Caring for our deceased.

Abstract

145 Background: In spring 2010, Off-Shift Administration (OSA) at MD Anderson Cancer Center received a spike in inquiries from staff concerned about the lack of uniformity in processing patient deaths occurring on campus. Procedures were known within administration, but no formal policy existed to substantiate requirements. A core team from Medical Affairs, Nursing, and OSA joined forces to address deficiencies and enhance the quality of end-of-life care across the organization. The core team then assembled two multidisciplinary groups to contribute to outcomes. Specific project aims were to increase physician completion of a death note within one hour of death from 83% to 95% compliance by April 2011. Monitoring of the death note was selected because it is often the first action barrier that further hinders processing a patient death. Methods: Key activity was carried out from July 2010 to July 2011. The first working group met to consider all processes relevant to expirations and write a policy. A second convened to address needed updates to clinical documentation. CLN1084 Caring for the Deceased Policy was implemented in January 2011. Education to physicians occurred in March 2011 and to ancillary staff in July 2011. In-services were given and announcements were made in various institutional communiqué. Results: Results were tabulated following a randomized monthly audit of deceased inpatient medical records. Audit specifications included a) determining presence of a death note and b) verifying that the note was completed within one hour of pronouncement. A March 2011 audit revealed 100% compliance of death note completion within one hour of the death. After the target end date, the team continued to see a superior 96.6% compliance rate. Clinical and support staff alike have also expressed great appreciation for reference tools now available to guide activity following a death on campus. Conclusions: Monitoring for compliance will continue as deemed necessary. The policy will also be reviewed regularly to assure accuracy and ongoing compliance with state law and hospital requirements. Finally, the core group continues to consult with departments who express interest in outlining specific departmental procedures (Rotary House, Regional Care Centers, etc.) that align with policy.