Forms – advance directives, death certificate, autopsy and dictations

 

ADVANCED DIRECTIVES

All patients should be questioned about advanced directives preferably before they become critically ill.  If a patient or legal surrogate requests DNR/DNI, document that discussion in the chart and write a DNR and/or DNI order via OrderNet or in the orders if on a non-OrderNet floor.  Remind the attending of record to co-sign the order within 24 hours or the order will expire.

 

AUTOPSY AND ORGAN DONATION

The American Medical Association and the College of American Pathologists continue to stress the importance of the autopsy.  Despite this emphasis, American medicine has seen a decline in autopsy rates that may not be completely explained by the use of extensive antemortem diagnostic techniques.  In fact, falling below minimum autopsy requirements (16%), is one of the most commonly cited deficiencies in residency review committees (RRCs).  It is Maryland law to offer organ donation to the family of the deceased.  The “death packet” contains the death certificate and consent forms for autopsy and organ donation.

 

It is important to provide the following information to the family:

·                     the person taking responsibility for the body may give permission for the examination

·                     the family is not charged for the autopsy

·                     the autopsy may confirm the clinical diagnosis or reveal additional causes contributing to the patient’s death

·                     the autopsy will not delay the funeral or interfere with the viewing of the body

·                     the autopsy contributes to physician education and improved patient care

·                     any findings are entrusted to the care team and the patient’s family.  Providing prompt, understandable autopsy findings may allow the family to reconcile with the patient’s death.

For questions pertaining to the autopsy in general or to any particular case, the Department of Pathology at The Johns Hopkins Hospital may be contacted at (410) 955-3765 or (410) 955-3500.  A pathologist on call for autopsy or the charge resident may be reached 24 hours a day through the paging operator.  Furthermore, the Department of Pathology has created wallet-sized, laminated cards summarizing the autopsy.  A copy of this card can be obtained by calling the above numbers.

Verbal consent is not valid for autopsy.  If a family member is not available, a telegram consent is required.  Contact the Admitting Office for details.

 

REQUESTING ORGAN DONATION

Requesting organ donation is Maryland law.  If the deceased’s family/health care agent gives consent for organ donation, or if you are unable to obtain consent, call the Transplant Resource Center at 410-242-1173 (24 hours/day).

 

DEATH NOTE

Document time death pronounced, examination for response to verbal/tactile stimuli, spontaneous respiration, heart sounds/pulses, pupillary response, and notification of family & attending.

 

DEATH CERTIFICATE

How to fill it out:

1.                   The certificate must be completed by the physician declaring the death.  Complete Sections 1,  23-30.  Do NOT fill out anything else. Leave space (as much as you can) between the deceased’s first and last names. Do not fill out the middle name (which will be added later).

2.                   The Hopkins resident “License number” is RES-000 (Section 29c).

3.                   NO ABBREVIATIONS.  Write out the month (do not use number).

4.                   Complete in black ink, making sure that all copies are legible.  Do NOT write outside of the lines.

5.                   All terms must be commonly accepted medical descriptions of diseases or pathological conditions.

6.                   Symptom complexes should not be used; instead, they should be broken down into their component parts to state the immediate cause of death and underlying condition(s).

7.                   “Cardiac arrest” or “respiratory arrest” are NOT acceptable causes of death.  A provisional cause of death may be provided when the exact cause is uncertain.  When findings are available which significantly alter the stated cause of death, the admitting office must be notified; a new certificate may be required.

8.                   The deceased patient’s family must call a funeral home (of their choice) to make arrangements to have the body picked up from the morgue; this is the only arrangement they have to worry about.

 

Your address at Hopkins:

Johns Hopkins Hospital

Tower 110, Doctors Lounge

600 North Wolfe Street

Baltimore, MD 21287