October 1, 2007

NOTIFICATION REGARDING PATIENT’S DEATH: The bereavement team at Dayton Children's is always working to provide support to our families when a child dies.  In turn, our goal is to support our staff as well. We feel that it is important to notify the primary care provider when one of their patients dies. For the past four years, when we can identify the primary care provider (PCP), we have sent a letter of notification to the physician after the patient has died. In addition, when we can identify the PCP, we will now call the PCP or on-call partner at the time the child dies on a 24/7 basis. The call will primarily come from the physician at Dayton Children's; it may also come from a nurse who has cared for the patient. Questions? Contact Cindy Asher, RN, CNS, chair of the bereavement team, at 937-641-3000 extension 8934 or by e-mail. 

PEDIATRIC RESPONSE TEAM: Rapid response teams have been established in hospitals around the country to care for deteriorating patients who do not require a full Code Blue activation. Dayton Children's in collaboration with other Ohio children's hospitals established a pediatric response team that started August 27. The team, which consists of an intensivist (if inhouse), ICU nurse, ICU resident and respiratory therapist, will respond to stabilize patients. The nurse or other staff member will usually contact the resident (unless the patient is acutely deteriorating) for evaluation of the patient's status before to calling the team. Patients who require the use of this team might be a patient having seizures that can't be controlled or a patient with worsening respiratory distress. The data regarding the use of this team will be tracked through the code committee and the ICU committee. Questions? Contact Cindy Asher, RN, CNS, at 937-641-3000 extension 8934 or by e-mail.

RECENTLY SOMEONE ASKED ME: What is supposed to be done as a part of providing informed consent before an invasive procedure is performed? We have a consent form that is standardized across the facility. The form is useful for surgery, invasive procedures outside the OR, sedation and blood administration. The institutional requirement is that the individual who is actually performing the procedure is expected to discuss the procedure with the family/patient and explain the nature of the procedure, risks, benefits and alternative procedures that are available.  Another health care professional actually presents the consent form to the family for signature. If the family/patient still has questions, the health care professional will call you so that you can answer the family/patient's questions.

In the event the physician also believes that there might be need for additional procedures, based upon the findings of the primary procedure, that should also be explained to the family in advance or a second consent should be obtained.  Practically, this means that the surgeon doing an exploratory lap might explain the risks and benefits of an appendectomy as well as the exploratory lap. Or perhaps the physician explains that one or more biopsies might be obtained, if the primary procedure suggests a need. The JCAHO and CMS are both very proscriptive in their requirements regarding consent forms. Questions? Contact Cindy Asher, RN, CNS, at 937-641-3000 extension 8934 or by e-mail.