Intrepreting Schedule Three for Equine Practices

Day one skill

Administration of medication

Guidance

• eRVNs may only administer medication to a patient when directed to do so by a veterinary surgeon who has the patient in question 'under their care'.
• Prescription of the medication is the sole responsibility of the veterinary surgeon. 
• Medicines must be used in accordance with the manufacturer's instructions.

Day one skill

Intravenous catheterisation

Guidance

• eRVNs may only place an intravenous (IV) catheter when directed to do so by a VS who has the patient ‘under their care’.
• eRVNs may administer IV fluid therapy to a patient when directed to do so by a VS.
• Prescription of the IV fluid is the sole responsibility of the VS.

Day One Skill

Phlebotomy

Guidance

• eRVNs may only take a blood sample from a patient when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• eRVNs may run diagnostic tests on samples as directed by the veterinary surgeon.
• Diagnosis of the condition remains the sole responsibility of the veterinary surgeon.

Day one skill

Radiography

CT, Scintigraphy and MRI

Guidance

• eRVNs may only acquire images from a patient using radiography, CT, scintigraphy, or MRI when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• The role of the eRVN here is to acquire images that are of a diagnostic quality.
• The eRVN can appraise the image taken however, the appraisal and diagnosis of pathology remains the sole responsibility of the veterinary surgeon.
• CT, scintigraphy and MRI are not Day One Skills, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.

Day one skill

Wound assessment, dressing and bandaging

Guidance

• eRVNs may only carry out wound assessment, dressing and bandaging of wounds when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• The veterinary surgeon should be kept fully informed regarding the progress of the wound.

Day one skill

Suturing and repair of superficial wounds

Guidance

• eRVNs may only carry out suturing and repair of superficial wounds when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• The veterinary surgeon should be kept fully informed regarding the progress of the wound.
• This is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.

Day one skill

Perineural analgesia

Guidance

• eRVNs may only carry out perineural analgesia when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• This is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.
• The role of the eRVN would solely be to perform the perineural analgesia procedure, with any associated appraisal or diagnosis remaining the sole responsibility of the veterinary surgeon.
• The directing veterinary surgeon should bear in mind that eRVNs should not undertake perineural analgesia where entry into a body cavity is required.
  NB: Analgesia of synovial structures such as joints is not considered to be appropriate to delegate to eRVNs, as this is considered by the RCVS to be entering a body cavity.

Example: Perineural analgesia of the distal limb, where appropriate training has been carried out and competence demonstrated.

Day one skill

Passing a nasogastric tube for the administration of fluids/feed or retrieval of reflux

Guidance

• eRVNs may only carry out nasogastric tubing when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• This is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.
• The prescription of feeds or fluid to be administered to the patient remains the sole responsibility of the veterinary surgeon.

Day one skill

Placing an endotracheal or nasotracheal tube to maintain a patient airway

Guidance

• eRVNs may only place an endotracheal tube when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• This is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.
• The prescription of inhalation agents to be administered to the patient remains the sole responsibility of the veterinary surgeon.

Day one skill

Euthanasia where there is a veterinary surgeon on the premises

Guidance

• eRVNs may only euthanise a patient when directed to do so by a veterinary surgeon who has the patient ‘under their care’.
• This is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.
• Euthanasia itself is not an ‘act of veterinary surgery’, however the administration of controlled drugs for the purpose of euthanasia is. Whilst the law allows an RVN to carry this out under the direction of a veterinary surgeon, the practical advice from both BEVA and the RCVS is that it is advisable for a veterinary surgeon to be on the premises and able to respond to a request for assistance if needed.

Day One Skill

Intravenous injection

Sedation

General anaesthesia

Guidance

Sedation by equine RVNs

An eRVN may administer and monitor sedation in a horse subject to the following:

1. The procedure is being carried out under the direction of a veterinary surgeon.
2. An animal specific sedative dosing protocol has been agreed for the eRVN to follow.
3. The directing veterinary surgeon is available (not necessarily on the premises) to advise in the event of complications or an indication to deviate from the agreed protocol.
4. The administration and monitoring of sedation, in relation to the specific patient and procedure, is within the scope of competence of the eRVN.

Standing sedation is performed frequently in equine practice and is associated with a very low risk of complications. Oral sedatives are regularly prescribed for owners to administer in order that a variety of (non-veterinary) procedures may be safely undertaken.

The ability for eRVNs to administer and monitor sedation under Schedule 3 facilitates safe delegation of a wide range of further Schedule 3 tasks to eRVNs.

The development of an animal specific sedative dosing protocol between the directing veterinary surgeon and eRVN is a pre-requisite of delegation, as is the requirement that the eRVN would be expected to contact the veterinary surgeon in the event of complications and / or indications that deviation from the agreed protocol might be necessary.

Maintenance of anaesthesia and equine RVNs

An eRVN may induce and maintain general anaesthesia in a horse subject to the following:

The procedure is being carried out under the supervision of a veterinary surgeon (Vet 1) other than the vet carrying out the surgery (Vet 2) i.e., Vet 1 is present on the premises and able to respond to a request for assistance if needed.

An animal specific anaesthetic drug dosing protocol has been agreed for the eRVN to follow.

The protocol provides for potential deviations to be explored, discussed, and pre-authorised.

The maintenance of general anaesthesia, in relation to the specific patient and procedure, is within the scope of competence of the eRVN.

Equine RVNs cover anaesthesia extensively within the RVN qualification, with assessment of both theory and practical skills.

In circumstances where a suitably trained eRVN is monitoring a patient under anaesthesia on behalf of a veterinary surgeon, the veterinary surgeon responsible for supervising the eRVN must remain on the premises and in a position to provide direct support if needed.

Anaesthesia durations and procedures are not specified in the RCVS guidance; however, the responsible veterinary surgeon would need to consider these when deciding whether it is appropriate to delegate the task.

Protocol driven anaesthesia is strongly supported and involves a pre-operative discussion between the case veterinary surgeon and the eRVN. The development of drug dosing protocols should be undertaken on a case-by-case basis by the responsible veterinary surgeon working with the eRVN. This enables potential deviations to be explored, discussed, and pre-authorised which, in turn, empowers the eRVN to make changes within predefined parameters and addresses concerns around the lack of prescribing powers for eRVNs potentially delaying action in the event of an anaesthetised patient becoming unstable (BVA, 2021). eRVNs would not be making a prescribing decision, they would be working within an accepted dose range of an anaesthetic drug that is appropriate and has been prescribed for the patient by the case veterinary surgeon. If an event occurs that requires the eRVN to deviate outside of an agreed drug range, the case veterinary surgeon would be contacted immediately for guidance.

References:

• BVA, (2021), ‘BVA and BVNA response to RCVS Legislative Reform consultation’ [Accessed 9th January 2023]

Day One Skill

Intramuscular injection

Vaccination

Guidance

• An eRVN may administer second, and subsequent, vaccinations to a horse under the direction of a veterinary surgeon.
• However, if the vaccination record requires certification by a veterinary surgeon, then the veterinary surgeon must be satisfied that the vaccine has been administered correctly (e.g. watched it being administered in person).
• The vaccination of horses is not a Day One Skill, and although the relevant theory will have been covered during the veterinary nursing qualification, appropriate in-house training should be completed before carrying out this skill.

The Veterinary Surgeons Act 1966 (Schedule 3 Amendment) Order 2002 provides that veterinary surgeons may direct registered or student veterinary nurses who they employ, to carry out limited veterinary surgery. Under this Schedule 3 exemption, the privilege of giving any medical treatment or carrying out minor surgery, not involving entry into a body cavity, is given to:

• Registered veterinary nurses (RVNs) under the direction of their employer to animals under their employer's care. The directing veterinary surgeon (VS) must be satisfied that the veterinary nurse is qualified to carry out the medical treatment or minor surgery.
• Student Veterinary Nurses (SVNs) under the direction of their employer to animals under their employer's care. In addition, medical treatment or minor surgery must be supervised by a VS or RVN and, in the case of minor surgery, the supervision must be direct, continuous and personal. The medical treatment or minor surgery must be carried out in the course of the SVNs training (RCVS 2023).

The RCVS has interpreted these terms as follows:

• 'Direction' means that the VS instructs the RVN or SVN as to the tasks to be performed but is not necessarily present.
• 'Supervision' means that the VS or RVN is present on the premises and able to respond to a request for assistance if needed.
• 'Direct, continuous and personal supervision' means that the VS or RVN is present and giving the SVN his/her undivided personal attention (RCVS 2023).

References:

• RCVS, (2023), ‘Delegation to veterinary nurses’, Accessed 9^th January 2023

The RCVS Day One Competences, Skills and Professional Behaviours for Veterinary Nurses are the minimum essential requirements that all SVNs are expected to have met in order to join the RCVS Register of Veterinary Nurses.

The requirements incorporate knowledge, skills and behaviours and ensure veterinary nurses are safe and competent to practise on day one, as follows:

1. Day One Competences: the minimum essential competences that the RCVS expect all student veterinary nurses to have met when they register.

1. Day One Skills Lists (small animal): the essential clinical skills, that veterinary nurses are expected to possess upon entering small animal clinical practice.

1. Day One Skills Lists (equine): the essential clinical skills, that veterinary nurses are expected to possess upon entering equine clinical practice.

1. Professional behaviours and attributes: the behaviours newly-qualified veterinary nurses are expected to demonstrate upon entering the profession.

Find out more about the RCVS Day One Skills.