Client Communication Rule
The Client Communication Rule, WAC 246-933-345 was created in response to concerns raised by the public on the importance of veterinarian communication with the client. This ensures clients can provide informed consent for veterinary care of their animal(s).
The rule formalizes and clarifies existing veterinary communication standards with clients and related record-keeping.
- Should the veterinarian review every possible diagnostic measure, medication, or treatment they might administer to a patient?
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No. The spirit of the rule is to set appropriate expectations with clients so they are informed of treatments and diagnostic testing. Veterinarians need not review “every possible” diagnostic measure, medication or treatment; however, they should review likely and foreseeable care they may administer based on the specific situation.
Veterinarians are held to a professional standard of care, which a competent veterinarian would reasonably do under the same or similar situation. Veterinarians must inform owners, in an easy-to-understand manner, of the likely risks and benefits of a particular diagnostic measure, medication, or treatment, so that the owner can make informed decisions about care.
- Should veterinarians contact the client each time there is a change to patient orders for treatment and care? Should they discuss all details of effects the change might have? Similarly, does every medication used during anesthesia require discussion with the client?
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A veterinarian should inform a client in advance about the components of a procedure, medications used and why, risks, benefits, alternative measures, and likely outcomes of a procedure. A general plan and likely and foreseeable adjustments to that plan should be developed and discussed with the client prior to hospitalization so the client can give informed consent. The intent is that clients understand the approach being taken.
In emergency situations or when the client cannot be contacted in a timely manner, it may not be reasonable for the veterinarian to seek consent.
- How detailed should documentation be? Is there general verbiage that can be used that would adequately cover everything conveyed to owners or should specifics be written down for each case, listing all differential and definitive diagnoses, proposed treatments, side effects, etc.?
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The rule requires a practitioner to document the following topics that were discussed:
- Proposed diagnostic tests;
- Differential diagnoses;
- Definitive diagnoses;
- Proposed treatments;
- Common side effects or adverse outcomes from proposed diagnostic testing or treatment;
- Most likely side effects or adverse outcomes from proposed diagnostic testing or treatment based on patient signalment and disease status. Patient signalment may include, but is not limited to, species, breed, age, and sex;
- Estimated cost;
- Prognosis; and
- Alternate diagnostic and treatment options for the patient.
The rule is intended to clarify the existing standard of care. While the exact amount of detail is best left to the practitioner's discretion, a third-party reviewer should be able to discern the information that was provided and the client's consent to care. The rule's intent is not to create additional requirements for documentation. It outlines the standard that the board uses when reviewing disciplinary cases. This should have minimal or no impact for veterinarians following general standards for documentation.
- Must veterinarians discuss with the client every possible side-effect, such as bruising with a blood draw with each owner?
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Veterinarians must inform a client of outcomes that are reasonably foreseeable. For example, if venipuncture is being performed in a patient with ecchymosis of unknown etiology, the potential for bruising and bleeding should be discussed with the client. The client should be given sufficient information so that they can provide informed consent.
- Some clients may not understand all the details of what veterinarians try to communicate with them. Can we still treat the patient?
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The veterinarian must provide enough information in a manner the client can understand so that the client can provide informed consent. If that is not possible in a non-emergency situation, the veterinarian should not provide care. In an emergency, if a client is unable or unwilling to provide informed consent, the veterinarian should provide sufficient care to deal with the emergency.
- If a client doesn't want to discuss the information can the veterinarian still treat the patient?
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The veterinarian must provide enough information so that the client can provide informed consent. If a client is unable or unwilling to provide informed consent, in a non-emergency situation, the veterinarian should not provide care. In an emergency, if a client is unable or unwilling to provide informed consent, the veterinarian should provide sufficient care to deal with the emergency.
- Are there any resources available to help us communicate and provide information to clients?
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Yes. Many resources exist. Client information sheets are available for many drugs through the FDA and many professional organizations offer handouts for clients on a variety of topics such as diseases, treatments, procedures, diagnostics, behavior, etc. Some organizations and clinics have also made resources available to the general public on their websites or other online platforms. The board is working on creating a list of links to available resources. This webpage will be updated when those resources are ready.
This rule is meant to clarify the board's expectations for client communication, based current standards of care and will not significantly change how the board handles disciplinary cases.
Continuing Education (CE)
- Where can I obtain free courses in Health Equity Continuing Education?
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Free courses and information pertaining to health equity continuing education are on our Health Equity Continuing Education webpage.
- Where can I find Suicide Prevention Continuing Education?
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RCW 18.92.280 (Laws of 2020) requires many licensed professionals, including veterinarians and veterinary technicians, to complete suicide prevention continuing education. The required education module was developed by the University of Washington’s forefront suicide prevention center with allotted funds. This is the only course that satisfies this requirement.
WAC 246-933-435 and WAC 246-935-305 further explain this requirement.
This CE counts towards the total CE requirements.
For additional information see our Suicide Prevention Continuing Education webpage.
- What are the Continuing Education requirements?
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In 2018 the Veterinary Board of Governors determined it was time to modernize the continuing education (CE) rules. Washington had one of the lowest requirements among all 50 states regarding the number of hours a veterinarian must earn each year. The board also wanted to address a number of policy issues, including expanding the list of approved CE providers and discontinuing its practice of approving CE case-by-case.
Current rules can be found in WAC 246-933-401 through 460. Commonly referred to as Veterinarian CE Requirements.
- How are the new CE rules different?
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The most significant change is the requirement for 30 hours over a two-year period. Previously, 30 hours were due every three years. The transition will be rolled out over the next three years as follows:
If continuing education is due on the veterinarian's renewal date in: The next continuing education due date is on the veterinarian's renewal date in the year below and every two years thereafter: 2019 2021 2020 2022 2021 2023 Other changes to the rule are summarized below:
Topic Previous Rule New Rule Alternatives to Meeting the Requirement There are no alternatives to meeting the CE requirement other than attaining 30 hours. Veterinarians may meet their CE requirement by achieving board certification or by being enrolled in a residency program throughout their entire CE period. The licensee must have been enrolled in a residency program approved by a veterinary specialty organization recognized by the AVMA. Credit may be obtained for a maximum of two reporting periods. Scientific Coursework There is no minimum requirement for scientific or clinic courses. A minimum of 20 scientific or clinical hours are required. Teaching as Credit There is no credit allowance for teaching. A maximum of 10 hours may be obtained through teaching via an approved provider or through a healthcare learning institution. Credit for Webinars Rules are silent on how live, interactive web-based study is counted. Clarifies that there is no credit limit for live courses attended remotely , provided attendees have the documented opportunity to question the instructor, hear the questions of other attendees, and receive responses in real time. Approved Providers The approved provider list is somewhat limited. Expands the approved provider list to include several new approved organizations and individuals. Board Approval of CE Courses If the CE provider or course is not approved by rule, the board will review CE courses case-by-case, as requested. The board no longer approves individual courses. CE Audits There is not clarity on the CE audit process. Clarifies required documentation when a veterinarian is audited. - When do the new rules go into effect?
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January 21, 2019 (except for the implementation of the new two-year CE period, which started January 1, 2019).
- How do I document my Continuing Education?
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Keep a running list with dates of classes and titles as well as fliers, certificates, web addresses, etc. It is helpful to start a new list on your birthday every year.
If you earned a board specialty, you need evidence of your specialty. This can only be used as a CE one time during the reporting period when the specialty certification is achieved.
For residents, the licensee must be in their residency for the entire reporting period, and can use this option for a maximum of two reporting periods. Proof of residency status will be needed for audit.
There are also other online options to track CE.
The Veterinary Continuing Education Tracking (VCET) tool provided by the American Association of Veterinary State Boards (AAVSB) allows you to record all your CE course work in a centralized database. VCET is a free program to veterinary professionals and provides an easy way for you to communicate your CE to the board. See AAVSB's website for more information.
If you have a MyAAVSB account already, then you automatically have VCET on your MyAAVSB portal. If you don't have a MyAAVSB account, just complete the brief application.
- Will the CE hours I accumulated before the rule change be valid?
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Yes. The list of approved providers was expanded and any courses separately approved by the board are still valid as qualifying CE.
- How do I know whether CE I take qualifies?
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As long as your CE courses meet the requirements in WAC 246-933-401 through 246-933-460, contribute to your professional knowledge and development, enhance services you provide to patients, and contribute to your ability to deliver current standards of care, they'll most likely meet the new requirement. The board has created a CE provider guide to help you understand more about the approved CE provider list in WAC 246-933-460.
It is not required for CE to be RACE approved.
Who Can Approve my Veterinary Continuing Education
WAC 246-933-460 Organizations, institutions or individuals approved by the veterinary board to provide continuing education courses. The board approves continuing veterinary medical education courses provided by organizations, institutions, or individuals (providers) including, but not limited to, the following:
- 1. The American Association of Veterinary Laboratory Diagnosticians (AAVLD)
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The AAVLD promotes continuous improvement and public awareness of veterinary diagnostic laboratories by advancing the discipline of veterinary diagnostic laboratory science. See the AAVLD website for more information.
- 2. The American Association of Veterinary State Boards (AAVSB) Registry of Approved Continuing Education (RACE)
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The RACE®program develops and applies uniform standards related to providers and programs of continuing education (CE) in veterinary medicine. See the RACE website for more information.
- 3. The American Veterinary Medical Association (AVMA)
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The AVMA is the nation's leading advocate for the veterinary profession. See the AVMA's website for more information.
- 4. AVMA Council on Education (COE) accredited veterinary medical colleges
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The AVMA COEis the accrediting body for schools and programs that offer a professional DVM degree or its equivalent in the U.S. and Canada. The council may also approve accredit foreign veterinary colleges. See AVMA's website for more information.
- 5. AVMA recognized veterinary specialty organizations
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The American Board of Veterinary Specialties (ABVS) of the AVMA recognizes veterinary specialty organizations and veterinary specialties promoting advanced levels of competency in well-defined fields of veterinary medicine. See AVMA's website for more information.
- 6. A board-certified veterinarian who is certified by a veterinary specialty organization recognized by the AVMA when teaching a course within his or her area of certification
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Board-certified veterinarians can be searched for on each specialty organization's webpage. Links to each specialty organization are included on its website.
- 7. Federal, state or local governmental agencies
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Including, but not limited to, the U.S. Department of Agriculture, Washington State Department of Agriculture, and Washington State Department of Health.
- 8. An instructor with credentials or qualifications in the health, husbandry, or therapy of minor species
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CE providers and participating veterinarians must apply due diligence to ensure education contributes to the professional knowledge and development of the practitioner, enhances services provided to patients, and contributes to the practitioner's ability to deliver current standards of care.
- 9. An instructor with credentials or qualifications in practice management or professional development.
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CE providers and participating veterinarians must apply due diligence to ensure education contributes to the professional knowledge of the practitioner and contributes to maintaining the business as a going concern.
- 10. Any international, national, state, provincial, regional or local veterinary medical association
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This includes the World Veterinary Association, American Veterinary Association (AVMA), AVMA member boards, and regional or local VMAs under the umbrella of a state VMA.
- 11. The Resources for Alternative and Integrative Veterinary Medical Education (RAIVE)
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RAIVE consists of a group of veterinarians who have AVMA-recognized board certification, one or more advanced degrees (e.g., OMD and PhD degrees) in addition to their veterinary degree, a faculty position in a veterinary school, VIN consultancy, publication of standard texts within the field, and/or a private (often AAHA-accredited) practice, who all have expertise in one or more areas of complementary and alternative veterinary medicine (CAVM).
- 12. A resident or intern in training for an AVMA-recognized veterinary specialty organization under the supervision of a board-certified veterinarian
- 13. The United States Animal Association (USAHA)
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The USAHA is a forum for communication and coordination among state and federal governments, universities, industry, and other concerned groups for consideration of issues of animal health and disease control, animal welfare, food safety and public health. See USAHA's website for more information.
- 14. A veterinarian who is a faculty member of an accredited college of veterinary medicine when teaching a course within his or her area of expertise
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This website provides a list of AVMA-accredited colleges of veterinary medicine. See AVMA's website for more information.
- 15. The Washington Physicians Health Program (WPHP)
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The WPHP facilitates the rehabilitation of healthcare professionals who have health conditions that could compromise patient safety, and to monitor their recovery. The WPHP offers mindfulness programs that can enhance a veterinarian's practice management.
- 16. What other CE providers has the board approved?
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- Approval of Food and Agriculture Organization of the United Nations
- The American Association for Laboratory Animal Science (AALAS)
- Graduates of an AVMA-recognized residency program who are eligible to sit for board exams. Residency graduates are eligible continuing education providers for up to one year after graduation.