RUSSELL COUNTY HOSPITAL
PATIENT CARE POLICYDEATHS, FETAL DEATHS & PRODUCTS OF CONCEPTION
APPROVAL SIGNATURE: / INITIAL DATE: / REVISION DATE:
4/1/02
PURPOSE: To care for a body after death to preserve the cultural expectations, rights and dignity of the family and expired patient. To describe clinical data requirements and to comply with state laws (KRS 213).
RESPONSIBILITY: Laboratory Associates, Pathologist, Medical Staff, Nursing Associates
EQUIPMENT: Provisional Report of Death Form, Autopsy Permit (if indicated)
POLICY:
1. All deaths shall be pronounced by a physician or by a Registered Nurse who has successfully completed training in determination of death. Notice shall be given to:
a. The family
b. All of the patient’s physicians
c. House supervisor
d. Hospital switchboard
e. Funeral directors requested by the family
f. County Coroner, if indicated: 1-270-343-6600
g. Pathologist, if indicated: 1-800-264-0514
h. Kentucky Organ Donor Affiliates, if indicated: 1-800-525-3456
2. Time and support shall be given to meet the grieving needs of the family and/or significant others by allowing viewing, privacy and physical contact, as appropriate. Clergy shall be contacted, as desired by the family.
3. If the death results in a coroner’s case, all tubes, invasive catheters and equipment shall be left until examination is completed. The following circumstances require notification of the coroner to determine if autopsy is indicated (KRS 72.025).
a. When the death of a human being appears to be caused by homicide or violence.
b. When the death of a human being appears to be the result of suicide.
c. When the death of a human being appears to be the result of the presence of drugs or poisons in the body.
d. When the death of a human being appears to be the result of a motor vehicle accident and the operator of the motor vehicle left the scene of the accident or the body was found.
e. When the death of a human being occurs while the person is in a state mental institution or mental hospital when there is no previous medical history to explain the death, or while the person is in police custody, a jail or penal institution, except to a sentence of death.
f. When the death of a human being occurs in a motor vehicle accident and when an external examination of the body does not reveal a lethal traumatic injury.
g. When the death of a human being appears to be the result of a fire or explosion.
h. When the death of a child appears to indicate child abuse prior to the death.
i. When the manner of death appears to be other than natural.
j. When human skeletonized remains are found.
k. When post-mortem decomposition of a human being corpse exists to the extent that external examination of the corpse cannot rule out injury or where the circumstances of death cannot rule out the commission of a crime.
l. When the death of a human being to be the result of drowning.
m. When the death of an infant appears to be caused by sudden infant syndrome in that the infant has no previous medical history to explain the death.
n. When the death of a human being occurs as a result of an accident.
o. When the death of a human being occurs under the age of forty (40) and there is no past medical history to explain the cause of death.
p. When the death of a human being occurs at the work site and there is no apparent cause of death such as an injury or when industrial toxins may have contributed to the cause of death.
q. When the body is to be cremated and there is no past medical history to explain the death.
r. When death of a human being is sudden and unexplained.
s. When the death of a human being occurs and the decedent is not receiving treatment by a licensed physician and there is no ascertainable medical history to indicate the cause of death.
4. The indications for requesting a Medical Autopsy are as follows:
a. Death within 48 hours of a surgical or invasive procedure (including outpatient procedures and radiology procedures).
b. Death associated with adverse event. (Any untoward patient event, that is not a natural consequence of the patient’s disease, or adverse drug interaction/reaction, or injury while hospitalized.)
c. Death in which the admission diagnosis suggests death was not expected.
d. Still born over 350 grams or 20 weeks gestational age (see #8 below).
e. Cases in which an autopsy may help allay concerns of the family and/or public regarding a death from high-risk infectious diseases.
f. All obstetric deaths
g. All perinatal and pediatric deaths
5. Post mortem care shall be provided, as appropriate.
a. All invasive equipment shall be removed, dressings changed and the body cleaned of fluids or soil.
b. The body shall be straightened, head elevated on one pillow with arms flexed over the abdomen.
c. Dentures shall be inserted and mouth closed.
d. Without using tape, the eyes shall be gently closed.
e. Personal belongings shall be given to the family or sent with the body.
6. The Provisional Report of Death Form shall be complete for all deaths. The Fetal Disposition Form shall be completed for all fetal deaths or products of conception not having a Surgical Consent form completed.
7. In the case of cremation, the coroner and physician shall sign the provisional Report of Death.
8. If there is a still born fetus that weights 350 grams or more, or has a gestational age of twenty 20 weeks or more, a Fetal Death Disposition Form and Certificate of Fetal Death shall be completed.
a. Upon the death of a fetus, Health Information Management Associates shall be notified to complete the Certificate of Fetal Death (if unavailable, nursing Associates shall complete).
b. A parent shall complete and sign the duplicate Fetal Death Disposition Form indicating disposition of the fetus. The family shall either designate a funeral home to be called or make provisions for home burial. The original disposition form copy shall be placed in the medical record and the second copy shall go with the fetus.
c. The fetus and all products (cord, placenta) shall be placed in a container, identified with the mother’s name and hospital number, and sent to the University of Kentucky Department of Pathology for examination and/or autopsy, if indicated on the Fetal Disposition Form.
d. If autopsy not indicated, the fetus shall be wrapped in a blanket for release to the family or mortuary.
9. If there is a death of a fetus that weights less than 350 grams and/or has a gestational age of less than twenty (20) weeks, this shall be considered a spontaneous abortion/products of conception and a Certificate of Fetal Death is not required.
a. A Fetal Disposition Form or Surgical Consent Form shall be completed by a parent.
b. The fetal products specimen shall be placed in a container of Formalin and taken to the Clinical Laboratory to be treated as a specimen, if indicated on the Fetal Disposition Form.
10. Regardless of the size of gestation, a fetus that is delivered showing any evidence of life such as a beating heart, the pulsation of the umbilical cord or definite movement of the voluntary muscle, shall be considered a live birth. If there is a live birth followed by a subsequent death, all criteria for Provisional Report of Death shall be followed.
11. If fetus is less than 350 grams or 20 weeks, a Provisional Report of Death is required if transported by family or funeral home for burial.
12. In all deaths, a physician order is needed for release of the body.
13. Autopsies:
a. The University of Kentucky, Department of Pathology, performs the autopsies for Russell County Hospital.
b. Permission for an autopsy should be sought as soon as possible after death.
c. The autopsy permit should be read carefully by the person who will sign the permit.
d. Consent should be obtained from:
1) The patient prior to his/her death.
2) Decedent’s next of kin (see e. below).
3) Legal guardian.
e. The following order of legal authority of next of kin shall be followed:
1) Spouse
2) Children (age 18 or over)
3) Grandchildren (age 18 or over)
4) Great-grandchildren (age 18 or over)
5) Father and/or Mother
6) Brothers and sisters (age 18 or over)
7) Nieces and nephews
8) Grand-nieces and grand-nephews
9) Maternal and paternal grandparents
10) Uncles and Aunts, and their descendents
11) Great-grandfathers and great-grandmothers
12) Brothers and sisters of great-grandfathers and great-grandmothers
13) Legal guardian or the person who assumes responsibility to dispose of the body
f. Permit for autopsy may be obtained by telephone, if necessary, and is properly witnessed.
g. The attending or medical back-up physician can obtain autopsy permission by phone and have two witnesses listen-in on the conversation.
h. The autopsy permit should be read over the phone, explained, as necessary, and the full name of the person giving permission should be entered on the form, as well as the relationship to the deceased.
i. Written authorization should be obtained later, if possible.
j. If the family requests an autopsy, nursing Associates notifies the attending physician of family member’s request for autopsy.
k. It is the responsibility of the medical back-up physician, in the absence of the attending physician, to obtain written permission from the family.
l. The autopsy permit is witnessed by two (2) members of the hospital staff by signing their names followed by their titles.
m. Permission by family member is not required for a coroner requested autopsy. The Coroner makes all arrangements.
n. In the event of SIDS” (Sudden Infant Death Syndrome) Autopsy, the family indicates on the SIDS Autopsy Request Form their desire for, or refusal of an autopsy. The action is initiated by the coroner and can be completed by the Emergency Department staff.
PROCEDURE:
1. Complete the University of Kentucky Autopsy Authorization form. (Please indicate any “restrictions”)
2. Complete and have patient’s legal next of kin sign the University of Kentucky Authorization for Release of Information form to permit the University of Kentucky to release autopsy results to Russell County Hospital.
3. Make a copy of the patient’s medical record.
4. Obtain payment (cash, check, money order or major credit card) for the autopsy from the family or funeral director. Refer to attached Price List for current charges.
Make check payable to: Kentucky Medical Services Foundation.
Autopsy (Adult) Complete $5,000
Autopsy (Infant) Complete $3,900
Partial Autopsy negotiated based on nature of restrictions
Ancillary tests billed separately
5. Inform UK autopsy pathologist on-call of pending autopsy.
a. Call (859) 323-5321 to obtain pager # of pathologist from paging operator.
b. Call (859) 323-3000. At tone, enter pager #. At second tone, enter your telephone #.
6. Send the following with the body via funeral home transportation to the University of Kentucky:
a. UK Autopsy Permission form
b. Authorization for Release of Information
c. Copy of patient’s medical record
d. Payment
6. The final autopsy report will be sent to the next of kin. A copy will be sent to the hospital if the legal representative authorized this release.
Date Reviewed: / 11/29/05 / Date Reviewed: / Date Reviewed:Date Reviewed: / Date Reviewed: / Date Reviewed:
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