treating the animals, Street Paws has partnered with Newcastle Cat and Dog Shelter and Manchester and Cheshire Dogs’ Home to provide emergency short term kennels for pets if owners need to spend time in hospital.

To find out more about Street Paws, visit and you can follow them on social media.


To view Street Paws Volunteer Vet & Nurses dates please click here

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Anaesthetic Equipment checks

Are you Good to Go?

The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use.


  • Check for breakages, cracks and missing parts
  • Has it been cleaned/disinfected?

Check contents are all present, sterile as appropriate and in-date


  • Check the scavenging system is operational (and is turned on when appropriate)
  • Ensure that the tubing is attached to the appropriate exhaust port of the breathing system, ventilator or anaesthetic workstation
  • When was it last serviced and is it due?

Check the O2 supply source is on:

If this is a cylinder

  • Do you need to change the cylinder?
  • Do you need to order more supplies?

If this is a concentrator/generatorIs

  • Is it plugged in and turned on?
  • Date of last service – is it current?
  • Check all cylinders for cracks/dents – don’t use, if it is!
  • Care should be taken to see that sealing washer (Bodok Seal) is present on the yoke and is in good condition to prevent leakage
  • Check the pipeline gas is connected (Shrader Probe connected) or the 02 concentrator/generator is switched on and working
  • Check the O2 flowmeter is working (the bobbin is revolving/floating freely and not sticking) and the control valve works smoothly
  • If the machine uses attached cylinders / back-up cylinder – attach & turn on each cylinder to check there are no leaks (‘hissing’)
    -Back-up cylinder. It’s vital to check the ‘back-up’ cylinder is fully functional, and has enough gas remaining to do a full op. You might need to rely on it!
  • Do all cylinders have the appropriate tag on? – FULL, IN USE or EMPTY



  • Turn on OXYGEN flow to 8l/min and then disconnect the pipeline/cylinder supply and the bobbin on the flowmeter should drop and trigger an alarm which should shut off when the supply is reconnected and turned back on.
  • Check the Oxygen Flush works
  • Check the O2 supply concentration

If you use N2O – check cylinder and flowmeter function, (with scavenging on). It is not possible to check contents by looking at the dial – contents are measured by weight of the cylinder.

The contents of these cylinders can be accurately measured by weighing the cylinders (1.87 g/L of gas) rather than by pressure gauge. The pressure depends on the vapour pressure of liquid and so does not indicate the amount of gas remaining in the cylinder if the contents are partly in the liquid phase. The pressure stays the same until all the liquid is converted to gas; after which the pressure falls until the cylinder is exhausted. Cylinder pressure varies only if temperature changes due to rapid emptying of cylinder causing cooling of contents due to absorption of latent heat of vaporization. Under this condition, cylinder pressure will decrease with cooling but will be restored as the cylinder warms up again.


  • Ensure it is mounted securely and locked onto the backbar (if it is a removable cannister). There must be enough volatile agent. The vaporizer dial must move easily through its whole rage and not stick. Check that the filler cap is closed.
  • Check when the next service is due. Report if close to or exceeding the 12-month recommended limit.

Manual leak test of vaporiser

(ONLY if permitted by manufacturer recommended instructions)

Set a flow of oxygen of 5L/min and with the vaporiser turned off, temporarily occlude the common gas outlet. There should be no leak from any part of the vaporiser and the flowmeter bobbin should dip.

Defect and Assembly checks

  • Check all breathing systems visually for defects (discard if in doubt)
  • Check the breathing system is assembled correctly and not missing any parts
  • Visually check the reservoir bags are intact (no holes, splits or tears)

1.The Quick-Squeeze Bag Test – checking the breathing system and reservoir bag

  • Attach the breathing system as normal with a reservoir bag
  • Close the APL
  • Occlude the breathing system (patient-delivery end)
  • Press the oxygen flush
  • Squeeze the bag
    – if the bag deflates, you have a leak in either the bag or the breathing system
    – change the bag for a new (or tested) one. Re-test
    – if the bag deflates it is most likely the breathing system has a leak (discard)
    – if the new bag remains inflated, it is likely the previous bag has a leak (discard)

2.The 2-Bag Test – checking the APL

  • Attach the breathing system as normal with a new (or tested) reservoir bag
  • Attach a new (or tested) reservoir bag to the patient end of the breathing system
  • Set fresh gas flow to 5L/m
  • Check the APL valve is working by squeezing both bags

Check that the cannister is sufficiently filled

Replace if a colour-change is more than 2/3rds of the cannister or after 14 hours of use


  • Check the endotracheal tubes, masks etc. are all available in the appropriate sizes, at the point of use, and that they have been checked for patency and (if cuffed) the cuff is functional; check they are clean!
  • Check that the appropriate laryngoscope is available, with appropriate head-sizes, and is functional


  • Check that your anaesthetic monitoring equipment is working e.g. pulse oximeter, multi-parameter monitor, Doppler, ECG etc

And finally; let there be notes!


  • A clear note should be made in the patient’s anaesthetic record that the anaesthetic machine check has been performed, that appropriate monitoring is in place and functional, and that the integrity, patency and safety of the whole breathing system has been assured
  • A record should also be kept with each anaesthetic machine to evidence the daily pre-session checks. Documentation of the routine checking and regular servicing of anaesthetic machines and patient breathing systems should be sufficient to permit audit on a regular basis

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Asking the boss for a raise

It’s not often I have had to prompt my boss for a raise in juicy beetles or ask her to appreciate my undoubted talents by upping the ‘Spikes Dinner’ rations in my evening dish but, yes, I admit it! There has been the odd occasion when she has slipped up and taken me too much for granted. A hedgehog cannot continue to happily live on meagre means, nor be inappropriately appreciated, thus matters need to be sorted! So, how did I go about successfully persuading her to agree to my demands?

It’s all in the planning. Who was it that said, “He who fails to plan is planning to fail”? (Answer below, if you’re interested!).

Ӣ Refer to Vet Suppliers!
Ӣ Ask a colleague who is a member of SPVS to access the latest
(2015) salary survey.
Ӣ Check out job-ads.
Ӣ WARNING: Be careful about asking your colleagues how much
they earn as some organisations frown heavily on this
practice. If you do, do it, be extremely discreet!
Ӣ Decide on a top figure you would be ecstatic to receive and a
bottom line figure as your absolute minimum.
”¢ Decide whether you will consider other ‘benefits’ in lieu of (or in addition to) a pay increase, and what they will be, such as additional paid holidays or CPD.

”¢ Choose a day and date when you know your boss isn’t rushed, is in a good mood and book the time out in the diary.
”¢ Don’t be afraid to cancel the meeting if the day runs away from either you or your boss. Re-book it for another day, rather than rush it through.
”¢ Some bosses like a ‘heads-up’ about the reason for the meeting. So tell them it is to discuss your salary; but don’t get drawn into a conversation about it before you are prepared to do so. On the spot challenges can be intimidating and result ina poor outcome!
Ӣ Otherwise, simply just ask for a meeting and be non-specific about the reason.

Ӣ There is no point in being over modest. Toot your trumpet!
Ӣ Perhaps ask a colleague to tell you what they think of your performance and Рgulp! Рactually believe them when they give you praise.
Ӣ Set out your specific reasons for requesting a pay raise. What have you done to exceed/excel?
Ӣ How have you supported the team?
Ӣ How have you improved the business?
Ӣ Write it all down in bulletpoints and take your notes into the meeting to refer to.

Ӣ Smile and be calm. Perhaps offer to make a cuppa for the pair of you.
”¢ DON’T say that you are not paid enough. That’s a direct challenge and is bound to aggravate.
Ӣ DO say that you have been considering all your responsibilities and how they could be represented in your pay.
Ӣ After you have spoken; ask your boss what they think, and then importantly: sit back, be silent, and allow your boss to speak.
”¢ Listen to what they have to say. Don’t interrupt.

The nitty gritty
”¢ If they ask you for your ideal salary amount — give them the ‘ecstatic’ one. Say, “I would be ecstatic with £x.”
”¢ DON’T give up the very second they draw their breath and say “no”. That’s part of the negotiating skill. Wait. Ask why they feel you cannot have a salary increase.
Ӣ Ask them what would consider a reasonable offer and, importantly, when it would take effect from.
Ӣ If this is within your hoped for salary range/benefits package, and you want to accept it, thank them politely and advise them that you will consider it.
Ӣ Accept it in writing, confirming the amount and start date.
Ӣ If not within your salary range / benefits package; ask whether a salary review is feasible in the future and if so when.
Ӣ Respond in writing to confirm this date. Diarise to set up a meeting for the date. Between now and then, prepare your case again.
”¢ If you do decide you need to leave because the gap betweenwhat you wish/need to earn and what is being offered, DON’T throw a tantrum and threaten to leave. Be professional. Be discreet. Resolve to make plans to find another job and, when you do, resign with your head held high.

Other ideas
Ӣ If you are working a lot of additional time, which has prompted your call for a raise, ask to reduce your hours and remain on your existing salary. At the very least it will give you more time to look for another job.
Ӣ Ask for paid overtime.
”¢ Ask your boss how they feel you can improve in the coming months, which might encourage a pay increase or bonus as a reward. Don’t forget to record this in writing (evidence of intent and timescales). You never know – if you switch your focus over to what they think is necessary – they may be more inclined to cough up!


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Communication – Difficult Clients!

Communication – Difficult Clients!

We’ve all met our fair share of challenging clients, haven’t we?

Theresa Time-Consumer: she overruns consults & pesters staff non-stop
Katy: Know-it-All who refers everything to ‘Dr Google’ or the breeder
Charlie: Cheapskate who wants it all but isn’t going to pay for it
Terry: Tyrant who has zero tolerance for everyone, everything and lets us know it
Susie: Sceptic who says she has tried it all before, but none of it works


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Communication Skills

Why are communication skills so important?

Good communication skills are essential if you want to find out the information you need to help your patient and client and for you to give your fantastic advice in an understandable way.



Hottest Tips:

Listening: ‘Ear, ‘Ear… it’s not just about hearing the words. It is about understanding what your client is saying.

Speak clearly and confidently: ‘I say, I say’…but not loudly or in a dictatorial manner.

Looking: ‘eye, eye’ … look (not stare) at the person you are talking to and make occasional eye-contact. [You’d be surprised by the number of times I’ve caught myself talking to my computer screen…DOH].

Avoid using jargon: … That’s a Big 10/4 Rubber Duck…. Eh? Express yourself in a manner at the client’s level of comprehension, not yours. It’s all too easy to think that because you understand what you mean, the client must as well.

“Yes, he has a comminuted fracture of the left tibia”….

What’s that? Oh, a Broken leg – why didn’t you say so?

Chat:… a professional natter. Have a friendly conversation your client rather than read-off a script. They will feel far more at ease, less anxious and take on-board your advice more readily and you’ll probably learn more yourself as they relax, open-up and tell you more about their pet.

Ask probing questions:… dig deeper. Don’t just rely on what you are immediately told – you need to find out as much information as possible.

For example: Weight clinic. Bert the Labrador isn’t losing weight.

Initial Question:  “What do you feed Bert”
Answer:  “2 bowls of weighed-out dried food daily”.
Confirmation:  “That’s great! You’re feeding Bert the amounts we talked about last time we saw you”.
Probe further:  “Does Bert get any treats?”
Ask what?:  No wonder poor old Bert is not losing weight. The client hasn’t understood that ‘food’ includes ‘treats’ and so doesn’t mention this until you dig deeper.


How does your client live their life? Understanding their point of view and their life circumstances.

You say: You say: “Bert needs to have supervised walks on a lead 3 times daily for a minimum of 10 minutes
and a maximum of 30 minutes per session”.

*You’ve set an impossible task as, without knowing it, the client can’t (or won’t) do this. The only exercise Bert will get is toddling around free-range and unsupervised in his owners garden, once in the morning and once in the evening.*

How do you gain compliance?: You need to find out more about the client’s circumstances. What can they do? What can’t they do? What can you suggest to help them, to help Bert.

Clever tip: Ask what Bert enjoys doing for exercise?

Use this as an opening question over “what exercise do you give Bert?” and you will gain far more information to help you design an achievable exercise plan.

Joint Commitment: Ask what the client is able to regularly commit to, in time and involvement, to help Bert have fun on his weight-loss journey.

Design Bert’s new exercise routine together with the client. A jointly agreed enterprise works better than a dictated regimen.

Stuck? Clever tip: Suggest ‘outside help’ – you’d be surprised how many times this has been the magic-wand suggestion for me. Suddenly your client is excited that they CAN do this for Bert!

Temporary or permanent solutions; for example; a dog-walker or maybe enlisting help from a family-member or neighbour to pop around to supervise the redesigned garden jaunts.

Orating:… No speech-making or just reading words from a hand-out sheet or form.

There needs to be a conversation interaction between you and your client.

If your client needs to read a form, allow them time to do so and check their understanding; [especially if it is a consent form]. 

Observe & Listen: … Listen to the tone and check their facial expressions and body language – to check for comprehension and to modify your delivery as appropriate e.g. 

  • nodding (understands)
  • eyes darting or wrinkled brow (doesn’t understand)…
  • terse replies (get on with it!)
  • shuffling their feet or fidgeting (nervous or they want to get out of there – either way they aren’t engaged and not listening to you)
  • leaning towards you and smiling (either they fancy you or you’ve got the message across successfully!)

Not sure?: … Never guess, find out. You can’t make the right decision if you don’t have the right information.

SKILLS! They’re multiplying!!

Ask open-ended questions:

  • Tell me about…
  • Explain to me…
  • Describe…
  • Who, what, where, when, how

Use close-ended questions as reflective or qualifying statements


Giving Fred his Tablets:

Tell me about giving Fred his tablets. Listen. Then reflect on and qualify the information provided by the client e.g.

  • “I see. Does that mean it’s difficult to give Fred his tablets?”
  • Client answer: YES.

Explain / describe to me about giving Fred his tablets e.g.

  • “What else have you tried to do?”
  • “Please describe how you give the tablets to Fred
  • “When does Fred get his tablets?”
  • “Who gives Fred his tablets?

Ask a close-ended question: When a Yes or a No answer is needed e.g.

  • “Do you have any other questions about giving Fred his tablets?”
  • Client answer: YES. Resume probing/open-ended questions etc to find out more
  • Client answer: NO. Your Job’s Done!

Ending a consult: to ‘close’ the consultation, and very especially for those times when the client over-stays, (perish the thought!)

Close-down techniques

  • pack away your equipment
  • move towards the door and open it
  • discreet time-check: never look meaningfully at a clock or your watch – that’s rude – however a discreet glance at the clock or your watch can politely can prod the client into understanding you need them to go

Repeat over-stayers:… in advance of the consult, ask a colleague to pop in, after, say 10 minutes, to ask for your assistance in 5 minutes time. You can say…

“Ah good, we’ve still got 5 minutes left on your consultation before I am needed. Is there anything else we need to discuss before I go?”

Have any questions or thoughts on this blog? Send them over to Alison –

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Personal Radiation Exposure Monitoring (PREM)

Okay, before you tune out to this necessary but, frankly, rather dull topic – please consider the following…

  • Do you know what your current annual ‘running-balance’ of exposure to radiation from X-ray sources is? No? You should do, you’re entitled to and it is definitely in your best Health & Safety interests!
  • Do you know what your responsibilities and rights are regarding PREM? No? Read on!



Are you aware that self-employed persons are responsible for making their own arrangements with an Approved Dosimetry Service for dose assessment and dose recording under Ionising Radiations Regulations 1999 (IRR99)?

Radiation doses-assessment and recording:

Exposure results:

Best practice is for all information to be passed from practice to practice when a nurse moves location. This is necessary because we should be monitoring our rolling twelve-month exposure for reasons of health, safety and action as required – RPS: Radiation Protection Supervisor (on-site supervisor)

Confessions of a slightly naughty nurse:

Also known as the episode where only half a ‘t’ got crossed & no ‘i’ was dotted!


Many locums are not aware of their responsibilities for dose assessment and recording under IRR99 and travel from practice to practice undertaking x-rays in happy ignorance of the law. Potentially jeopardizing their health and safety by remaining unaware of any accumulated, and potentially excessive, radiation exposure within the last twelve-months.

Using the practice’s own dosimeter badge – or other device – certainly appears to fulfil the criteria of a self-employed person ‘making their own arrangements with an ADS for dose assessment and dose recording under IRR99’. That is, so long as you are recording your rolling twelve-months’ exposure total.

Let’s think about this process. The badge is eventually sent off by the practice within their usual reporting time-frame, be that on a monthly or quarterly basis. It is read and a report is prepared for the exposure that this particular badge has recorded. Any issues identified are then passed to the practice to deal with…

What if there is a radiation exposure identified?

  • To whom does this exposure belong? It may be difficult to identify this as a ‘general-use’ or ‘spare’ badge has very likely to have been used by multiple people within the reporting period.
  • When did the exposure occur? Near impossible to tell to the exact day/date as the report is at best a monthly one and more generally a three-monthly one.

Why is this relevant to a locum?

  • You need to know what your rolling twelve-month exposure is.
  • Due to the peripatetic nature of locum-working, you are normally long-gone before the report appears. Does the practice get in contact with you after you have left?
  • The practice should get in contact with you to advise of the identified issue – even if they cannot be certain it was you that was exposed. It is sensible to show the exposure in your records, just in case.
  • You need to know what do you do with the information.
  • You need to know who is responsible to you for on-going information and assistance.

As a matter of routine, you should receive a copy of your dose assessment and recording report from every practice you work at – issues or no issues. If you do not already, then request these reports as you are entitled to them.

Permanent employee:

  • Similarly, for a permanent employee, who has changed employers within any one twelve-month period, it is sensible to obtain your own dose summary and termination records. You are fully entitled to do so under regulation 21 (6) IRR99. You can then pass the information onto your new RPS.
  • Some employers do pass the information on to the next practice or obtain it from the previous one(s); but check!

TIP: You can also request a copy of your full dose record from the ADS (record-keeping) within a reasonable period of any such request.


1. Practice-provided dosimeter badge. Is usually the ‘spare’ or ‘general use’, un-named, badge. No one person’s activities can be accurately identified.

2. The exposure report from the un-named badge is not specific; it could record activities of anyone at any time within the reporting period (one month’s or usually a three months’ period). The badge could be even be worn by a different person on the same day! The information is useless for individual monitoring purposes.

3. Unless you provide a report to each practice of your ‘running balance’ exposure total, and they provide you with theirs, your annualised total exposure undoubtedly cannot be assessed and therefore any issues cannot be addressed.

***This method clearly cannot accurately monitor an individual’s radiation exposure. You need to set up a different arrangement for yourself***.


Buy your own dosimeter badge!

Take charge of your own safety and obtain a dosimeter badge for yourself, with access to your very own RPS and RPA. It is, I believe, by far the easiest method and is also very reasonable on the purse (around £15 per annum).

The personal preference of my RVN Alison is to apply for an account with ‘JAK Marketing’ (other providers available)

From JAK Marketing:

You will receive a quarterly monitoring kit, consisting of:

  1. A location-badge to place in-situ, to monitor background radiation, whilst working at the practice,
  2. A body-badge to wear
  3. A return envelope.
  4. Send the two badges off every quarter and receive an official exposure report, to keep
  5. Make every practice aware you have your own badges.

This has been wholly accepted wherever Alison, my RVN, went. When she returned to permanent work she continued to use her own badge until the (paid for) year expired and then went onto the practice’s own system. She gave the practice copies of her exposure reports throughout.



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