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Technician Evaluation

Summary:

The intention of this section is to provide veterinary technicians with guidelines for writing the patient care plan portion of the veterinary medical record. As there is no standardized format for writing a veterinary care plan, the following principles are only one example of how a care plan may be formulated.

Objective

  • To identify abnormalities, events, or phenomena that require nursing intervention or action by the veterinary technician.
  • To carry out diagnostic and therapeutic procedures prescribed by the DVM/VMD.

What to Include

Technical evaluations are problems and needs are identified based on the following:

  • the client’s primary complaint and history
  • the DVM/VMD’s diagnosis and prescription
  • the veterinary technician's assessment
  • hospital protocol
  • good husbandry and care practices
  • commonly accepted nursing practices.

List and number the technician evaluation of problems and needs in the order of immediacy from most to least critical.

Note the date when each problem is identified and when it is resolved.

Sample Technical Evaluation

The following is an example of how a technician evaluates a patient.

The DVM/VMD diagnoses the presence of mastitis in a cow. According to the client’s report and observations made by the veterinary technician (VT) and DVM/VMD, the cow’s udder is swollen and congested. The DVM/VMD orders a culture and sensitivity test.

Technical Evaluations

1

Mastitis (DVM)

2

Congested udder (client, DVM, VT)

3

Poor husbandry (history, VT)

4

Poor milking practices (history, VT)

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Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.