Patient Flow Setup

Patient Flow Overview

Patient Flow is a digital drug log that helps your clinic meet all state veterinary board requirements with ease. It calculates drug doses using your clinic’s protocols, supports documentation of exams, SOAP notes, surgical techniques, and medical notes, and enables exceptionally fast client communication.

In this section, we will review how to set up your drug protocols, pre-calculated drug charts, controlled substance bottle inventory, and Patient Flow automations.

The Patient Flow chapter gives an overview of how to use each function once set up.

Drug Charting

Drug Charts / Protocol Setup

Set up standard protocols for each species your clinic services. Non-standard protocols are useful for common variances your clinic may encounter such as aggressive or brachycephalic patients.

Learn how HERE.

Available Drugs Setup

Enable drugs your clinic use that do not need a standard chart pre-generated. This is best for uncommon uses.

Controlled Substance Draw Structure

Most clinics will use Centralized Controlled Substance draw structure. This creates one master drug log for the clinic. A De-Centralized draw structure is used for larger clinics that may operate teams. The drugs are divided up and assigned to teams. The drug bottle can only be used by the assigned team. A drug log is created for each team.

Controlled Substance Setup

Here you can set up and manage your controlled substance bottle inventory. Add new bottles to this section when your clinic receives them. Create new bottles of compounds as your clinic mixes them up in-house.

By clicking manage for any of the drugs, you can add new bottles, waste bottles in the system and see how a bottles history. Learn how HERE.

Settings

Here you can toggle to enable or disable these options depending on how your clinic runs.

• Does your clinic keep animals overnight as a routine part of spay/neuter surgeries?
• Does your clinic uses extended exam?
• Does your clinic want to see rechecks in Patient Flow?
• Does your clinic want to see Basic Wellness appointments in Patient Flow?
• Set exam defaults to "normal." If not enabled, the TPR, Subjective, and Objective will not be auto-selected to normal.

Note: If an animal is checked in and this setting was not enabled, changing it will not move them to Patient Flow. Updates to this section apply to appointments checked in after the update.

Automations

In Patient Flow, when an animal's services are completed, staff click the "Done" button. Here, you can enable automatic actions to occur when the animal is marked as done.

When Done is clicked it can do any combination of the following:

• Move animal to Checked Out status.
• Send take-home template to the owner via email or text.
• Send take-home paperwork to print.
• Send pickup text to public clients, allowing you to stagger pickups across your clinic day.

Note: You must have the Call & Text Addon set up to utilize texting functions. Learn how to set it up HERE.

NOTICE: The Drugs tab from Checkout was phased out in 2021 and replaced with Patient Flow. It is no longer supported by Clinic HQ.

Drug Chart / Protocol Setup

Drug Chart Setup

Your clinician will need to establish the protocols and drug doses used for standard and non-standard anesthetic procedures. To get started, go to Settings > Patient Flow Setup > Drug Chart/Protocol Setup.

You will need:

1. Your clinic's protocols.
2. Current drug charts.
3. Formula for dosing.

Note: Before entering your charts, establish whether your clinic measures weight in kgs or lbs. This setting is located in Settings > Clinic Profile > Preferences.

The chart setup should be your standard dosing based on species and maturity. The charts cannot be restricted to sex. Any deviations from one standard dosing would be set up as a non-standard protocol. These would be for cases where your clinic uses different dosing for animals such as aggressive, male vs. female, brachycephalic, etc.

If you follow the ASNA drug protocol, we have that available HERE.

Dog Protocols

1. From the Standard Protocols section, click Dog Protocol.
2. This is broken into Pre-Med, Induction, Surgery, Emergency, and Reversal drugs. The section you set the chart up under is where you will draw and record the drugs in Patient Flow.
   • Pre-med = Pre-med & Exam tab
   • Induction = Drug Draw tab
   • Surgery = Surgery tab
   • Emergency = Any PF Tab
   • Reversal = Surgery tab
3. Click Create a New Drug Chart on the right of Pre-Med Drug Protocols.
4. Search for and select the medication you would like to create a chart for. Choose the administration route and chart color. For compounded drugs, enter the size bottle you typically mix up at a time. This allows you to confirm the recipe matches yours.
5. In the Chart Generator section, click +Add Weight Range.
6. Enter the drug formula used to create your physical drug chart. If the formula is unknown, consult your veterinarian. If your protocol deviates from the formula, you will need to manually adjust those values on your draft chart.
7. If there are multiple formulas for each weight range, you can click +Add Weight Range. It is important that your weight ranges do not overlap, and that all weights down to a tenth of a decimal exist on your chart. If they do not, the system will have no value to reference and no suggestion will be displayed in Patient Flow.
8. Click Create Draft Drug Chart.
9. Review your chart and compare it to your physical chart. Make any adjustments as needed. These exact values are what will populate in Patient Flow, and Clinic HQ is not responsible for any errors or omissions in drug calculations.
10. If the values are correct, click Save Final Drug Chart at the bottom of the screen.

Note: If your drug chart has two different concentrations for different weight ranges, you will set up one chart for each concentration. For example, in the ASNA Protocol, we would set up a chart for Acepromazine 1mg/mL and one for Acepromazine 10 mg/mL. This creates two columns in Patient Flow and the dosage amount for their weight will show up in the corresponding column.

Complete these steps with each category of drug, entering the individual drugs in the order they are drawn.

Cat Protocols

1. Go to Drug Charts / Protocol Setup > Cat Protocol.
2. Select the drugs that apply to your clinic and complete with the same steps as dog protocols.

Since cats are often not given a pre-med, you may record your charts under the Induction section. When in Patient Flow, you will push the patient to the Drug Draw page, then draw up induction meds there.

Non-Standard Protocols

1. Go to Settings > Patient Flow Setup > Drug Charts / Protocol Setup
2. Under the Non-Standard Protocol section, Click +Add Protocol.
3. Enter the protocol name (e.g. Brachycephalic Protocol) and the species it is for.
4. If there is overlap from your standard protocol, click Copy From Standard Protocol and make adjustments as needed for this chart.

In Patient Flow, when you click on the animal's Drugs button rather than selecting Given, which would input the standard protocol, you can select the name of the non-standard protocol.

Setup and Manage Controlled Substances

Controlled Substance Bottle Setup

This process allows you to add controlled substance bottles to your drug log to meet compliance requirements. You will complete this setup during initial implementation and each time controlled drugs are received by the clinic.

Setup Preparation

• Have a complete list of all controlled substance bottles currently in your clinic.
• For new HQ clinics, plan to add bottles close to your go-live date to avoid outdated inventory in the system.

Step 1: Start your drug log for the day

1. If not started already, you will need to start your drug log to begin adding controlled bottles. From the Dashboard, go to Clients > Medical > Drug Logs.
2. Click Start Day.
3. Complete the Confirm Bottle Balances popup to move forward.

Step 2: Input your bottle inventory

1. Go to Settings > Patient Flow Setup > Setup Controlled Substances and Compounded Controlled Substances.
2. Click Setup Controlled Substances.
3. Find the drug you would like to work with and click Select.
4. Click Add New Batch of Bottles.
5. Fill in the lot number & expiration date for the lot.
6. Choose the number of bottles of this lot you are entering.
7. Select the amount per bottle. If the number is not available in the dropdown menu, type in the amount.
8. Type in the first bottle number you are entering.
9. Select the manufacturer. If you can't find the correct one fill out a help ticket to get it added.
10. You can include the invoice number if required by your state or if you would like that in your drug log.
11. Confirm your bottle details and have the veterinarian who oversaw this log initial in the Witness box.
12. Click Add Bottles Batch.

Compound Controlled Substance Bottle Setup

When you mix a compound controlled substance, you will need to create that new bottle in Clinic HQ and your drug log. To mix the bottle in Clinic HQ, you must know the amount of each individual drug, which individual bottle numbers were used, and the total volume of the new final bottle. You can only create one bottle at a time when setting up compound bottles.

1. Go to Settings > Patient Flow Setup > Setup and Manage Controlled Substances.
2. If this is the first time creating this compound click Setup Controlled Substances. Find your mixture in our list and Select. If you do not find the exact recipe in our database, open a help ticket to request it be added.
3. If you have previously created this compound, find it in your inventory list and click Manage.
4. Click Add New Batch of Bottles.
5. The Number in the upper left corner is your new compound bottle number. Verify that the prefix and number are correct.
6. Fill in the Amount with the total volume you mixed.
7. The amount of each individual drug used will be automatically calculated. Under the column Amount, verify the draw amounts are correct.
8. Under the column Bottles, notice the textbox and "Total" in bold. This is the total being pulled from the selected bottles. Verify the total pulled from the bottle is correct and the bottle number being drawn from is correct. If needed, open bottles to draw more. Sometimes you may need to go into a negative balance on a bottle or draw from more than one bottle. Use the textbox field to specify exactly how much you were truly able to pull from the selected bottle.
9. Click Save to create the new compound bottle and log the drugs used.

Bottle Inventory Management

Partially Used Bottles

When entering bottles for the first time, you may have an open and partially used bottle. Manage the drug you just entered and click the Edit pencil icon to adjust the remaining amount. Indicate how much is currently in that bottle.

Understanding Bottle Status

Closed = not used, still in inventory Open = in use Done = used up, nothing more to draw out

Automation Setup for Patient Flow

Automations

In Patient Flow, when an animal's services are completed, staff click the "Done" button. Here, you can enable the following automatic actions to occur when the animal is marked as done.

• Set the animal status to Checked Out
• Text clients to notify them their pet is out of surgery and when to pick up.
• Email take-home paperwork to clients
• Print take-home paperwork

If it is an anesthetic appointment, the automation will be triggered when clicking "Surgery Done" on the Surgery screen of PF. If it is a non-anesthetic visit, the automation will be triggered when clicking "Done" on the Treatment sheet tab for non-anesthetic PF.

Automation Filtering

Different automations can be set up for specific types of appointments. The following filters are available:

• Patient Flow Type: Anesthetic vs Non-Anesthetic
• Client Type: Public vs Volume
• Species: Dog, Cat, etc.
• Animal Type: Owned, Foster, Community Cat, etc.

Automation Setup

1. Go to Settings > Patient Flow Setup > Automations.
2. To create an automation, click +Add Rule button.
3. Enter a name for your automation.
4. Select which actions should occur in this setup.
5. Apply any appointment filters if necessary. If none are selected, the automation will be triggered for all appointment types.
6. Save your settings.

Text for Pickup

An automation can text public clients that their animal will be ready to be picked up in X number of minutes. For example, it can auto-text something like “Sam will be ready to be picked up in two hours” when you click the Done button. This automation supports staggered pickups, which we promote. This way, pets don’t have to be at the clinic any longer than necessary, and disaggregating pickups makes checkout less chaotic.

In order to use the text automations, your clinic must have Call & Text enabled. Learn how to set it up HERE. Learn how to set up your pickup text in Confirmations & Reminders HERE