16- Home Care, Compliance, and Follow-Up
When treatments are required at home, the instructions should be explained carefully and clearly to the client. To have compliance, we must engage the client in perceiving the value of carrying out our recommendations. Additionally, the client must understand how, and be able, to perform the prescribed task. Both verbal as well as visual (written, emailed) homecare or discharge instructions should be given. When previously unfamiliar treatments are prescribed (e.g., subcutaneous injections, administering a pill, trimming nails), the most effective form of educating and ensuring success includes three steps (See-Do-Teach):
- Describe and/or have the client read a how-to brochure) and show the client how to perform the technique,
- Have the client do it, and
- Have the client teach someone else how to do it.
There are many excellent websites and videos to reinforce the lesson, some of which are listed in the Resources. The AAFP/ISFM Feline-Friendly Nursing Care Guidelines includes a client brochure (Nursing Care for Cats, Practical Tips for Pet Owners) at: Cathealthy.ca/catvetsnursingcare.
Should several treatments be recommended (e.g., oral antibiotics, subcutaneous fluids, a therapeutic diet, nutraceutical supplements), better compliance is likely if treatments are prioritized. In general, nutritional, hydration, and analgesic needs should be provided for every patient.
The effects of a visit to the veterinary clinic or a period of hospitalization may be felt when the cat returns home. This should be taken into consideration as we help the client plan reintroduction to the home environment, as there are often other pets and people for the cat to deal with. Depending on the reason for the veterinary visit, there will be some degree of disruption to the patient’s serenity. If the cat was hospitalized due to illness or was anesthetized, the ability to cope with inquisitive or hostile housemates could be difficult. Advise the client to allow the cat to acclimate to the home environment in a separate room for a period of time. This will also allow odours acquired in the hospital to dissipate.
Success is best achieved by taking a team approach – involving the client, the veterinarian, and the rest of the healthcare team. We must ensure that the client understands why we are telling them to administer and persist with treatments, and we must show ongoing and caring involvement. It is a good investment of time to call the day following a visit or discharge and, in the case of illness or ongoing treatment (e.g., a new diabetic), to follow up with additional phone calls every 2-4 days as suits the patient’s and client’s needs. Contacting the owner for progress reports will improve compliance, patient outcome, and client satisfaction.
Videos on syringe feeding, brushing teeth, giving insulin, administering subcutaneous fluids, etc., are also available. Cat caregivers like to show off their skills and help others.
Cornell University College of Veterinary Medicine has a series of videos on a number of procedures and diseases
at Cathealthy.ca/partnersah. They include:
- Brushing your cat’s teeth
- Giving your cat a pill or capsule
- Giving your cat liquid medication
- Taking your cat’s temperature
- Trimming your cat’s nails
- Caring for your diabetic cat (includes a video on how to give an insulin injection)
- Gastrointestinal diseases in cats
- Cat owner’s guide to kidney disease (includes a video on subcutaneous fluid therapy)
- Managing destructive scratching behaviour in cats
- A pet owner’s guide to cancer
Having a library of good websites and video links or making your own clinic “how-to” videos is extremely helpful. Videos made by clients may have the advantage of being more convincing than those made by healthcare professionals, but content should be reviewed before recommending them to clients. Examples of useful videos to have on hand include how to:
Measure blood glucose:
Use an inhaler for asthma medications:
Esophagostomy tube feeding:
(Courtesy of Dr. Susan Little)
Change a KittyKollar® (video) and Living with an E-tube (handout):
Similarly, having a selection of web resources that you have reviewed and feel comfortable with will guide your clients to appropriate reading materials when they want to learn more about their companion’s medical condition. Here are some suggestions: