Pre-visit sedation can be extremely beneficial for fearful, anxious or aggressive pets. A successful sedation and analgesia program has many critical components, from ensuring the veterinary team understands the chosen messaging to customizing the protocol for each patient to encouraging client administration of medication before check-in.
Tasha McNerney, a certified veterinary technician specializing in anesthesia, said the process should involve the entire team, including client service representatives, technicians, assistants, veterinarians, and kennel and grooming staff.
EDITOR’S NOTE
This is the second in a three-part series on using sedation and analgesics to improve veterinary care and boost the bottom line. This Clinic Consult series is brought to you by Dechra.
“Once everyone is trained on recognizing signs of stress and anxiety, we can communicate these concepts better to owners and advocate for pre-visit sedation or sedation,” she said.
Defining Your Philosophy
The foundation for a pre-visit sedation program involves evaluating your hospital’s layout, staff, clients and patients. Sedation won’t be effective if your team members don’t react calmly when they recognize stress signs in pets. In addition, your clients must understand the advantages of pet sedation; otherwise, they might not be receptive to your suggestions.
Strategies for a successful sedation and analgesia program include:
- Explain to clients the reasons for and the elements of pre-visit sedation.
- Ensure team members are well-versed in the information they provide so that all pet owners hear a consistent message.
- Educate team members on how a stressed, anxious patient presents and how they should respond.
- Encourage a team member who is especially good with problem pets to help handle your most challenging patients.
- Have clients perform a trial run before a scheduled visit so you know the medication’s effect on the pet and so the client is prepared for the pet’s reaction.
- Reassure clients that a pet’s sleepy response is normal.
- Ensure that patient records clearly show the medication, dose and effect so you can adjust the dose the next time, if necessary.
- Advise clients to keep their pets in a safe, quiet spot at home until the sedative wears off.
How the Team Benefits
For team members, pre-visit sedation can lead to:
- Reduced injury risk: Frightened, stressed pets often become aggressive and bite or scratch anyone restraining them. Pre-visit sedation helps mitigate the problem and reduces workers’ compensation claims.
- Improved efficiency: Controlling an aggressive or fearful patient might require several team members, but minimal restraint is needed when a pet is adequately sedated.
- Better morale: Team members don’t like wrestling with patients. Morale rises when they can successfully examine a pet, perform diagnostics and administer treatments.
“Sedation forms the cornerstone of low-stress handling for pets, offering a humane solution that mitigates anxiety and facilitates smoother veterinary procedures for everyone involved,” McNerney said.
Determining Pre-Visit Protocols
Dr. Alicia Karas, a veterinarian with Tufts Veterinary Emergency Treatment and Specialties, said tailoring pre-visit sedation isn’t all that different from a custom anesthesia protocol.
“We as veterinarians need to avoid one-size-fits-all protocols because our patients vary in size, shape and age,” she said.
When devising a pre-visit sedation protocol, consider the patient’s American Society of Anesthesiologists (ASA) status, including their signalment and any concurrent diseases. (Learn more at bit.ly/3Me40Lk.) Young and middle-aged patients generally tolerate higher sedation doses, while senior pets are more sensitive to many medications.
Also, consider how a patient’s breed, demeanor and health status might impact the prescribed dose. For example, extremely stressed patients will likely need a higher dose at home or injectable sedation in the exam room. Brachycephalic or airway-impaired pets should be sedated because panic inhibits their breathing ability.
Include clients in the decision making to confirm they are physically able to medicate and handle the pet. For example, the owner of a heavily sedated large dog might have difficulty getting the patient into and out of a car.
Remember that anxiety and fear can exacerbate a pet’s pain response, so include analgesia in your sedation protocol in certain situations. For example, analgesia can be helpful when
performing a painful procedure, such as cleaning an infected ear or examining a sore body part.
“Be empathetic to pain, understand that it may be present, and if you know there is pain, include a pain medication,” Dr. Karas said.
Teaching Your Staff
You must educate all team members — from receptionists to veterinarians — so they successfully communicate the need for pre-visit sedation and encourage compliance. Also, prepare your team to respond to client questions, fears and concerns with understanding and empathy. Ensure that everyone uses simple, compassionate language that stresses you recommend sedation for the pet’s benefit and not because the patient is a “bad dog.”
Be aware that some clients are averse to seeing their pets sedated. Managing client expectations is crucial. What can help is to have team members explain enthusiastically how a sedated pet better tolerated a blood draw or nail trim, for example.
Educating Clients
Many clients who hear “sedation” get nervous because they think it means putting a pet under general anesthesia. Explain that sedation causes mild to moderate relaxation and reduced anxiety and that the pet typically remains conscious and responds to stimuli. In contrast, anesthesia induces a controlled, deeper state of unconsciousness.
When you implement a successful pre-visit sedation and analgesia protocol and educate clients, you greatly benefit the veterinary team and alleviate patient stress and anxiety, allowing pets to receive the care they need.
FINDING THE RIGHT WORDS
Dr. Alicia Karas recommends using simple language to ensure clients understand and agree with your recommendations for pre-visit sedation. For example:
- Say, “Let’s give your pet something to make them a little sleepy,” rather than, “Let’s sedate your pet.”
- Use “pain management” or “pain medication” instead of “analgesia,” a term some pet owners might not understand.
- Avoid phrases such as “knock them out,” which can sound violent and crude.
- Avoid saying, “Put to sleep,” when talking about general anesthesia so clients don’t think “euthanasia.”
Take a soft approach and focus on the benefits to the pet when introducing the idea of pre-visit sedation. For example:
- “Ms. Smith, I think we can help Fluffy with her nervousness during her veterinary visit next week. Would you be interested in giving her something to calm her before leaving the house?”
- “Pre-visit sedation has helped many other cats and dogs who find veterinary visits difficult. It would be a great option for your pet.”
- “We recommend pre-visit sedation for Rover because veterinary appointments cause him so much stress.”
- “I know how upset Spot gets about his blood draws. Would you be interested in something that can help decrease his anxiety?”