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One treat does not fit all

Documentation of positive reinforcers to the veterinary visit

In my previous article, I wrote about how to use rewards during the veterinary visit be less fearful at your clinic.  If you use these techniques at your clinic – good for you and your staff!  You are a part of a growing movement to lessen the stress on animals during examination and treatment.  I call this approach to practice the “gentle doctor and technician” exam.

Your staff is ready and willing to accommodate the various needs of a pet to help achieve the least stressful exam.  Animals are handled with patience and care.  The technicians and doctors are able to recognize the mental state of the pet by the body language that pet is displaying.  Dogs and cats are no longer petrified of exam tables, or waiting areas.  Your staff is likely feeling good about their job, and your clients are happier.  Now, how do you remember what reward worked best for each patient? Does that really matter? 

One of the best ways to shape behavior is to have consistent handling, rewarding and staff interactions with the pets.  Of course there may be a different ability of one technician to do “jolly talk” compared to another.  If both workers know to use “jolly talk” on a particular patient that likes that, then that patient will behave better for both workers.  If a tech tries to reward with food treats, and does not know about “jolly talk”, then this pet will be anxious and possibly backslide on learning that the veterinary clinic is not all bad. Every pet will have a preference for certain rewards, especially liking some treats or places for exam much better than others.  One treat does not fit all pets!  I am sure you have seen that in your own pets so we need to remember and use that reward preference to help us in our work.  Documentation of rewards for a particular patient is one way to provide consistent exam experiences no matter what staff members are performing the exams.

Documentation of rewards for a pet is not enough though, to really match up procedure and reward.  There needs to be a way to score or rate how motivating a reward is to the pet.  Many veterinarians are familiar with scoring systems used for pain or body condition.  These accepted scoring systems have helped veterinary staff know what is being described from one vet to another.  A scoring system for acceptance of a reward helps refine the documentation of rewards.  Now you will know what works for this pet during this exam.  This is one of the most efficient ways to get the best behavior from your patients and knock the socks off your clients at the same time!

Great, now how do you do all this?  The Bella Behavior Label System was developed to provide both a quick way to record the rewards for exams as well as score the reinforcer.   Having an established system for documenting and scoring the reinforcers on the medical record  will insure the consistency in handling your patients need.  The rewards are right there for all to see!  The staff does not have to figure out rewards every time the pet comes in.  I developed this system after presenting “Documentation and Scoring System of Food and Praise Drive as Positive Reinforcer to the Veterinary Visit” to the American Veterinary Society of Animal Behavior in Atlanta July 2010. 

The Bella Behavior Label System (pat. Pend)

The system:

A  label is pre printed with categories of reward choices, place of exam and any other modifiers that help decrease anxiety in the patient.  Unscored labels are placed on the summary sheet of the medical record to be scored at the exam.  New labels can be placed over old ones as reinforcers change.  There is extra space available for notes – what special situations take certain reinforcers.  Posting the label in an obvious place for the staff to see will help insure consistent handling by the staff. 

The scoring system:

Food motivation
(-)           animal will not accept the treat
(+)          animal will take treat after 2-4 attempts                f sniffing or mouthing
(++)       animal will take treat after 2 attempts of sniffing or mouthing
(+++)     animal will take treat after first offer
(++++)  animal will seek treat and readily take treat
No mark means that item was not evaluated

Verbal/physical praise
(+)          fearful body language is reduced slightly
(++)       fearful body language is significantly reduced and stays reduced
(+++)     Animal shows relaxed body language and stays relaxed
(++++)  animal shows relaxed body language and seeks attention and praise/petting
(-)           animal increases body tension or shows other anxious response

Scoring place of exam
Technician will note fear or relaxation stat of the animal when on the floor/table/in arms/or other place for exam.  Just one + and – are used here because it is difficult to evaluate the degree of motivation placed alone has.
(-)           increased or most fearful body language
(+)          reduction of fearful body language

Use of DAP and Feliway ( CEVA Labs) as modifiers
Technician will  note anxiety level of the patient and spray DAP or Feliway  as appropriate and note the response
(-)           fear or tension increases with use
(+)          fear or tension decreases with use

Using the system

Technicians will offer high ranking, appropriate rewards as they greet, weigh and escort the patient to the exam room. Food rewards, verbal/physical praise are offered and the response of the patient is noted.  Actual scoring can be determined after a few attempts of various rewards and giving some  time for the pet to acclimate to the exam room.  DAP and Feliway are used as needed to help calm a tense animal.  The responses are noted according to the scoring system on the label attached to the medical record.  The veterinarian also follows the recorded rewards to help positively condition the patient to the doctor.

Example of scoring a patient

Bella’s nail trim

Bella, the beagle, is eagerly seeking the chewie treats in my hand as she is rewarded for standing on the exam table. According to the owner, Bella hates having her nails trimmed, and this is her first time at our office for nail trims.  She is neither aggressive nor tense about the table, me or the exam room.

Bella is not taking the chewie treats as I start the nail trim.  She is pulling her body away, and looking sideways at my hand and beginning to tense her body.

Peanut butter was immediately offered which she gobbled right up as I proceeded with the nail trim. You can see she is standing on the table, not pulling away from me and focused on the highly motivating reward. 

Bella’s label was scored a 4 + for both peanut butter and chewie treats.  It was noted that peanut butter was best for nails. 

Establishing a scoring system allows the staff to know the hierarchy of rewards for that patient.  Now the staff can offer the most desired reinforce for the most difficult exam because they know the “score”. A universal scoring system allows the same “language” for all staff to use.  This common language facilitates consistency with various staff for handling and treatment.

Learn more about rewarding during the exam, and using the labels system to have your staff efficiently incorporate these methods into your patient exams.  Impromed will be offering a 3 part webinar beginning March 31 through April 14.  Go to to sign up.

Sally J Foote, DVM  CFBC-IAABC
Okaw Veterinary Clinic Tuscola IL

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