Minimum Standards for Practice Techniques

PURPOSE: This rule defines the minimum standards for the delivery of various services. (1) Radiological Services. (A) All veterinary facilities must have adequate diagnostic radiological services, unless there exists a written agreement to provide these services through another facility. (B) A radiograph is the property of the veterinarian or the veterinary facility which originally ordered it to be prepared. However, the radiograph or a copy of it shall be released within a reasonable time period upon the request of another treating veterinarian who has the authorization of the owner of the animal to which it pertains or directly to the owner or owner’s agent. An original radiograph shall be returned to the originating veterinarian within a reasonable time period after written request. Radiographs originating at an emergency hospital or clinic become the property of the next attending veterinary facility upon receipt. Documented proof of transfers of radiographs shall be verifiable. (C) Radiographs should be stored and maintained for a minimum of five (5) years from the date the radiograph was taken. All exposed radiographic films shall have a permanent identification, legibly exposed in the film emulsion, which will include the following: 1. The hospital or clinic name or facility permit number; 2. The identity of the person taking the radiograph; 3. Client identification; 4. Patient identification; and 5. The date the radiograph was taken. (2) Laboratory Services and Equipment. (A) Clinical pathology and histopathology diagnostic laboratory services must be available within the veterinary facility or through outside services. (B) Laboratory data is the property of the veterinarian or the veterinary facility which originally ordered it to be prepared and a copy shall be released within a reasonable time period upon the request of another veterinarian who has the authorization of the owner of the animal to which it pertains or directly to the owner or owner’s agent. (C) A laboratory must be equipped with a microscope. (3) Dispensed Drug Labeling. (A) No legend drug or biologic shall be prescribed, dispensed, or administered without the establishment of a veterinarian-client-patient relationship or the direct order of a licensed veterinarian who has an established veterinarian-client-patient relationship with that animal(s). (B) The veterinarian in charge is responsible for assuring that any legend drugs and biologicals prescribed for use in the veterinary facility are properly administered, for maintaining accurate records to include strength, dosage, and quantity of all medications used or prescribed and for instructions to clients on the administration of drugs when the veterinarian will not be providing direct supervision. (C) All drugs and biologicals shall be maintained, administered, dispensed, and prescribed in compliance with state and federal laws. (D) All repackaged legend drugs dispensed for companion animals shall be in approved safety closure containers, except that this provision shall not apply to drugs dispensed to any person who requests that the medication not be placed in these containers, or in those cases in which the medication is of a form or size that it cannot be dispensed reasonably in these containers. (E) All drugs dispensed shall be labeled in compliance with all state and federal laws and as a minimum include: 1. Name, address, and telephone number of the facility; 2. Patient’s name; 3. Date dispensed; 4. Directions for use; 5. Name, strength (if more than one (1) dosage form exists), and quantity of drug and the expiration date when available; and 6. Name of prescribing veterinarian. (F) All clients shall have the right to receive a written prescription from their veterinarian to take to the pharmacy of their choice so long as a valid veterinarian-patient-client relationship exists. (G) Records shall be maintained of all medications prescribed and dispensed for any animal or group of animals in that animal’s individual record or the herd owner’s record. These pharmacy records may be transferred, in whole or in part, from one veterinarian to another, in writing or by telephone, at the request of the client/owner or owner’s agent, when necessary to continue treatment or disease prevention medication started by the original attending veterinarian. (H) A veterinarian may dispense no more than a seven- (7-) day supply per patient from an office stock compounded preparation provided by a licensed pharmacy. A patient-specific prescription must be issued to continue treatment beyond seven (7) days and comply with all other requirements under this rule. (4) Vaccinations. (A) A vaccination is the administration of a vaccine to an animal in an attempt to prevent disease. (B) A veterinarian-client-patient relationship must exist prior to administration or dispensing of a vaccine for diseases which are communicable to humans and which are of a public health significance in order to ensure that the patient is medically fit to receive it. In order to implement the exemption provisions of section 340.216.1(5), RSMo, the board recognizes that the following diseases are communicable to humans and are of public health significance, and that only a veterinarian may immunize or treat an animal for these diseases: 1. Brucellosis; and 2. Rabies. (C) A plan for initial vaccination and subsequent revaccinations shall be formulated and communicated to the client. (D) No vaccine shall be dispensed or administered unless provision has been made for treatment of vaccination-related emergencies. If this treatment is not to be provided on-site, clients will be advised where emergency service is provided. (5) Disposal of Dead Animals. Sanitary methods for the disposal of deceased animals shall be provided and maintained. When the owner or owner’s agent of a deceased animal has not given the veterinarian authorization to dispose of his/her animal, the veterinarian shall be required to retain the carcass for at least AND INSURANCE three (3) days following the death or three (3) days after notification to the owner or owner’s agent, whichever is longer, in accordance with section 340.288.4, RSMo. (6) Anesthesia Services. (A) General anesthesia is a condition caused by the administration of a drug or combination of drugs sufficient to produce a state of unconsciousness or dissociation and blocked response to a given pain or alarming stimulus. Appropriate and humane methods of anesthesia, analgesia, and sedation shall be utilized to minimize pain and distress during surgical procedures. (B) A veterinarian shall comply with the following standards when administering a general anesthetic: 1. Every animal shall be given a physical examination within twelve (12) hours prior to the administration of an anesthetic; and 2. The animal under general anesthesia shall be under continuous observation until at least the swallowing reflex has returned and not be released to the client until the animal demonstrates a righting reflex. This shall not preclude direct transfer of an animal under anesthesia to a suitable facility for referred observation. (C) Equipment. 1. Anesthetic equipment in accordance with the level of surgery performed will be available at all times. The minimum amount of support equipment required for the delivery of assisted ventilation will be— A. Resuscitation bags of appropriate volumes; and B. An assortment of endotracheal tubes with cuffs in working condition. 2. Oxygen equipment will be available at all times. 3. Some method of respiratory monitoring is mandatory, such as observing chest movements, watching the rebreathing bag, or use of a respirometer. Some method of cardiac monitoring is recommended and may include use of a stethoscope or electrocardiographic monitor. (D) Effective means shall be provided for exhausting waste gases from hospital areas in which inhalation anesthesia is used. These means shall comply with existing federal, state, and local regulations and may include use of filtration canisters, gravitational or negative-suction venting, or a combination of these. (E) Anesthetic equipment will be maintained in proper working condition. (7) Surgical Services. (A) Sterile surgery shall be defined as procedures in which aseptic technique is practiced in patient preparation, instrumentation, and surgical attire. (B) Surgery Room. 1. A room shall be designated for aseptic surgery and it shall be clean, orderly, and properly maintained. 2. Nothing in this section shall preclude performance of emergency aseptic surgical procedures in another room when the room designated for that purpose is already occupied. 3. The surgery room will be well-lighted and will be provided with effective emergency lighting. 4. The floors, table tops, and counter tops of the surgery room will be of a material suitable for regular disinfection and cleaning, and will be cleaned and disinfected regularly. (C) Instruments and Equipment. 1. Instruments and equipment will be— A. Adequate for the type of surgical service provided; and B. Sterilized by a method acceptable for the type of surgery for which they will be used. 2. In any sterile procedure, a sterile pack will be used. (D) Sterilization. Aseptic surgery requires sterilization of all appropriate equipment. An acceptable method of sterilization must be used on all instruments, packs, and equipment intended for use in aseptic surgical procedures. (E) Attire for surgical service. When performing clean surgery, the surgeon(s) and ancillary personnel shall wear clean clothing. (8) Dental Service. (A) Dental operation means— 1. The application or use of any instrument or device to any portion of an animal’s tooth, gum, or any related tissue for the prevention, cure, or relief of any wound, fracture, injury, or disease of an animal’s tooth, gum, or related tissue; and 2. Preventive dental procedures including, but not limited to, the removal of calculus, soft deposits, plaque, stains, or the smoothing, filing, or polishing of tooth surfaces. (B) Nothing in this rule shall prohibit any person from utilizing cotton swabs, gauze, dental floss, dentifrice, toothbrushes, or similar items to clean an animal’s teeth. AUTHORITY: sections 340.200 and 340.210, RSMo 2016.* This rule originally filed as 4 CSR 270-4.031. Original rule filed Nov. 4, 1992, effective July 8, 1993. Amended: Filed April 14, 1994, effective Sept. 30, 1994. Amended: Filed March 10, 1995, effective Sept. 30, 1995. Amended: Filed Oct. 10, 1995, effective April 30, 1996. Amended: Filed April 1, 2003, effective Sept. 30, 2003. Moved to 20 CSR 22704.031, effective Aug. 28, 2006. Amended: Filed March 31, 2008, effective Sept. 30, 2008. Amended: Filed July 25, 2018, effective Jan. 30, 2019. Emergency amendment filed March 20, 2019, effective March 30, 2019, expired Jan. 8, 2020. Amended: Filed March 20, 2019, effective Sept. 30, 2019. *Original authority: 340.200, RSMo 1992, amended 1999, 2004 and 340.210, RSMo 1992, amended 1993, 1995, 1999.