PROTOCOL FOR DEATH DOCUMENTATION –

SEE NOTEBOOK WITH EXAMPLES AT NURSES STATION

 

 


All live born babies, regardless of gestation or birth weight, will receive a medical record number and chart.  The chart will have a note completed by the fellow or attending and may be a death note or a history and physical, but must include the birth weight.

 

LIVE BIRTH defined by Tennessee Code Annotated, Section 68-3-102(9) approved May 9, 2005:

"Live birth" means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of the pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.  Heartbeats shall be distinguished from transient cardiac contraction, and respirations shall be distinguished from fleeting respiratory efforts or gasps.

 

NON-VIABLE LIVE BORN INFANTS

Neonatology (fellow or attending along with the NNP) should attend every delivery with gestational age estimated greater than 20 weeks in order to help determine viability.

 

Any fetus, regardless of weight or gestational age, with a detectable heart rate after delivery, is considered a live born infant.  However, infants for whom medical intervention is futile, are considered non-viable.  Infants <22 weeks gestation and <400 Grams are usually non-viable.  More mature infants with multiple congenital anomalies incompatible with survival may also be considered non-viable.  Select infants at 23 and 24 weeks gestation whose parents have opted, in consultation with perinatology and neonatology, to provide comfort measures only, may also be treated as non-viable.  When medical intervention is deemed futile, parents may choose to keep their dying infant with them in the Labor and Delivery area.  Alternately, they may choose to have the infant brought to the NICU.

 

  • If the infant remains with the family in the mother's room, the OB nurse is responsible for monitoring the infant and notifying NICU staff when the infant expires. The OB staff is responsible for bereavement care, transporting the body to the morgue, and the disposition of the fetal remains.

  • If the infant is brought to the NICU, a neonatal nurse will monitor the patient. The NICU staff is responsible for bereavement care, transporting the body to the morgue, and the disposition of the fetal remains.

  • In either case, a NICU physician is responsible for pronouncing the infant's death AND COMPLETING THE PAPERWORK.  The NICU Staff are responsible for reporting deaths in either scenario.

 

Documentation can be completed by the Neonatal Nurse Practitioner, Intern/Resident, Fellow, or Attending at the time of death (directions follow):

1. Report of Death Form Located in StarPanel

2. Neonatal Disposition/Autopsy Form MC 2972 (1/2007)

3. Vermont-Oxford Network Delivery Room Death Form (if 401 grams or more)

4. History and physical with Death note, the fetus/newborn with have a medical record number and a chart

5. Death Certificate at the time of death to be signed by physician with a Tennessee license

6. Bereavement checklist (Called Post Mortem Checklist) available for staff nurses in NICU edocs

 

REPORT OF DEATH FORM

1.  Medical receptionist will page the "Decedent Affairs" Representative on beeper 835-0390.  The MR in L&D/OB will page the "Decedent Affairs" Representative on beeper 835-1497

   The admitting office has someone in house 24 hours a day.

   They will need to know:

  • baby's first and last name

  • birth date and time

  • death date and time

  • gestational age and birthweight

  • attending's name

  • funeral home name and town location

  • Confirmed completion of report of death and death certificate

  • Name of the TDS representative notified

2. The provider will complete a "Report of Death" form electronically located in Star Panel under the green section "forms" click on Death Report then click on Report of Death. This will generate a new form to complete which includes questions to prompt notification to the Medical Examiner regarding any reportable event. You will need to complete the name of the ME called and a case number if accepted. Complete all fields in ROD and save as final.

 

DISPOSITION OF REMAINS FORM

The Decedent Affairs Representative will direct to which location to FAX or bring the white copy of the Disposition of Remains Form. The yellow copy stays with the fetus.

 

There is no longer a graveside burial of cremains at the May Memorial Service. There is a May Memorial Service at VCH and the parents should be asked whether they want to be notified. If they do make sure we have a valid mailing address.

 

The parents may choose or decline an autopsy.  Listed under each of the autopsy selections are options for disposition of the remains. 

If the parents choose the option that states  "Prefer to take home for my own personal burial in accordance with the Public Health Laws of Tennessee", then:

The MR will page the Decedent Affairs Representative, and tell them that the parents want to take the body.  The Decedent Affairs Liaison will send additional paperwork :

 

1. If the parents want to take the body and they live out of state, a Transit Form will be sent from Admitting.  The transit form should be carried by the person the parents designate to transport the body.  The origional goes with the body and the copy goes to Decedent Affairs. They will give it to the funeral home when they deliver the body.  The family will need to check with local ordinances if they prefer to bury the body themselves.

 

2.  "Release of Liability" form: obtain from Decedent Affairs.  Photocopy the Release of Liability form and send the copy to Decedent Affairs.  The  original stays with the chart and a copy goes with the patient representative.

 

DEATH CERTIFICATE

 

At time of death the licensed physician or fellow completes the Certificate of Death per the highlighted sections on the example form located in the Death Packet. Note: This form MUST be signed by a licensed physician or fellow (not a resident)   If no attending or fellow are in the unit to sign the Certificate of Death, the unit has 24 hours to get the Certificate of Death signed and submitted to Decedent Affairs as instructed by the Decedent Affairs Liaison.

The nurse or designee places a patient label/stamp on the back of the Certificate of Death in the “Additional Information” box.

The completed form is brought to the DAL representative when the body is being placed in the morgue or is tubed to VUH Admitting station 404 in care of DAL

The decedent affairs liaison (DAL) documents receipt of the Certificate of Death in the database, makes a copy for our records, and enters date mailed to Funeral Home or the State for processing.

 

Filling out death certificate:

 

1. Use the patient identification card to stamp the back, or use a hospital computer generated sticker on the back.

2. The funeral home will complete items 1 to 22b.  Do not write in this area.

3. Item 23 to 24 will be completed by the Registrar of Records for the State of Tennessee, do not write in this area.

4.  Items 25 a, b, c, is completed by a physician licensed in Tennessee.

5. Item 26 a, b, c, is completed by the medical examiner if relevant.

6. Item 27 to 30 should be completed by a physician licensed in Tennessee.

7. The death should NOT go with the body to the funeral home or morgue.

8. If there is no physician licensed in Tennessee available at the time of death, then the death certificate should be completed within 24 hours and submitted to the DAL office. 

Tennessee Donor services needs to be contacted for all live births regardless of the gestation.  The TDS representative's name must be provided to the DAL a the time of death while completing the paperwork.

 

 

 

VERMONT-OXFORD NETWORK FORM

This form will be filled out for any live birth >22 weeks gestation OR >400 Grams and the baby did not receive resuscitation or intensive care.  Death may occur in labor and delivery or in the NICU.

1. Star panel option:

Enter patient's medical record number.  Click 'enter data', when this window opens, click 'forms'.  From this list choose 'pediatrics' then choose 'neonatology', then choose "VON Death Notice Form".  When the form is completed, Click 'save as final'.

2. Paper copies are available.  Place in mailbox of neonatology nurse researchers.

 

HISTORY AND PHYSICAL OR DEATH NOTE IN STAR PANEL

1. Can be typed into star panel.

2. Can be hand-written and scanned into star panel.