End of Life Checklist PDF

Preview

Summary

end of life care checklist...

Description

1

2016 Adult End of Life Checklist RN CHECKLIST Refer to policies 13276 Post Mortem Care/ 13779 donation after cardiac death Notify House Supervisor and Chaplain of patient’s death or anticipated patient death. Consider ordering a grief cart if many family members are in attendance—check with Nurse Manager first. Notify attending physician: 1) of the death and 2) ask which physician will be signing the death certificate. At patient’s death, determine if RN or MD must pronounce patient death. 1  For RNs performing death pronouncement, 3 obtain order to pronounce patient death.  Complete Death (Pronouncement) form in Cerner Ad Hoc (or eform #3005 00). Determine if Medical Examiner’s (ME) case. 1 If ME’s case: notify ME at (602) 506-1138.  Do not move or alter body until directed by the ME.  Leave in all of patient’s lines, tubes, etc. until directed by ME. If law enforcement needed see Post Mortem policy.1 Call Donor Network of Arizona (DNA) at 1-800-447-9477 within one hour of death. They will need to speak with patient’s nurse to get information about patient. DNA will: A. Check to see if patient has already provided first person consent for donation and B. Check to see if patient is suitable for tissue/eye donation. DNA will call the unit back usually within one hour with the answers to A. & B. (Complete Anatomical Gift Notification Cerner form (eform #1424 00.)  If patient meets criteria for tissue/eye donation, only a trained requestor can speak with the family regarding the donation.  Complete Arizona Anatomical Gift Consent Cerner Form (eform # 1423 00(or #1423 0001-Spanish) at this time.

Notify the family of the death.  If autopsy requested, notify MD and house supervisor 1, for the order for autopsy and complete Autopsy Authorization Letter (eform# 1418-0004) and Authority to Release Remains to Mortuary Transport Services, LLC (eform # 1418-0003). NO PHONE CONSENTS ALLOWED.  If family requests notify the following (if not already present) :Chaplain &/or Social Worker If the patient is not an ME case and there is no autopsy, prepare the patient’s body for the family to view. 2 Give jewelry, watches, and personal belongings to family and document in Cerner belongings form. Complete the Record of Death/Human Remains Release (Print on demand #3004), including physician (s) who will be signing the death certificate. Provide the condolence sheet, calling attention to the security information & obtain name of mortuary from family. Notify the mortuary.  If family is unable to choose a mortuary, provide them with condolence letter and HS contact information, 480-543-2284 do not offer to call mortuary. We cannot incur financial obligations for the family.

Notify consulting physicians of patient death and document notification. Offer time and privacy as needed. Ensure Human Remains form is filled out properly. Contact SWAT RN or house supervisor for assistance.. Physician phone and fax should be completed. Intensivist 480-256-3335 fax 480-256-3682 Hospitalist 480-543-2034 fax 480-543-2647 BHIP 480-657-1100 fax 480-409-2512 DO NOT LEAVE Family contact information blank Utilize Capacity management to submit transport request; indicating Morgue and quantity of two for number of transporters. Provide the transport team with the completed Record of Death/Human Remains Release during handoff of patient. THIS NEEDS TO BE CHECKED BY CHARGE NURSE before the transporter will leave the unit.

Adult End of Life Checklist p. 2 The paperwork needs to be completely filled out including donor notification. If the patient is being considered for donor (i.e. eye or tissue donation) then e-form (#1423) Arizona anatomical gift consent must be filled out and a copy sent down with the body attached to the release of human remains form (#3004). Donor must be called and documented on all impending demises including BHIP patients. Call the House supervisor if you are referring to the ME office or an autopsy is requested. Please have the families contact the mortuary. Our staff should not be calling them as this is a financial agreement between the representative and the mortuary. If they do not have disposition chosen that is fine just make sure the family representative contact is completely filled out. Then provide the letter below.

Forms to be completed: 1. Cerner Death (Pronouncement) Note 3 (eform# 3005 00) 2. Cerner Anatomical Gift Notification (eform #1424 00) 3. Record of Death/Human Remains Release (eform #3004) 4. Arizona Anatomical Gift Consent Form (eform #1423 00 or 1423 0001-Spanish) 5. Authority for Autopsy (eform # 1418-0004) 6. Release Remains to Mortuary Transport Services, LLC. (eform # 1418-0003) Important Contact Information MEDICAL EXAMINER: Phone: (602) 506-1138 Fax: (602) 372-8696 Backup Fax: (602) 506-8496 LAW ENFORCEMENT Mesa PD: Chandler PD: Tempe PD: Phoenix PD:

Phone: (480) 644-2211 AJ PD: Phone: (480) 782-4130 Scottsdale PD: Phone: (480) 350-8311 Gilbert PD: Phone: (602) 262-6151

Phone: (480) 982-8260 Phone: (480) 312-5000 Phone: (480) 503-6500

AUTOPSY Contact House Supervisor CASE MANAGEMENT/SOCIAL WORKER

SPIRITUAL CARE  

For Emergency, call 1-FIND and request the On Call Chaplain For all other requests, place a consult through Cerner “Consult: Spiritual Care”

RISK MANAGEMENT (Please confirm need to call with House supervisor before calling Risk)    1.

(602) 747-4750 8:30 am-5 pm; (602) 839-2000 after hours, weekends, holidays. Available 24/7 if needed. Complete incident report if patient was in 4 point restraints within 24 hours of death.

Post Mortem Policy 13276.6 Mosby’s Nursing Skills Postmortem Care Quicksheet 3. AZBN Determination of Death: Role of RN/LPN 2010 2.

1

We extend our condolences to you and your family during this time of loss. We would like to make this process as efficient as possible by asking for your assistance in assuring that your loved one is taken to the appropriate mortuary. To better assist you and your family during this most difficult time, we will only release your loved one upon notification of your mortuary choice.

Please make arrangements with the mortuary before contacting the Banner Gateway House Supervisor at 480-5432284 within 24 hours. When calling, please give the individual your name, loved one’s name or their hospital number, the mortuary you have chosen. 1.

Post Mortem Policy 13276.6 Mosby’s Nursing Skills Postmortem Care Quicksheet 3. AZBN Determination of Death: Role of RN/LPN 2010 2.

1

Once again we extend our condolences and thank you for your assistance....