THE AAHA CANINE VACCINATION GUIDELINES: 2017 UPDATES & INSIGHTS

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1 THE AAHA CANINE VACCINATION GUIDELINES: 2017 UPDATES & INSIGHTS Richard Ford, DVM, MS, DACVIM and (Hon) DACVPM, Editor Emeritus Professor North Carolina State University Raleigh, North Carolina Link Welborn, DVM, DABVP, Chair Tampa Bay Animal Hospitals Tampa, Florida The recently revised and expanded AAHA Canine Vaccination Guidelines were released in a web-based (mobile-ready) format on September 5, 2017, and are available at: The objective of this presentation is to provide veterinarians, and staff, with an overview of updated vaccination recommendations for dogs and to introduce the revised online menu selections and format. By converting to a web-based format, the Canine Vaccination Task Force is enabled to provide timely updates on vaccination recommendations, references, and newly licensed biologics for use in dogs seen in clinical practice and shelters throughout the United States and Canada. The reader is reminded that information provided within the AAHA Canine Vaccination Guidelines website is intended to be used to facilitate efforts in developing or updating vaccination protocols in clinical practice and within the shelter setting. The Guidelines and recommendations should not be construed as defining immunization requirements, recommending a specific course of treatment, or offering procedural standards of care in veterinary medicine. It should be noted that variations from the recommendations outlined within the Canine Vaccination Guidelines are at the discretion of the individual clinician; variation should be based on knowledge of the health status of the individual patient, novel or geographic risk factors for exposure to vaccine-preventable diseases, and limitations unique to the individual practice setting. Whenever possible, evidence-based support for specific recommendations outlined in the Canine Vaccination Guidelines has been cited (see the tab: REFERENCES). Other recommendations are based on established immunological principles, practical clinical experience, and expert consensus. Further research is needed to fully document and support certain recommendations. In addition, veterinarians are reminded that decisions concerning the selection and use of vaccines in canine (and feline) patients should always be based on available scientific evidence in conjunction with personal knowledge and experience.

2 What follows are highlights of key updates and additions to the AAHA Canine Vaccination Guidelines (2017): VACCINATION RECOMMENDATIONS for GENERAL PRACTICE This section provides updates on recommendations for individual CORE and NON-CORE vaccines. Revised recommendations for initial vaccination of the young dog as well as booster recommendations for adult dogs are addressed. In addition, a Remarks section offers insights on several key issues/controversies concerning individual vaccines. Noteworthy is the recommendation for administration of an optional 4 th dose (at 18 to 20 weeks of age) of a combination Distemper-Parvovirus- Adenovirus-2 vaccine. Based on data supporting the fact that vaccine interference from maternally derived antibody is extended beyond 16 weeks of age in some pups, administration of a 4 th dose option is indicated in dogs living within high risk areas ( High Risk being defined as geographic locations or housing facilities where the prevalence of unvaccinated dogs is particularly high and infection rates for Distemper and [especially] Parvovirus are high). Recommendations for vaccines licensed since the publication of the last iteration (2011) Canine Vaccination Guidelines (canine influenza (H3N2 and H3N8) and oral Bordetella bronchiseptica) have been added. Regarding future revisions, the online format currently in use allows real-time updates as new vaccines, and new information regarding existing vaccines, become available. VACCINATION RECOMMENDATIONS for SHELTER-HOUSED DOGS A primary goal when implementing a vaccination protocol for shelter-housed dogs is to establish and sustain herd immunity within the population at risk and to provide protection of individual dogs. Therefore, as many dogs as feasible should be vaccinated on intake as a means of mitigating infection risk. Although vaccination on intake is currently considered the best practice in shelter medicine, such protocols do not equate to immediate immunization/protection. For this reason, veterinarians who practice shelter medicine contend with infection and outbreak risk on a continuous basis. Timing of pathogen exposure (field versus transport versus shelter exposure), age and health status of the individual dog, presence of interfering levels of maternally derived antibody, etc., are among the various factors that impact the ability of a well-executed vaccination protocol in an animal shelter to prevent infection and transmission of pathogens. The current recommendations for vaccination of shelterhoused dogs have been extensively reviewed and updated by veterinarians actively engaged in the practice of shelter medicine. And, although these recommendations do not represent a universal consensus of opinion on vaccination-protocols for all animal shelters, this section of the Guidelines does offer important insights and recommendations for developing or revising a shelter-based vaccination protocol. ANTIBODY TESTING vs VACCINATION (NEW) Recent interest among veterinarians, and clientele, to assess a pet s immune status vs. simply administer regularly scheduled booster vaccines have resulted in the growing use and availability of antibody tests (for canine distemper, parvovirus, adenovirus). However, the paucity of information available on test indications and interpretation of results in individual dogs easily leads to inappropriate testing recommendations and misinterpretation of results. This section of the Canine Vaccination Guidelines represents a unique resource on quantitative (ie, titers) and qualitative (ie, point-of-care test

3 kits) antibody testing in practice. Included in this section are 12 clearly defined indications for antibody testing. In addition, an interpretive algorithm is offered for each indication that provided patient management guidance based on a positive, or a negative, test result. Included among the various antibody test indications outlined in this section are: 1) antibody testing following completion of the initial vaccine series (puppy) to assure the patient has been effectively immunized; 2) antibody testing to guide decisions on the need to re-vaccinate dogs that are overdue for a scheduled booster; 3) antibody testing in lieu of re-vaccination in a patient with a history of a vaccine adverse reaction;4) antibody testing in lieu of re-vaccination in a dog with chronic illness (eg, hyperadrenocorticism, cancer, etc); 5) pre-breeding assessment of antibody levels in the breeding bitch and more. RABIES VACCINATION (NEW) Of all the vaccines currently licensed for use in dogs, rabies vaccine is the only vaccine that, in most States, is required by law. But, the laws governing rabies and rabies immunization vary from State to State and can even vary within a State. Confusion over the interpretation of (and access to) current State law can easily lead to mistakes and inappropriate actions on the part of the veterinarian (dog bites to humans; dogs exposed to a known or suspect rabid animal; actions by the veterinarian if the patient is currently vaccinated or is overdue, and much more). This newly introduced section of the Canine Vaccination Guidelines offers veterinarians rapid access to critical information (via link to: on several must know issues, all of which have been validated by public health officials in respective States. OVERDUE FOR VACCINATION (NEW) At the request of practicing veterinarians, the Canine Vaccination Guidelines now include a section dedicated to recommendations for vaccinating dogs that are overdue for a scheduled vaccine. This section addresses two categories of dogs that are overdue : 1) puppies that are (or become overdue) for a vaccine dose at or during the initial series, and 2) adults that are overdue for a scheduled booster as well as adult dogs that have no vaccination history, an incomplete vaccination history, or a history of inappropriate vaccination. Differences among the types of vaccine administered (modified-live, recombinant, killed) AND the length of time since the last dose was administered significantly impact the overdue protocol applicable to the individual dog. For this reason, recommendations within this section address all vaccines, in both categories, individually. Unfortunately, studies specifically addressing vaccination protocols in young, or adult, dogs that are overdue for re-vaccination (booster) are not available. Furthermore, this issue is not addressed by manufacturers (nor is it required to be) in the course of vaccine licensing studies. Therefore, the recommendations put forward within this section are based on a consensus of expert opinion and in consultation with the vaccine manufacturer(s). As new information becomes available, these recommendations will be updated/revised accordingly. VACCINE STORAGE AND HANDING (NEW)

4 A new addition to the Canine Vaccination Guidelines, this section presents a series of critical points regarding the importance of proper storage and handling of vaccines in a practice setting. It is important to note that improper storage and handling of vaccines can lead to decreased immunogenicity of the product leaving the vaccinated patient susceptible if exposed. Information in this section has been derived from the 2016 Vaccine Storage and Handling Toolkit (Centers for Disease Control and Prevention) and has been excerpted and edited specifically for animal hospitals. Topics are presented in bulleted format and range from staff training to best practices for storing vaccine and diluent in a refrigerated unit. Key points (which may surprise you) should be considered by all veterinarians and staff who are involved in handling or administering vaccines. For example: 1) some vaccine antigens (such as attenuated [MLV] canine distemper virus) are particularly susceptible to degradation following re-constitution; 2) vaccines should never be stored in a syringe; 3) diluents are not interchangeable (never use a stock vial of sterile saline or water to reconstitute a dose of vaccine); 4) never pre-draw vaccines in anticipation they will be used later in the day; 5) a single exposure to freezing temperatures (32 F or colder) will destroy some vaccines and more (much more). THE VACCINE LABEL (IMPORTANT UPDATES) Although not the most exciting vaccine-related topic, labels for veterinary vaccines are currently undergoing substantial change. Beginning in the fall of 2016, under the authority of the USDA s Center for Veterinary Biologics (CVB), labeling changes started to take place and will continue over a 4 to 6 year period. Material presented in the Canine Vaccination Guidelines is not intended to represent a comprehensive review of the issues involved. Instead, two (2) of the most significant changes impacting decisions made in practice have been summarized and should be reviewed. The first, efficacy indication statements, addresses the decision to eliminate the so-called tiered language describing differing levels of effectiveness (often used in marketing of vaccines). This will be replaced with a simplified statement that the product is effective for the vaccination of healthy animals against a specific disease. Second, new labels will no longer carry a routine, default recommendation for annual revaccination. Manufacturers are now allowed to publish duration of immunity data on the product label (ie, the package insert). THERAPEUTIC BIOLOGICS (NEW) Recent advances in the development of vaccines has led to the discovery of a growing number of unique biologics capable of treating, rather than preventing, disease. A small number of therapeutic biologics are now licensed for use in the treatment of specific canine diseases, such as melanoma, T-cell lymphoma, B-cell lymphoma, osteoarthritis, and canine atopic dermatitis. Within this section, information on the product, the manufacturer, and specific indications for use are provided. It s important to note that therapeutic biologics are just now being introduced (and licensed) for use in veterinary medicine. More are in development now and will be added to this list as these products are licensed and prescribing information becomes available. FREQUENTLY ASKED QUESTIONS The Frequently Asked Questions section of the Canine Vaccination Guidelines has been completely revised and updated with references added whenever possible. The focus of this section is to provide responses from field experts on vaccine-related questions that are controversial or for which peerreviewed (evidence-based) studies are limited or lacking. To facilitate reader s efforts in locating

5 information on specific points, this section has been divided into eight (8) topic categories (plus an Explanation of Terms ) that are aligned with TOPIC SELECTIONS used throughout the Guidelines. In addition, each question has been highlighted with a short identifier that will enable the reader to identify the topic(s) of interest quickly and avoiding the need to read through several unrelated questions and responses. CONCLUSION The 2017 AAHA Canine Vaccination Guidelines are now available as an online educational resource for practicing veterinarians and staff. Comprised of 14 independent sections not including References, the updates and additions to these Guidelines represent the most comprehensive, and expanded, revision since the first version was published in As an online document, updates on product, resources, and references will be regularly reviewed and added as the information becomes available. ACKNOWLEDGEMENTS The Canine Vaccination Task Force would like to recognize the time and expertise of several individuals (listed on the website HOME page) who have generously offered their time and expertise in reviewing and editing the 2017 AAHA Canine Vaccination Guidelines. Their input has been invaluable in the complex process of identifying and recommending best vaccination practices for veterinary medicine. In addition, the Task Force wishes to acknowledge the help and support of the American Animal Hospital Association for providing the administrative support and technical solutions input required to develop and implement this first online version of the AAHA Canine Vaccination Guidelines. These guidelines were supported by a generous educational grant from Boehringer Ingelheim, Merial, Merck and Zoetis.

6 Bring the Newly Updated AAHA Canine Vaccination Guidelines to Life in all Areas of Your Practice Dr. Link Welborn, DVM, DACVP, Chair Tampa Bay Animal Hospitals Tampa, Florida Brian C. Conrad, CVPM Hospital Administrator VCA Meadow Hills Animal Hospitals Kennewick, Washington Liza W. Rudolph, BAS, RVT, VTS (CP-CF, SAIM) Veterinary Technician Specialist Consultant and Educator East Coast Veterinary Education, LLC PetED Veterinary Education and Training Resources The recently revised and expanded AAHA Canine Vaccination Guidelines were released in a web-based (mobile-ready) format on September 5, 2017, and are available at: The objective of this presentation is to provide veterinarians, hospital administrators/managers, and staff alike tools and systems in order to implement and educate your staff and your clients on the updated AAHA Canine Vaccine guidelines. Our goal is to create a consistent and clear plan for you to find success in your own practices. This unique set of speakers will bring real life scenarios from their own practices and viewpoints from veterinarian, a hospital administrator, and specialized registered veterinary technician. The morning session will provide all 3 viewpoints and conclude with a group panel discussion and question and answer session. Vaccination Guidelines When we think of the implementation of the guidelines, it is important to remember how confusing and overwhelming vaccine schedules can be for the average staff member and client. Lots of initials and numbers and abbreviations. 3 weeks, 4 weeks, 1 year, 2 years, 3 years How are we ever supposed to keep track? Clients need and want consistent advice from their veterinarian. They want to be in an environment that is able to demonstrate confidence. There is nothing worse than having a team member say over the phone I think your pet will need this Is this a guess or is this really what they need? The AAHA Canine Vaccine Guidelines establish all of the above. A committee of knowledgeable and educated group of health care providers, researchers, and scientists have established consistent protocols that aim to create reliable and optimum health outcomes for our beloved pets in today s world. Gone are the days of It has worked for me for 25 years so I am sure it

7 will work for another 25 years. To implement the new and revised guidelines we first need to look at change management. Change Management - We all have had some type of success in our practices. Some more than others. But what differentiates ongoing success is for the ability to realize we must continue to be innovative and change to meet the demands, wants, and needs of our clients and future clients. Where we tend to slip up is we see and feel success in our practices and we have a human nature element in all of us to sit back and say finally, we made it. I made this mistake at the two practices I manage in Kennewick, Washington. It relates to our client service. We held weekly meetings, we created staff incentives, we solicited client feedback, reviewed other companies out of our industry who we could learn from. The list goes on and on in all of the effort, training and attention we placed on client service. Innovation differs from invention in that innovation refers to the use of a better and, as a result, novel idea or method, whereas invention refers more directly to the creation of the idea or method itself. Innovation differs from improvement in that innovation refers to the notion of doing something different rather than doing the same thing better. The goal with change is to maintain relevancy within our community. That is to say we need to continue to change and modify to meet the needs and wants of our clients and their pets. Not an easy task. What is more fearful is the AVMA is reporting that approximately 10,000 veterinary practices will change hands (i.e. sell or close) over the next 10 years. This is a sign that many of our baby boomer practice owners are preparing for retirement and thinking about an exit strategy. The concept of selling and retirement is a great thing. After all, many of these practice owners have worked hard, taken risks, and ultimately sacrifices time, sweat, and tears to make it this far. Human tendency is to keep things status quo. The feeling by many practice owners is if it is successful today, then it will be successful tomorrow and next year. I can just cruise into retirement over the next 10 years. Nothing could be farther from the truth. This will lead to a slow death of the business deteriorating its worth and the satisfaction of those that work there. It is a very scary cycle that we are seeing. The other scenario that is being played out by practice owners that are considering retiring and/or selling is the following. There is a great book titled Predictable Success by Les McKeown. It the book, he walks the reader through the life stages of any business. The stages are somewhat fluid, that is to say, a company or in our case a veterinary clinic can move back and forth depending on its health and leadership. In the other concerning scenario, the author terms it BIG RUT. He describes the business owner or owners as getting to the point where they fail to see or remember they exist for the client. All or most decisions about the business are made with the What s in it for me attitude or mentality. With leadership failing to realize its most important asset, the client/customer, they fail to realize the importance of innovation and change. Quite frankly, it is discouraged. This has similar effects as does the mentality mentioned above of just placing the veterinary clinic on cruise control. In both of these instances, damage is done and for some of the damage, it won t be able to be undone.

8 If this sounds like you, it is time to take a hard look in the mirror and decide how you are going to get out of the BIG RUT and continue to innovate and make positive changes to the clinic right up until the end. The new AAHA Vaccine Guidelines are a perfect example. 85% of Americans will tell you they do not like change. Why would they? It is so much easier and comfortable to keep things the same. The idea of learning a new software system or a new diagnostic tool seems daunting. It is the goal of the leadership team to work with the doctors and staff and help them thought the turmoil period. That is to say that when creating change in the practice, the goal would be to improve services and or products and or become more efficient at the same time. When creating the change, we will usually see a increase of morale to begin with but that will be very short lived as the staff starts to find road blocks and hiccups to the new plan. I am sure you have never any of your staff say Can t we go back to the way we used to do it? I hope you could hear the sarcasm in that question. When making changes in the hospital, the biggest obstacle or failure on the leadership team is not allowing for enough time for the support team to digest all of the information. Many times, the leadership team has had discussions or thought about the change for weeks, months or sometimes even years. Then one day we decide to flip the switch and take action and we wonder why everyone is completely enthused or on board with our brilliant idea. Creating Value in Your Staff s Eyes Before we can have an educated set of clientele, we have to have an educated set of doctors and staff. After all, why not just run down to the feed store and pick up one of those vaccine vials for a $1.99? How can you possible justify a client paying $25.00, $35.00, or more for a little vaccine? Now is the time to sit down with your staff and have the talk. Explain to them and define to them what are the AAHA vaccine guidelines and how did they come about? Explain to them the importance of consistency and having one message and one focus to your clientele. Explain to them why you have selected the series of vaccines that you have and what the advantages are. Instill the excitement and confidence you have with some of the newest technology that allows for greater protection while maintaining safety standards like never seen before. Change is constant and that applies for strains of diseases along with trends and research that is ongoing and always changing the landscape for pet health. When you have informed, educated, and confident staff, you in turn will have similar results in your clientele. Take the time to work with you staff and don t have them questioning whether or not the vaccine at the feed store will produce similar results to anything found in your hospital. Once they recognize the value in what you do and offer, the rest will be easy. The Importance of Customization For years we have talked and discussed the idea of Customer Intimacy. Simply put, techniques and communication systems put in place to make each client feel like they are the only ones that exist. Whether you practice sees 5 clients in a day or 55 clients in a day, each client and their pets are made to feel special and the recommendations made for their pets were made because of their individual needs, risks, and well-being going forward. The AHHA Vaccine Guidelines allow and encourage this based off of the core and non-core vaccine recommendations. It is important to educate your staff and your clientele in making recommendations based on each pet s lifestyle, risk factors, and history. Within minutes, a good summary can be obtained from the client and

9 specific recommendations created to benefit that specific pet. The 2-3 minutes this takes is critical in establishing trust and client compliance in accepting recommendations. Currently, our baby boomer generation still makes up the largest sector of clientele that we see. This will be changing in the coming years and the millennials will begin to overtake that lead. Customization and personalization for this segment group will be expected as will transparency. Again, this is what is so exciting about the guidelines. We are able to demonstrate that key leaders of the industry have set have mapped out recommendations for their loved ones to enhance and encourage healthy lifestyles for their pets. Client Communication - We could probably create a book titled: Veterinary doctors and staff are from Mars, Clients are from Venus. It is amazing how we often have a communication barrier gap. This is certainly not on purpose. At least I hope not. I once told my staff I could write a book just on all of their secret codes and short hand phrases. Some of them are quite funny yet for someone that is only in a veterinary clinic a couple of times of year are never going to get it. Nor should they have to. It is our job as the pet-care providers to communicate to our clients in a clear and concise manner in which they understand it. More than understand it. They should be able to in turn go back to their spouse, significant other, family members, etc. and re-communicate the recommendations, the diagnosis, the concerns, the celebrations etc. When you start to raise the communication bar to that level it becomes quite a feat. It s going to take more than a good bed-side manner to accomplish that. Imagine all of the technology we can glean from to illustrate our points as just one of the tools we will discuss. We must first understand and make an assessment of who it is we are talking too and at what level of communication they would like. We have seen where we can easily talk over clients heads and maybe worse than that is when we talk at such a remedial level to the client that they leave the practice so frustrated feeling like they are back in kindergarten. It is much like the Goldie Locks and the Three Bears. Too hot is similar to the client being talked to over their heads. Too cold is talking to them at such a remedial level they get frustrated. We are trying to find the porridge that is just right. The problem is each client is going to be slightly different. This relates back to the importance of customer intimacy noted above. We have clients that walk in to our clinics that are brand new pet owners. We then have clients that have owned pets for 40 plus years. We have clients that have a background in the medical profession and clients that have watched a lot of Greys Anatomy and House. We have clients that have taken the time to read up on subjects and other clients that just want their rabies vaccine so they may get their city pet license requirements out of the way. As you get a better picture of the pet s need you also have to gain a better picture of the client s needs? Some will be completely fine with your recommendations and others might be on a knowledge plane that is such they want to discuss the biochemistry of the vaccine itself. Evaluate each appointment and communicate appropriately. This can be an art at times. You are not a salesman Each doctor and support staff member are advocates for each client and pet they see and work with. Never in the job description will you find salesman or saleswoman listed. I realize sometimes we can feel this way. After all, we enter the exam room and have a plethora of options and recommendations we review with each client. Do you want this and oh, by the way, I think

10 you should have this and the list continues. Keep in mind clients are counting on our expertise and recommendations. I have concluded several client focus groups. Every time I bring up the question do you feel you are being upsold? Their response is always the same. Not if it is presented correctly. What is the correct way to present is always my follow up questions. Their response overwhelmingly is make us understand why. If it seems that the recommendation is just because then they do feel like they are being upsold. If they can see relevancy and value then they have indicated it is not an issue. When discussing vaccines, especially non-core vaccines, explain why you may or may not be making the recommendation. Although I indicated above trust has taken a hit in our industry, we still have the majority of our clients believing we are going to conduct ourselves in an ethical manner and aren t going to make frivolous recommendations. It is all in your attitude. Once you and your staff realize you are an educator and advocate for each pet as opposed to a salesman, you demeanor will change and so will compliance. Assuring Consistency As noted above, consistency and making sure all of the staff is on board is critical, I recommend providing a consistency quiz. This would be used following group training and/or a general staff meeting in which you launch or educate everyone on the new guidelines. It can be as simple as 5-7 questions related to the topic. While it may seem juvenile, it has been an incredible asset to me and my practices assuring I have everyone saying and thinking alike. When we go to correct the quizzes, it becomes very obvious who gets it and who doesn t. For the minority that missed the main points, we simply meet with them individually to review the information again and make sure they are now on the same page. The manufacturing reps of these vaccines are diamonds in the rough and are not utilized to their fullest. Meet with each one and have them work with your staff in small groups to understand the vaccines you are going to carry, the science behind them, the warranties or guarantees, the safety data, and the value to when it is used. Furthermore, have them trained for those off chance reactions. Using the high end vaccines, generally the companies will stand behind them in the event of adverse reactions. More value than the feed store once again. Myth Busting During the group discussion/live panel, we will go through many of the myths that are heard in the exam rooms each week: Vaccines cause the illness Vaccines cause adverse reactions Vaccines are unnecessary as most of the diseases are rare Vaccines should be dosed by weight Vaccines cause cancer Training and education are instrumental in creating objective and understandable explanations. The key to myths is to understand there are many resources in the world we live in. Some reliable and others very opinionated and biased. The unfortunate problem we run into is clients and some staff don t have the education to decipher true versus untrue claims. Certainly this can become emotionally. Clients can be made to feel like we are merely trying to upsell as opposed to doing what is in their pet s best interest. Clear and empathetic communication are critical in working with our clients with clear and concise explanations. Keep in mind, we are not communicating to scientists the majority of the time.

11 Empathy in understanding the client s concerns, fears, and reservations. Simple one on one discussions can go a long way in establishing trust with you client and assuring protection for their pets. The myths are out there. Neighbors, breeders, family members, box store retailers all have an opinion. Some have a strong opinion. We find acknowledging their concerns and giving factual and scientific evidence will dissuade many of these myths. Being able to reference the AAHA Vaccine Guidelines is just one more tool in your arsenal for working with your clients and their pets. Another limiting factor you will run up against is time. Unfortunately, we do not have an hour to spend with each client on vaccine education. Training and educating your staff will aid in overcoming this additional roadblock. We also know having the client hear a similar message from multiple team members aids in the educational process. Take the time to work with your staff. Putting the Client in the Driver s Seat - This year some billion dollars will be spent on pet care and pet products. We have more threats in way of competition than ever. We are seeing human healthcare and technology companies entering our industry as a branch out. We need to work on creating and monitoring systems that will keep our clients put. When a client feels like they are not listened to or have a say in how services or products sales are going to go then they will look for alternate providers. This words may resonate as we discussed communication skills with vaccine myths. Simply making a client feel inferior or telling them something isn t going to work. We need to come to conclusions together and ultimately empowering the client. Let s take a page out of the dental industry and see a few examples of how they demonstrate to their patients that they are in control of their visit. It starts first by a visual queue of handing over the remote to the individual TV installed in the operatory. They tell the patient they can watch any show they want. In continues with handing the patient the controls to the massage chair they are sitting in. Inter-oral cameras are used to show patients what the dentist is seeing and comparing the current pictures with ones that show what their teeth could look like. It s up to them if they want to hear more information. These are just a few examples of how dentist offices put their patients in control of their visit rather than dictating to the patient how it is going to be. Now I am not advocating that we have massage chairs in the exam rooms for the pets but it s important to realize other industries are taking this idea of control to heart. I also want to make sure you are not misinterpreting what I am saying. I am not asking the client to play doctor nor do I want them to. I just want our doctors and staff to be conscious of the idea that the client needs to feel involved and a part of the experience. Especially as we see some of our newer generations emerge. We know for clients to feel in control with a service provider they must be able to trust the business. Words and phrases such as integrity, character, exceptional talent, drive to personal excellence, internal moral compass, honesty, and leadership round out descriptors for establishing that trust. Cookie cutter approaches to providing care to the patients will leave the client feeling taken advantage of. They will feel in control as they drive their records out of your facility. Clients will congregate to easy as it further makes them feel in control knowing the business is there to take care of their needs. A recent Harvard Business Review published a study indicating 56% of

12 consumers complained of having to re-explain issues. We see this in our clinics when we make clients repeat histories or call back to check on medications and explain again what they are looking for. Imagine clients confused or unsure of vaccines for their pets. 57% complained of having to switch from Web to phone. I agree, we can further put the client in charge when we give them tools to use at their convenience (i.e. online scheduling). But if we are going to offer these tools, we better make sure they work and that we are responding. And lastly 59% of the survey respondents indicated they expended moderate to high level of effort to resolve their issues. If clients are going to feel in charge than they are going to have to have resolution in a timely and effective manner. As the issues arise, make sure to work on concrete and well communicated plans to the staff to resolve the issues from repeating themselves. You can offer further confidence to the clients by further communicating the changes you and the staff have taken to prevent the issues from arising again. Adverse Reactions: We do know from time to time that adverse reactions will occur. Based on the AAHA guidelines and their recommendations, many of the vaccines noted come from reputable and reliable manufacturing companies that back their products. The manufacturing companies have guarantees and warranties in place that should be communicated to the staff and clients alike. In the rare instances when an adverse reaction does occur, your doctors and staff should be organized and prepared to take advantage of said warranties. This includes understanding what is covered, how to submit reimbursements, how to invoice on your practice management software and finally, how to record the incident in your Adverse reaction log. The support staff should be doing the leg work for the client making for an easy experience. Remember the importance of the easy experience noted above. Conclusion: The AAHA Vaccine Guidelines is a set of invaluable tools that offers consistency and a roadmap for the wellbeing of our pets. The guidelines are well thought out and overseen by an impressive set of peers that have done extensive research and debate in a setting expectations for our industry to follow. Working with your doctors and staff on the implementation is critical to their success. Once the guideline are integrated within your practice, you will find the wellness visits and vaccine visits to be easier and more efficient. Taking the time to fully personalize the schedules based on risk will add to the client s feelings of customization and being in control. Additionally, whether you have 5 staff members or 55 staff members, the guidelines offer clear and concise direction and policies for the pet making it much easier to find cohesiveness within the entire team. The guidelines ultimately raise the level of medicine being practiced within our great industry. We wish you well with your journey as you take the time to work with your team in defining, understanding, performing, and repeating the AAHA vaccine guidelines knowing it will lead to the greater good of the practice and ultimately adding to your current success.