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pg01 Peartree Impressions | Euthanasia Protocol Guide

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2 Euthanasia Protocol GuideClinic Resources


as a retired veterinarian, I know that some of the most challenging

moments in a practice occur around the proce-

dure of euthanizing an animal. It’s an emotional

experience for the pet owner, of course, but it’s

also a challenging and stressful time for veterinary

care providers — a time when all team members

can benefit from situational training and client

communication guidelines. That’s why I created

this tool to assist veterinarians in developing a

euthanasia protocol for their practice.

Over my 27 years as a companion animal veteri-

narian, I have seen the benefits of carefully

defined and consistently followed euthanasia

protocols. I encourage all veterinary medicine

practitioners to create clear processes and

communication strategies around life’s ending

procedures for animals. These processes can

include roles for specific staff members,

agreed-upon talking points for addressing the

most sensitive issues, directives for how clients

can participate in the procedure, the provision

of memorial keepsakes and more.

In my practice, we provided a quality memorial

keepsake to all clients who had lost a pet.

Presenting them with this gift gave us the oppor-

tunity to a) provide a measure of comfort at a

difficult time, b) show clients that we under-

stand the special bond they shared with their

pet and c) begin the healing process after the

death of a loved companion. Over the years, I

found incorporating memorial keepsakes into

our clinic’s euthanasia protocol to be one of

our most effective practice-building tools.

This euthanasia protocol guide is based on

research from national veterinary associations,

as well as from insight gleaned through my

personal experience. My hope is that it will

cultivate dialogue and make a lasting contribu-

tion to the veterinary profession.

Dr. Brent Humphrey, BSA (Honors); DVM

“As a companion animal veterinarian and practice owner for 27 years, I understand and appreciate the value of your

animal care team and the demands of a busy practice.”

Dr. Brent Humphrey, BSA (Honors); DVM


why develop a euthanasia protocol at your practice?

Your veterinary team works hard to build rela-

tionships with clients throughout their pet’s life.

Through preventative care, procedures and

consultations, your team builds a bond of trust

with clients.

Perhaps the most critical opportunity to enhance

that trust is around end-of-life procedures for

pets. Years spent building a strong rapport with

a client can be irreparably damaged if a euthanasia

process is mishandled. Damage of which your

practice may never become aware.

This is one of a number of reasons why it is

imperative to create a well thought out and

well-documented euthanasia protocol to ensure

a consistent, high level of care throughout

end-of-life procedures.

Research shows that end-of-life procedures at veterinary practices are critical for a variety of reasons. Here are three key reasons why your clinic should consider developing and implementing a Euthanasia Protocol:

Animal compassion:The veterinarian has no greater role and obliga-

tion than to prevent animal suffering and to

provide a humane euthanasia when all viable

alternatives have been exhausted. It’s a critical

element of our work as veterinary care providers.

“A good death as a matter of humane tech-

nique: When the decision has been made to

euthanize and the goal is to minimize pain,

distress, and negative effect to the animal,

the humaneness of the technique (ie, how

we bring about the death of animals) is also

an important ethical issue. As veterinarians

and human beings it is our responsibility to

ensure that if an animal’s life is to be taken,


it is done with the highest degree of respect,

and with an emphasis on making the death

as painless and distress-free as possible.”

— American Veterinary Medical Association, Guidelines for the Euthanasia of Animals, 2013

Client relationships:End-of-life is part of life’s journey. Sadly —

at some point — owners and veterinary care

providers will need to discuss the euthanasia

procedure that completes a pet’s life journey.

Well-managed practices should have clear

protocols, established communications

practices, and trained staff to support clients

and patients through this process.

Almost 87% of clients who have had to

euthanize a pet reported a positive correlation

between support from the veterinarian and

staff and their ability to handle the grief

associated with their pet’s death.

— American Veterinary Medical Association, Guidelines for the Euthanasia of Animals, 2013.

Staff support:Veterinary care providers become attached to

patients and pet owners. Being involved in

end-of-life care can be stressful and emotionally

taxing. A sound euthanasia protocol can help

care providers navigate these difficult times,

reducing the emotional burnout or compassion

fatigue that can come along with this situation.

These are important factors in the morale of

the healthcare team.

Studies report that veterinarians and practice

team members are present at the death of

patients five-times more often than other

health care professionals…Many veterinary

team members experience stress as a result

of supporting pet owners through the death

of a pet.

— Shaw, Lagoni, “End-of-Life Communication in Veterinary Medicine,” Veterinary Clinics: Small Animal Practice, 2007.


“Almost 87% of clients who have had to euthanize a pet reported a positive correlation between support from the veterinarian and staff and their ability to handle the grief

associated with their pet’s death.”

American Veterinary Medical Association,

Guidelines for the Euthanasia of Animals, 2013


what is a Euthanasia Protocol?

Euthanasia is a single procedure that induces a

humane death in animals. A euthanasia protocol

is a document that addresses methods and

communication for the entire end-of-life care

journey. That journey begins the moment your

veterinary team opens the lines of communica-

tion on this subject with a client. A euthanasia

protocol can address:

• staff roles and responsibilities

• discussions about euthanasia with client/

assessing pet quality of life

• procedures for scheduling euthanasia

appointments

• procedures for payment and paperwork

• preparing veterinary team members

• discussing the euthanasia process and body

care options

• the steps in the actual euthanasia procedure

• providing grief support information and

resources

• follow up: memorial keepsakes, sympathy

cards, checking in


Points to consider when building your euthanasia protocol:

• Discussing a euthanasia protocol with your team

can be an opportunity to engage support staff to

take on responsibilities that don’t require direct

veterinary involvement.

• Discuss with your team members where any

miscommunication and weaknesses have

occurred. Encourage and anticipate an honest,

open and perhaps emotional dialogue.

• Explore how your approach with an established

client will differ from the approach towards a

newly enquiring pet owner.

• Expect that the challenges your team explores

through the process will help to minimize future

client conflict and miscommunication.

• Foster an ongoing dialogue with team members

to ensure your euthanasia protocol is refined,

up-to-date and relevant. This process can evolve

successfully through regular staff meetings.

• Know that the euthanasia protocol will be

an important tool for existing staff and an

invaluable resource for new team members.

Three approaches to end-of-life care: What category identifies your current practice euthanasia procedure?

category ❶In category 1 practices, the veterinarian

handles most of the client relations

regarding the euthanasia procedure including

the medical consultation, discussion of the

euthanasia procedure, pet’s remains, keep-

sakes and estimate preparation. Support

staff primarily deal with invoicing and act

on information or direction provided by

the veterinarian.

These practices may be short-staffed or the

practice owners have made a conscious deci-

sion to limit the use of support staff to front-end

duties and technical responsibilities.


category ❷ Category two practices take a team approach

to client interactions around end-of-life care

but have no set protocol in place. The result

is an inconsistent, improvised methodology

with unclear staff responsibilities and vari-

able results.

This practice model can easily lead to miscom-

munication between team members and a less

productive, less pleasant clinic atmosphere.

Critically, it can create more stress for clients

during an already stressful time and erode the

veterinary care/client relationship.

category ❸ Category three practices use a thoughtful,

well-documented euthanasia protocol and a

team approach to end-of-life care for animals.

The veterinarian’s involvement is primarily to

discuss, through consultation, the medical

“why’s” and the euthanasia “how’s.” Team

members have clearly defined roles with

respect to patients and clients and are well

versed in talking points and procedures

regarding the handling of pet remains and

keepsake choices; preparing and handling

estimates and invoices and more.

This practice recognizes the value of written

protocols to minimize communication pitfalls

and related stress while enriching client and

patient care. It also maximizes staff potential,

creating team bonding, potentially increasing

clinic efficiency and profitability. The result of

this approach is practice building.

Being involved in end-of-life care can be stressful and emotionally taxing. A sound euthanasia protocol can help care providers navigate these difficult times, reducing the emotional burnout or compassion fatigue that can come along with this situation. These are important factors in the morale of the healthcare team.


how to implement an euthanasia protocol at your practice.

Start by looking at how end-of-life procedures are currently handled in your practice. Here are some questions to consider as you do this:

❶ How does your euthanasia process make your team members feel?

Discover what works and what does not. This

process is not a critique of personnel, but rather

creates dialogue to express which components

of the communication/client interaction are

working and which are not. This frank discussion

will allow you to evaluate what issues need to

be addressed to reduce circumstantial stresses.

❷ What training has your staff received regarding euthanasia communications with clients?

This training could have been within your

practice or from previous experience. Is this

level of training sufficient? Does it need to

be supplemented?

❸ What team members are best suited to handle this stressful client/patient interaction?

Identify team members who are empathetic,

have strong coping abilities and the communi-

cations skills to deal effectively with the

circumstance.

❹ How does client/staff communication differ between established clientele and new clients?

New clients may not be as well-bonded with

your practice. How does your practice address

this challenge in its euthanasia procedures?


❺ Has your practice determined all costs and labour associated with its pet end-of-life care? Consider if the following labour costs are accounted for:

• time spent booking the euthanasia appointment

• time spent reviewing and processing final

payment for the procedure

• time spent in advance of the appointment

preparing the client and discussing the details

of the euthanasia procedure.

• time spent discussing the handling of the pet

remains

• time spent presenting and selecting memorial

keepsakes

Next, establish and list all of your hard costs for

this procedure. These can include pharmaceuti-

cals, hospital supplies, cremation services

(based on weight), burial services and memorial

keepsakes.

Once you calculate the labour and hard costs,

compare them to your current fee schedule to

determine if your fees are adequate.

❻ Should we offer memorial keepsakes?

The North American Veterinary Community

(NAVC) recommends providing a clay paw print

as part of your practice’s euthanasia protocol.

“The paw print is the most traditional and cher-

ished memorial item—sometimes even more

than cremains.” Offering a quality clay paw print

can be a practice-building custom for your clinic;

one that offers comfort to a grieving pet owner

and nurtures your client relationships. Pet

owners may not be familiar with all the memorial

choices your practice offers. It is important that

these products and services are presented

consistently in a caring and professional manner

prior to the euthanasia procedure.


“A companion animal practice that gains a reputation for providing EOL (end-of-life) care in a skillful, compassionate

way will retain clients and gain referrals as a result.”

AAHA and IAAHPC 2016 End-of-Life Care Guidelines


protocol preparation checklist.

Booking the appointment:

• Take into account the time required for the

procedure as well as the time needed to

comfort the client afterward. Don’t double

book your euthanasia room or team members.

• Offer a pre-euthanasia discussion with an

Animal Health Technologist.

• Ask if the family wants to be present for the

actual procedure.

• Determine how they wish to handle the pet’s

remains.

• Present the options for memorial keepsakes.

• If cost information is requested, provide a price

range. Actual costs will depend on their wishes

for the pet’s remains. Let them know that more

specific details will be provided during the

pre-euthanasia discussion.

Team communication prior to appointment:

• Make sure all team members are prepared

to provide recommendations and information

to the pet owner.

• Prepare a euthanasia package containing

up-to-date authorization documents, procedure

forms and information. Include promotional

information regarding the handling of remains

and keepsakes so the pet owner can make an

informed decision.

• Ensure that costs to be discussed with the

pet owner are already entered in the computer

ready for adjustment as decisions are being

made by the pet owner.

Welcoming the pet and pet owner:

• Ensure that the exam room or comfort room

is ready so the clients don’t have to wait in the

reception area.


• If reception staff are busy with other clients,

ensure another team member is available to

escort them immediately.

• Prior to the procedure, ensure the clients know

which staff members will be working with them

through this process.

The pre-euthanasia discussion:

• Have the team member introduce themselves

and explain the sequence of events and what

to expect from the actual procedure.

• If catheterizing the pet, explain what is going to

happen and take the pet to the treatment area.

Be sure to remind the clients that the pet will

be returning shortly. Keep the clients updated

if there is any delay.

• Always keep the clients informed about what

is happening with their pet.

• Go over the paperwork carefully and ensure

that the clients understand what they are

signing and why. Emotions are running high

and misunderstandings can occur — keep

communication simple at this point.

• Discuss the pet remains. Determine if the

clients want a home burial, general cremation

or private cremation? If private cremation is

requested, allow time for the client to choose

an urn from your crematoriums brochure.

• Discuss belongings. Does the client wish to

keep their pet’s collar/leash / blanket, etc?

• Offer memorial keepsakes such as clay paw

prints. Remember to show a sample so that

the client understands what is available to them.

If there are colour or product choices to be

made for this, make them now.

• It is a good idea to check name spellings at this

point. It can prevent disappointment when the

ashes or an impression are returned to the pet

owner later.

• Complete the invoice and discuss the payment

method. It is easier to do this while the pet is

out of the room.


The euthanasia procedure:

• The sedated pet is returned to the room.

Remind the client of the effects of the sedation.

• Offer to keep the client company until the

veterinarian comes.

• The veterinarian arrives and answers any final

questions for the pet owner.

• The veterinarian explains the what to expect

from each procedure before beginning the

process.

• If the pet owner does not wish to be present

for the final procedure, administering the pre-

euthanasia sedation at this point will afford

them time to say goodbye. At this point, the

veterinarian may take the time to assure them

that they made the right decision and to

express their own sorrow over the loss of the

pet. This is particularly important for established

clients to hear.

• If the family chooses to be present and is ready

to proceed, the procedure should be handled

quickly but compassionately, with little or no

time between the administration of the drugs.

• The veterinarian calmly, quietly explains the

procedures as they happen and describes

the effects of any drugs administered. This

helps the client to understand that things are

happening as they should and provides the

opportunity to focus on their pet.

• Time is now taken to check for a heartbeat

and pronounce the pet is dead.

• At this point, the veterinarian may take the time

to assure the client that they made the right

decision and to express their own sorrow over

the loss of the pet. This is particularly important

for established clients to hear.

• Some veterinary care providers provide a sheet

detailing grief support resources such as books,

articles, websites, support groups, and, in some

cases, referral to a counseling professional.


Post euthanasia care

• Allow the client time to grieve and say goodbye

to their pet.

• Ensure that when the family is ready to leave,

the appropriate team member stays with the

pet. Clients often look back as they leave and

they are comforted knowing that the pet will

be cared for by a friendly and compassionate

person even after they have left the clinic.

• Sending condolences to the family should be

done as soon as possible.

• Use a form or checklist signed by staff

members to ensure protocols are followed

and the client’s wishes are honoured regarding

handling of the pet remains and keepsakes.

Especially during busy times, it is important

to have fail-safes in place.

• Having a designated team member look after

these final matters is also an effective way of

dealing with the pet remains and keepsakes,

as long as another team member is trained to

take over during vacation or sick days.

conclusion.End-of-life care is a complex, multi-pronged

responsibility for veterinary care providers.

The primary roles are to maximize the animal/

patient’s comfort and to minimize its suffering.

A secondary, but significant challenge is to

provide support to the pet owner/client. The

most effective way to address this challenging

responsibility is to follow a coordinated plan of

action. By implementing a euthanasia protocol

that addresses roles and responsibilities,

procedures, memorial gifts and communication,

your veterinary care team is better able to

provide the care and compassion needed by

both patient and client at this difficult time.

“A companion animal practice that gains a

reputation for providing EOL (end-of-life)

care in a skillful, compassionate way will

retain clients and gain referrals as a result.”

End-of-Life Care Guidelines, 2016, American Animal Hospital Association and the International Association for Animal Hospice and Palliative Care

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