End of Life Care Clinical Pathway — Emergency Department

Medical Examiner Case: Documentation and Body Preparation

MD: Documentation (Available in EPIC Discharge Navigator)

Preliminary Cause of Death	Must be completed
Dispo & Follow Up	Click the magnifying glass next to the disposition field Select Deceased-Medical Examiner or Deceased-Morgue
Medical Examiner’s Notice and Pronouncement of Death Form If patient is entered into EPIC as an alias (ie, Omicron Omicron Ninety-Nine), please hand-write the patients name and DOB on the printed Medical Examiner's report Complete Deceased Checklist in EPIC Open Medical Examiner Report in the Summary activity Print this report and give to nurse to accompany body to ME	Name Age Time of Pronouncement Circumstances of death "Thumbnail sketch" of key past medical history Clear elements of natural disease, trauma Narrative of medical decision making, very important for medical examiner's work Resuscitation medication List only the names of the common resuscitation medications Add dose/frequency for uncommon medications
FORMS NOT TO FILL OUT	Permission for Autopsy Death Report and Pathology Consultation Report Certificate of Death

Sign-out by Inquiry
Special circumstance, ME accepts the case but does not do an autopsy.
Provider should offer family an autopsy, if autopsy desired, need to fill out Autopsy
and Pathology Consultation Report (See Non-ME Case).

RN: Documentation/Body Preparation

Follow Evidence Preservation Policy - View Patient Care Manual

Initial Body Preparation	Place in clean gown, close eyes, lift jaw, arrange in supine position Move to Room 5 (if available)
Lines/Tubes	Endotracheal tube may be cut to the lips Do NOT remove: Chest tubes IV access: IO, IV lines, PICC Do NOT circle on body where prior lines/tubes were placed
Evidence Collection	Place bullets, knife blades, gunshot pellets, narcotics in separate container Maintain chain of evidence Fill out chain of possession label Document transfer to security or police Date, time, and security officer name or name/badge number of police officer
Belongings	Gather all belongings and place in paper bag for ME
EPIC Documentation	Complete End of Life Flowsheet in EPIC Progress Notes: Document EVERY family interaction and interaction with the deceased with: Family and staff present, and support provided, using the dot phrase “.edbereavement”
Keepsakes	If Child Life unavailable (M-F 1a-7a, Sat/Sun 1a-8:30a) assist in keepsake process (handprints, pictures, locks of hair) with ME and family Molding Process Video Clay Links Tip Sheet Note ME will allow keepsakes the majority of the time If ME staff communicating with CHOP MD denies request, please confirm with the Medical Examiner on call
ME Case Body Disposition	After family departs, move the body to the morgue if medical examiner is not immediately available to retrieve the deceased Label ID tags in body bag kit Attach ID tag to right great toe/right ankle Wrap in disposable sheet/blanket and place in body bag; attach ID tag to body bag Documentation to accompany patient to Morgue/ME’s office Medical Examiner Report Physician Note If Available Copy of code record (after scanned into EPIC by PCA) CD with skeletal survey and other imaging (if applicable) Contact security for escort to morgue

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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End of Life Care Clinical Pathway — Emergency Department

Medical Examiner Case: Documentation and Body Preparation

MD: Documentation (Available in EPIC Discharge Navigator)

RN: Documentation/Body Preparation

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End of Life Care — Medical Examiner Case: Documentation and Body Preparation — Clinical Pathway: Emergency

End of Life Care Clinical Pathway — Emergency Department

Medical Examiner Case: Documentation and Body Preparation

MD: Documentation (Available in EPIC Discharge Navigator)

RN: Documentation/Body Preparation