Why Do We Use Medications Off-Label?
When a patient enters palliative care, the approach shifts away from prolonging the life of the patient, and towards increasing the comfort levels during the time that they have left and maintaining a strong bond between the owner and patient. For this reason, we may need to reach for medications that are not specifically labelled for our intended use (i.e. may not be registered in Australia, or is only registered for human use, or is not registered for the purpose with which we will be using it). It is important to make it very clear to owners when we do elect to use medications in this way.
What Do Consent Forms Cover?
At Sunset Vets, we sit down with owners during our consultation and go through consent forms that discuss the use of medications off-label. Our consent forms detail a number of key points, including the fact that:
- The medication may not be specifically registered in Australia for a particular medical condition, or in the species of animal we are treating
- The veterinarian may advise the use of the medication outside the recommendations, or even in contradiction with the recommendations listed on the package insert
- There may be known, or unknown side effects or adverse consequences associated with the use of the medication under the circumstances and the owner is to familiarise themselves with the known risks and accepts these risks
- The owner agrees to unconditionally indemnify the veterinarian against any claim arising from any adverse consequences or damages that arise from the use of the product
We also have an additional release form for the use of NSAIDs that specifically outlines the possible side effects with their usage, as well as the recommendation to have regular blood tests to ensure the medication is suitable for the patient.
Are Your Consent Forms Appropriate?
Familiarise yourself with the off-label consent forms used at your practice, and if you have a professional indemnity insurer, they should be able to peruse your consent forms and give advice about their adequacy. Going through an off-label consent form with an owner may sound tedious, but in reality it only takes 5-10 minutes out of your consultation time, and is such an important step in insuring transparency between yourself and the owner, as well as protecting yourself from potential legal complications down the track. Most importantly, informed consent allows us to achieve one of the core goals of palliative medicine – ensuring our patients’ pain levels are appropriately managed during the time that they have left.