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Practice Management

Bringing the Best of In-Home Euthanasia Into Your Clinic

by Dani McVety, DVM
    Old dog

    As veterinarians, we often have the honor of seeing our patients from cradle to grave. We also have two separate parties to please: the client and the patient. We usually know how to please the patient, but the client is another matter, especially when it comes to euthanasia. Just as there are specialists in advanced clinical medicine, there is a unique group of veterinarians who have limited their practice to in-home euthanasia. Although there is no diplomate accreditation for veterinary end-of-life care, these doctors have become incredibly specialized in the art of saying good-bye in the home. Everything from explaining the euthanasia process to accepting payment is elaborately and meticulously rehearsed. These vets fight fear and anxiety in clients and their pets with kind words and gentle gestures. You may not be able to provide a unique experience for each of your end-of-life patients, but incorporating some of the following ideas may help make this time a bit easier for everyone involved.

    Location, Location, Location

    A euthanasia experience that is anything less than absolutely perfect is a business risk, and, unfortunately, some aspects of the clinic setting make this risk greater. I have heard families recount having to walk through the lobby of the clinic crying or getting back in their car without their beloved pet. No matter how you decorate your Comfort Room with soft lighting, padded blankets, or pretty pictures, there’s no getting around the fact that it is in a hospital. Why is this important? In a survey conducted by Lap of Love Veterinary Hospice, almost 25% of owners who experienced an in-hospital euthanasia said that they would not return to that clinic (either because they found it too sad or because the experience was a bad one). In the same survey, 38% of owners who experienced in-hospital euthanasia said that having the procedure performed at home would have helped them cope with the loss of their pet.

    So if you can’t leave the clinic premises, how can you make clients feel more “at home” and reduce any negative associations with your hospital? Consider taking the experience outside, perhaps to an area secluded by bushes or a memorial garden with a fountain. Creating such a space would be an inexpensive improvement to your facility and a way to show clients how much you care. At minimum, offer to come to a client’s car for a large, recumbent animal that will be given a home burial. If inadequate venous access is a concern, consider that many patients pose greater challenges in this respect—I have seen technicians place IV catheters in 2-week-old, dehydrated kittens. Give yourself and your staff credit for your skills, and don’t let fear keep you from providing a service that can increase both your patients’ and your clients’ comfort.

    If you do offer euthanasia in a nonclinical setting, having an easily portable supply bag with extra butterfly catheters, additional drugs, flush, a tourniquet, and even a few muzzles ready at all times helps make the procedure simple and easy. Refrain from taking a stretcher or basket out for removal of the body until after the pet is passed, as the sight of these objects while the pet is still alive can be difficult for the client.

    Talking to Clients

    At such an emotional time, owners may be angry, spiteful, rude, and irrational. Handling the situation with care, compassion, and empathy, even when speaking on the phone, is the first step and certainly the most important. Speaking concisely, slowly, and as gently as possible helps convey your empathy.

    Before. For a scheduled euthanasia, clients should be admitted to the exam room quickly. Preferably, staff should be aware of the appointment and meet clients at their car to assist with the pet or to simply provide moral support. All the paperwork should be prepared and completely filled out ahead of time, even with the date, and ready for the client’s signature. For private cremations, provide one nice, standard urn instead of asking distraught owners to make a decision in a time of crisis. After choosing an urn at such a difficult time, some owners report feeling stressed and anguished when looking at it later. If clients are interested in a custom urn, they will ask.

    Billing. This requires finesse. Most in-home euthanasia veterinarians rarely talk about billing or pricing unless the client specifically asks. Normally, we ask, “Do you have any questions about fees or anything else?” This gives the client an opportunity to ask about money without feeling awkward. Each housecall veterinarian also has his or her own way of presenting the invoice, such as washing hands or preparing the body after giving the invoice to the client, thereby giving the client some space and privacy. Many clients choose to mail a check, which is rarely abused under the circumstances. If you are a general practitioner who charges for euthanasia (some do not for regular clients), offer to mail the bill. However, this is rarely possible in emergency facilities or for owners who are not established clients. To lessen the “please pay now” appearance, the doctor should enter the exam room, explain the process, and ask if there are any questions or concerns before the client is asked to sign anything. Then the prepared paperwork can be presented to the client for a signature, and payment can be handled with the client in the room. This approach adds value to your service before any financial discussion takes place. The goal is for clients to feel confident that you care first and foremost about the comfort of their pet.

    Explanation. Before the euthanasia, owners need a brief description of the process. Every veterinarian has his or her own presentation of the euthanasia process. Keeping it simple is always best. Describing the sedation and euthanasia injections as you might describe vaccinations and IV fluid administration can help alleviate some of the tension by giving the client familiar, “normal” images of what you will be doing. I sometimes describe a Telazol sedation injection as a “kitty tequila”: it may sting for a second, but it will feel warm and fuzzy in a few minutes! Reassure the client that the euthanasia injection is simply a large overdose of anesthesia that will allow the pet to pass away peacefully in its sleep. Many clients believe euthanasia stops the heart like a heart attack, and we know heart attacks are painful in humans, so this is a misconception that should be corrected to alleviate any concerns.



    “Doctor, how will I know it’s time?” Dr. McVety gives clients her answer to this common question. Read it here.



    Whether to give a detailed explanation of the possible negative effects occasionally seen with euthanasia is a personal preference. Many in-home euthanasia veterinarians have found that too much information causes anxiety and prevents the owners from seeing the procedure as anything but perfectly peaceful. Others prefer to give clients a complete picture of possible events so that they are prepared for those possibilities. In my own experience, with the use of heavy sedation, the occurrence rate of stretching, agonal breaths (hiccups), or muscle twitching is less than 5%. If these reactions happen, I explain them to the owner. A clear, calm voice goes a long way.

    Awkward silences. While waiting for the sedative to take effect, small conversation can be started if appropriate. Try to keep the conversation around happy memories of the pet. If you didn’t know the pet well, ask what he or she was like in younger years, what funny things he or she did, or where the client came up with an unusual name. This usually lightens the mood and helps the owner remember the good times. When you are ready to move to the next step, always ask the family, “Are you ready?”

    After. After the euthanasia, choose your words carefully. This is usually a very emotional time, and many owners do not want to talk. Many in-home euthanasia veterinarians use words like “He has transitioned” or “She is at peace now” to notify the family of the pet’s passing.

    It has been shown time and again that physical touch increases good will, and this moment is no exception. If appropriate, gently touch the owner on the elbow or back (the most neutral areas) to let them know you care. Many of us also make it a point to touch the pet, usually on the head. Clients appreciate proof that we care.

    When removing the pet from its home for cremation, in-home euthanasia veterinarians have a flat stretcher for large dogs and a basket for smaller pets. Wrapping the pet in a blanket before transportation improves the client’s last memory of his or her beloved animal. In the clinic, removing the pet from the exam room in a dedicated basket and blanket (we use blankets with paw prints on them) would be much nicer than simply wrapping the body in an old towel. When appropriate, removing a large dog on a pet stretcher covered with a blanket (available from any veterinary supply source) can also show your dedication to the pet. Remember to give clients as much time as they need. This is usually the most difficult time for them.

    Some clients may wish to consult a grief counselor after the passing of their pet. Human hospices often have great resources for dealing with grief. You may wish to consider asking local hospice services for their assistance in providing information for grieving clients.

    Keepsakes

    You don’t have to spend $8 to $18 each on clay paw prints for your clients. Worse yet, giving clients the option to buy one may be seen as too much marketing. You should provide some kind of remembrance token without asking. Craft stores sell several kinds of air-dry clays that cost about $1 for each paw print. The print can be placed in a plastic, sealable sandwich bag to give to the client. You can also save the small amount of fur you clipped for venous access in another small bag. At Lap of Love, we also provide a pet-loss booklet we developed. In the book are some wonderful poems, information about grief, and some articles about canine and feline grief. There is also a space to write the pet’s name and date of passing and a list of local shelters that could use any donations of pet items families no longer wish to keep.

    Follow-Up

    A sympathy card is essential. At Lap of Love, we also make condolence calls 7 to 10 days after the euthanasia and send families an e-mail a month later to let them know we’re thinking about them. In addition, all families receive a year-out card, sent about 360 days after the passing of their pet.

    Dr. McVety is a founder of Lap of Love Veterinary Hospice and In Home Euthanasia.

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    These Care Guides are written to help your clients understand common conditions. They are formatted to print and give to your clients for their information.

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