Health care facilities should have clear policies to address all animals permitted in the facility. This may include therapy dogs, service animals, and facility dogs, where appropriate. Formal policies and procedures specifically for AAI and safety should be developed in collaboration with different departments and/or staff members with a stake or interest in the program, such as volunteer services, infection control, physicians, administrators, and nursing services. Therapy dogs should not be permitted to enter the health care facility without being enrolled in your AAI program. Please note that the recommendations in this chapter are included in the online downloadable template (docs.lib.purdue.edu/AAI) administrators can tailor to their facility.
•the purpose of the AAI program;
•dog and handler requirements for participating in the AAI program, including training, registration, renewal, retraining and reinstatement, and retirement; and
•AAI procedures, including areas approved for visitation, maximizing patient safety, proper sanitation, dog welfare, therapy dog identification, and handling adverse events.
For maximizing patient, staff, and AAI team safety, several basic policies and procedures are advised to supplement health care facility’s existing policies and procedures:
•AAI teams must be registered and currently enrolled in your facility’s AAI program to enter the health care facility.
•AAI teams will only visit patients in approved areas and not have contact with patients allergic to dogs or in isolation.
•AAI teams must adhere to all program policies and procedures set forth by the AAI program and health care facility or be excluded from participation.
•AAI teams must meet all health care facility requirements for volunteers.
•AAI teams may visit no longer than two hours per day with a break after one hour.
3.1Therapy Dog Evaluation and Testing
It is critical to require that appropriate evaluation and testing of any dog entering a health care facility take place before engaging in AAI. Evaluation of fitness and health of the dog, evaluation of the dog’s temperament, and testing of all control commands (e.g., sit, stay, come) should be completed. Relying on a reputable, external therapy animal organization to test and evaluate dogs for work in your health care facility provides external validation of a dog’s appropriateness for participating in AAI. However, these organizations vary in the rigor and comprehensiveness of their evaluation criteria. This chapter addresses the important evaluation criteria to consider in selecting an external therapy dog registration organization for an acute health care facility. Links to several external organizations that evaluate and register therapy dogs are provided in Additional Resources.
The registration group(s) that you select to meet initial requirements for participation in your AAI program should evaluate dogs and their handlers for appropriateness in health care facilities and emphasize behaviors to maximize safety of patients and staff. The evaluation must include screening for any sign of aggression by a dog as an indication that the dog is not appropriate for therapy dog work. Basic therapy dog control commands that registration organizations require are depicted in Table 1.
|Command||Command Description||Example Image of Command|
|“Sit”||Dog is instructed to place hindquarters on the floor.|
|“Stay”||Dog is instructed to remain stationary until released.|
|“Down”||Dog is instructed to lie down on the floor.|
|“Come”||Dog is instructed to immediately move in front of or next to the handler.|
|“Leave it”||Dog is instructed to ignore an interesting object such as food.|
|“Controlled walk”||Dog is able to walk next to handler in a “heel” position (the dog is walking directly in step with the handler’s heel) or on a leash (the leash is relaxed, indicating the dog is not pulling).|
Note: While present in the health care facility, the handler must always hold onto the leash.
For all health care settings, it is important for therapy dog evaluations to include the dog’s proper response to control commands in crowded areas, and with distractions such as food (see “Leave It,” Table 1). For everyone’s safety, the dog must consistently walk on a leash without pulling, walk on a leash through a crowd, and walk past other dogs and people without pulling on the leash. These control commands ensure that the dog is able to maneuver through the environment while avoiding potential hazards, and minimizing the chance of injury to patients, family, staff, and visitors in the facility. Control commands also ensure that in an emergency situation, handlers can maintain control over their dogs safely and effectively.
Temperament testing is an important measure of a dog’s appropriateness for participation in AAI. Situations specific to your health care facility should be tested. For example, a dog must tolerate “clumsy petting” like that received during interactions with patients with limited dexterity. A dog must tolerate “rough embraces,” such as those potentially offered when greeted by an excited young child. Additionally a dog must be able to react calmly to wheelchairs, walkers, canes, and medical equipment commonly encountered in a health care facility. Reactions to these scenarios can shed light on the dog’s fitness to participate in AAI in your health care environment. Testing should include watching the dog’s reaction to novel stimuli: how the dog reacts to loud noises and how the dog reacts to greeting and meeting strangers. Some tests may include the opening and closing of an umbrella, or rattling a metal bucket, to assess response to novel visual and auditory stimuli. How well a dog reacts to these scenarios can help to predict their reactions to the many novel stimuli they will inevitably encounter in a health care facility.
Equally important, the evaluation must also include the behavior of the therapy dog handler and the interaction between dog and handler. Handlers must be constantly attentive to their dogs, communicate clearly and appropriately (e.g., not harshly) with their dogs, maintain constant control over their dogs, and monitor their dogs’ needs and well-being.
All team handlers participating in AAI should fulfill the requirements of a volunteer working in your health care facility. AAI programs should work closely with the designated office that oversees volunteer activities in order to comply with rules and regulations applied to volunteers. At a minimum, volunteers should complete the following items (see Table 2) in order to participate in an AAI program.
|Human vaccinations||Individuals should be up to date on all vaccinations recommended by the health care facility (e.g., Varicella, Tdap, MMR, Hepatitis B, Meningococcal, Influenza).|
|Orientation||Individuals should complete orientation to the facility. This orientation should provide an overview of the facility and visitation areas.|
|Patient confidentiality||Individuals should complete training in HIPAA.*|
|Background check||Individuals should submit to and pass a background check. Those who fail a criminal background check should be excluded from participation.|
|Human health||Individuals cannot volunteer when ill with potentially communicable diseases.|
*Health Insurance Portability and Accountability Act of 1996.
3.3Orientation and Training of AAI Teams
After AAI teams have met all program entry requirements, orientation to your health care facility and facility-specific training will increase the likelihood of successful visitation and retention of AAI teams. While both the human (through a designated volunteer services office at the health care facility) and the dog (through a therapy animal registration organization) have likely received instruction on interacting as an AAI team and volunteering in a health care facility, orientation is important in order to familiarize them to your particular facility and the areas approved for AAI.
An AAI program manual, such as the online downloadable template (docs.lib.purdue.edu/AAI) available with this manual, with all rules, regulations, policies, and procedures should be provided to each AAI team upon admission to your program. This manual should be updated as program revisions are made, and all teams made aware of any changes in policy and procedures immediately.
Shadowing, or following an experienced AAI team visiting a patient at the facility, is recommended as an important component of orienting new AAI teams (see Figure 5). Shadowing without their own therapy dog provides new handlers with an opportunity to become familiar with the facility and observe how AAI is conducted at your particular facility. It can also be an opportunity to ask questions and address any confusion before the new handler is in the environment with his or her own dog. Shadowing shows the new handler how AAI program policies and procedures are implemented, providing a real-life demonstration of AAI to facilitate skill building, comfort, and safety in your health care facility.