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pg01 Peartree Impressions | Euthanasia Protocol Guide
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2 Euthanasia Protocol GuideClinic Resources
pg02 Peartree Impressions | Euthanasia Protocol Guide
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
pg03 Peartree Impressions | Euthanasia Protocol Guide
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,
pg04 Peartree Impressions | Euthanasia Protocol Guide
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.
pg05 Peartree Impressions | Euthanasia Protocol Guide
“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
pg06 Peartree Impressions | Euthanasia Protocol Guide
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
pg07 Peartree Impressions | Euthanasia Protocol Guide
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.
pg08 Peartree Impressions | Euthanasia Protocol Guide
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.
pg09 Peartree Impressions | Euthanasia Protocol Guide
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?
pg10 Peartree Impressions | Euthanasia Protocol Guide
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.
pg11 Peartree Impressions | Euthanasia Protocol Guide
“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
pg12 Peartree Impressions | Euthanasia Protocol Guide
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.
pg13 Peartree Impressions | Euthanasia Protocol Guide
• 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.
pg14 Peartree Impressions | Euthanasia Protocol Guide
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.
pg15 Peartree Impressions | Euthanasia Protocol Guide
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