36C25818R0052-012.pdf

SOP NO: QPM&C Number REVISION: Original

TITLE: Decedent Affairs Standard Operating Procedure

FILE: Decedent Affairs Procedures

PAGE: 1 of 8 EFFECTIVE DATE

RELATED PROCEDURES:

SOP HISTORICAL RECORD

DATE: WRITTEN/REVISED

BY:

APPROVED BY: REVIEWED BY

February 13, D. Pierson //signed//

Q.S. Ringenberg, MD //signed//

M. Lumm, MS, RN //signed//

July 7, 2011 V Valenzuela

REMOVED

REVISION DATE REVISION DESCRIPTION

Southern Arizona VA Health Care System QPM&C

Decedent Affairs Office

Tucson, Arizona

DECEDENT AFFAIRS STANDARD OPERATING PROCEDURE

1. PURPOSE: To define policy and procedure within the Decedent Affairs Office which assures guidance and support for veterans, family members, hospital staff, and our community, ensuring that all areas of decedent affairs are administered with dignity, benevolence, confidentiality, efficiency, and earned respect.

2. POLICY: Decedent Affairs Coordinator or designated medical staff will process the deceased veterans (in-house and those being processed Dead on Arrival (DOA)) cases in an accurate, efficient and expedient manner. Their next of kin (NOK) are entitled to specialized care with an emphasis on comfort and dignity. The Decedent Affairs Coordinator shall perform all management actions related to the patient’s death.

3. RESPONSIBILITY:

a. Attending Physician: Responsible for notifying family and requesting autopsy if NOK is present and signing death certificate.

b. Unit Coordinator or nursing staff: Responsible for informing Decedent Affairs, arranging transportation of the body to the morgue, closing the administrative medical record.

c. Ward Clerk: Responsible for entering death note into CPRS.

d. Decedent Affairs Coordinator: Responsible for completion of all required forms and documents, obtaining consent for autopsy, providing information to the family, arranging for final disposition of patient remains, and notifying external agencies.

e. Administrative Officer of the Day (AOD): Completing actions of the Decedent Affairs

Coordinator after normal duty hours, on weekends and holidays.

4. RECORDS/FORMS/DOCUMENTS

(1) The Decedent Affairs Coordinator will complete the following forms:

(2) Decedent Affairs Worksheet in the Computerized Patient Record System (CPRS).

(3) Mortuary Register spreadsheet called “Death Log” located on the QM Shared Drive.

S:\Decedent Affairs\Death Reports 2008.xls

(4) VA Death Benefits Handout (Burial Benefits for Veterans in Receipt of or eligible for compensation or pension and for those who die in a VA facility).

S:\Decedent Affairs\Burial Benefits 7-23-08.doc

(5) VA Form 10-2065 (R) Funeral Arrangements.

http://vaww.va.gov/vaforms/medical/pdf/VHA-10-2065-fill.pdf file:///C:/Documents%20and%20Settings/VHATUCValenV/Local%20Settings/Temporary%20Internet%20Files/Content.Outlook/Death%20Reports%202008.xls file:///C:/Documents%20and%20Settings/VHATUCValenV/Local%20Settings/Temporary%20Internet%20Files/Content.Outlook/Burial%20Benefits%207-23-08.doc http://vaww.va.gov/vaforms/medical/pdf/VHA-10-2065-fill.pdf

Southern Arizona VA Health Care System QPM&C

(6) VA Form 10-1171 Notice to person designated by veteran regarding personal effects.

http://vaww.va.gov/vaforms/medical/pdf/10-1171.pdf

(7) VA Form 21-2008 Application for United States flag for burial purposes.

http://vbaw.vba.va.gov/bl/20/cio/20s5/forms/VBA21-2008.pdf

(8) Standard Form 523A Disposition of Body http://contacts.gsa.gov/webforms.nsf/0/F5D157C6E6FAEEB785257204004E5EE2/$file/ sf523A.pdf

(9) Human Remains Release Form (State of Arizona) http://www.azdhs.gov/vitalrcd/images/Human_Remains_Relese_Form.pdf

(10) Standard Form 523 Authorization for Autopsy http://contacts.gsa.gov/webforms.nsf/0/5749A8F2BBBE9418862572E5005730C9/$file

/sf523.pdf

(11) Patient Information for Autopsy at University Medical Center

S:\Decedent Affairs\BLANK FORM FOR UMC AUTOPSY INFO.doc

(12) Submit Request to Medical Examiner for official Autopsy Report (when applicable) using SAVAHCS letter head.

(13) VA Form 2064 Authority to release and ship effects and funds http://vaww.forms.va.gov/va/Intranet/VARF/getformharness.asp?formName=2064-form.xft

(14) Death Certificate

(15) VA Form 10-2068a Inspection of Services and Merchandise Furnished for Contract

Burial. http://vaww.va.gov/vaforms/medical/pdf/102068a.PDF

(16) Funeral homes in Tucson, Arizona. S:\Decedent Affairs\List of Mortuaries2.doc

5. INTER-FACILITY DEATH PROCEDURE:

a. Unit Coordinator or designated staff will provide the following information to the

Decedent Affairs Coordinator by calling x6423 or the AOD (after hours, holidays and weekends):

(1) Name of patient

(2) Social Security Number http://vaww.va.gov/vaforms/medical/pdf/10-1171.pdf http://vbaw.vba.va.gov/bl/20/cio/20s5/forms/VBA21-2008.pdf http://contacts.gsa.gov/webforms.nsf/0/F5D157C6E6FAEEB785257204004E5EE2/$file/sf523A.pdf http://contacts.gsa.gov/webforms.nsf/0/F5D157C6E6FAEEB785257204004E5EE2/$file/sf523A.pdf http://www.azdhs.gov/vitalrcd/images/Human_Remains_Relese_Form.pdf http://contacts.gsa.gov/webforms.nsf/0/5749A8F2BBBE9418862572E5005730C9/$file/sf523.pdf http://contacts.gsa.gov/webforms.nsf/0/5749A8F2BBBE9418862572E5005730C9/$file/sf523.pdf file:///C:/Documents%20and%20Settings/VHATUCValenV/Local%20Settings/Temporary%20Internet%20Files/Content.Outlook/BLANK%20FORM%20FOR%20UMC%20AUTOPSY%20INFO.doc http://vaww.forms.va.gov/va/Intranet/VARF/getformharness.asp?formName=2064-form.xft http://vaww.forms.va.gov/va/Intranet/VARF/getformharness.asp?formName=2064-form.xft http://vaww.va.gov/vaforms/medical/pdf/102068a.PDF file:///C:/Documents%20and%20Settings/VHATUCValenV/Local%20Settings/Temporary%20Internet%20Files/Content.Outlook/List%20of%20Mortuaries1.doc

Southern Arizona VA Health Care System QPM&C

(3) Time of death

(4) Presence of next-of-kin (NOK) and notification status

(5) NOK authorization for an autopsy

b. Unit Coordinator or designated staff will arrange to transport body to the morgue.

c. Decedent Affairs Coordinator or designated staff (AOD) reviews progress notes cause of death and other relevant information.

d. Medical staff (MD/RN) will determine necessity of notifying the Office of the Medical

Examiner (OME) (See attachment A for list of deaths that require OME notification).

(1) DAC or AOD will contact OME at 520-243-8600 during regular hours and 520-243-

8610 after duty hours and provide relevant details. The OME will either accept or refuse the case.

(2) OME assigns a case number.

(3) Medical staff will notify NOK that the case is being turned over to the OME, as needed.

(4) Morgue staff will complete the Human Remains Release Form and the Disposition of

Body Form (SF 523A).

(5) OME contacts Medical Records/Release of Information at x5018 and requests hard-copy progress notes, discharge summaries, or other relevant records for the last admission.

Release of Information will bring the copies to the Decedent Affairs office.

(6) Decedent Affairs Coordinator contacts OME with the case number, hardcopy progress notes, and release forms.

(7) OME comes to Decedent Affairs Office to pick up forms and records.

(8) Decedent Affairs Coordinator contacts Pathology at x6284 or x1837 to arrange pick up at the morgue.

e. Decedent Affairs Coordinator or designated staff (AOD) initiates Decedent Affairs

Worksheet in Computerized Patient Record System (CPRS). If OME has been contacted, enter the information into the worksheet.

(1) Log into CPRS, Select the Patient, and in the Notes tab select New Note.

Southern Arizona VA Health Care System QPM&C

(2) Use a new appointment and enter 98-12 Decedent Affairs for encounter information.

Select New Progress Note then select Decedent Affairs Worksheet.

(3) Complete the information on the worksheet and save or enter electronic signature and save. See attachment B for sample of Decedent Affairs Worksheet. Once the worksheet has been signed, additional information must be entered using an addendum or a new progress note.

f. Funeral home will initiate the death certificate (VS-2, Rev. 3/08). See attachment C for sample death certificate.

g. Physician signs the certificate and enters the cause of death.

h. Decedent Affairs Coordinator will contact the NOK and provide the following information either in person or via the telephone.

(1) Provide the family information on death benefits and list of funeral homes in the

Tucson area.

(2) Assist the family in obtaining personal effects – contact the clothing room at x6387 or via pager number 4556. The clothing room is located in Bldg. 2, room 192.

(3) If no NOK, the personal effects are donated to the donation room or discarded as appropriate.

(4) Complete VA Form 10-1171, Notice to person designated by veteran regarding personal effects.

(5) Obtain information regarding consent for Autopsy – See Facility Memorandum 06-xx-02, Postmortem Examination and Reports of Death to Medical Examiner, for procedures.

Complete Standard Form 523 and the Patient Information for Autopsy at University Medical

Center.

(6) Obtain information regarding donor status.

i. Decedent Affairs Coordinator will complete VA Form 2064, Authority to release and ship effects and funds to have cash sent to NOK. If there is no NOK, the cash is released to the

General Post Fund. These forms are sent to Patient Travel, Bldg. 60, Room 1614, extension

2989.

j. The patient’s NOK provides Decedent Affairs office the name of the funeral home which they have chosen. Decedent Affairs Coordinator completes VA Form 10-2065 (R) Funeral

Arrangements.

k. Decedent Affairs Coordinator completes VA Form 21-2008, Application for United

States flag for burial purposes.

Southern Arizona VA Health Care System QPM&C

l. The Decedent Affairs Coordinator enters the patient information into the Mortuary

Register spreadsheet located on the QM Shared Drive.

m. Decedent Affairs Coordinator or designated staff will report the death to the Donor

Network of Arizona (1-800-447-9477). Enter this information into the CPRS Worksheet. If the worksheet is already signed, add an addendum or enter a new progress note in CPRS.

n. Decedent Affairs Coordinator contacts the funeral home to pick up the patient remains.

(1) Funeral home representative comes to Decedent Affairs Office.

(2) Decedent Affairs Coordinator provides representative with the Human Remains

Release, Disposition of Body Form, flag, and death certificate (if completed).

(3) Decedent Affairs Coordinator calls Pathology at x6284 or x1837 to arrange pick up at the morgue.

o. If no NOK, the remains are considered unclaimed. These veterans have a right to be interred at the closest State or National Cemetery. Southern Arizona VA Healthcare System maintains a contract with a funeral home to handle arrangements for unclaimed remains. See attachment D for procedures on Unclaimed Remains.

(1) The Decedent Affairs Coordinator contacts the Office of Acquisitions and Material

Management Purchasing Agent at x4615 to obligate funds with a contracted funeral home.

(2) The Decedent Affairs Coordinator completes an on-line obligation form (2237) using

Vista.

(3) The Purchasing Agent contacts the contracted funeral home directly to provide financial information

(4) The Decedent Affairs Coordinator contacts the contracted funeral home to make arrangements for pick-up (see paragraph n).

(5) Decedent Affairs Coordinator obtains shirt, tie, suit, socks, and underwear from the donation room (extension 4557, Bldg. 1A, room 134) for interment. Decedent Affairs provides clothing to the funeral home.

(6) Contracted funeral home contacts the Decedent Affairs Coordinator when body is ready for viewing

(7) Decedent Affairs Coordinator goes to the funeral home and ascertains the body has been properly prepared, the coffin is suitable, and the dececed has been afforded respectable

Southern Arizona VA Health Care System QPM&C treatment throughout the process. The coordinator complete VA Form 10-2068a (Inspection of

Services and Merchandise Furnished for Contract Burial).

NOTE: Other funeral homes may provide this service for unclaimed remains at no charge to the VA hospital on a case-by-case basis.

p. All completed forms and any paperwork related to the patient’s death will be maintained in Decedent Affairs Office for one month and then sent to Medical Records, mail code 11-136D, to be filed in the verteran’s Administrative/Medical Record.

6. DEATH OUTSIDE VA FACILITY PROCEDURE:

a. Decedent Affairs is notified by family members, external medical facility, or the Office of the Medical Examiner.

b. Decedent Affairs Coordinator will enter the death notice in Vista.

(1) Log into Vista

(2) Select the “Details Menu”

(3) Select option 1, “Death Entry”

(4) Enter relevant information at each prompt.

c. Decedent Affairs Coordinator will provide information as requested to NOK regarding burial benefits and funeral homes.

d. Decedent Affairs Coordinator will, on request of the family only, contact VA physician sign the death certificate. This is physician dependent and there is no requirement to provide this service.

7. DEAD ON ARRIVAL PROCEDURE:

a. When admission had been authorized, the death is considered a VA Inter-Facility death and all procedures outlined in paragraph 5 of this SOP apply.

b. When admission had NOT been authorized: Medical staff will notify NOK and OME immediately. Disposition of the remains will be made in accordance with the instructions of the

NOK, unless stipulated by OME. Mortuary services will not be authorized.

8. REFERENCES:

a. 2007 Edition of VA's Federal Benefits for Veterans and Dependents booklet.

Southern Arizona VA Health Care System QPM&C

b. VHA Manual M1, Part 1, Chapters 4 and 14

Attachment A

REPORTABLE DEATHS

According to Arizona Revised Statutes (11-593) deaths reportable to the OME are those which occur:

1. When not under the current care of a physician or nurse practitioner for a potentially fatal illness.

2. Deaths resulting from violence.

3. Death occurring suddently when in apparent good health.

4. Known or suspected homicide, suicide or accidental poisoning.

5. Deaths known or suspected to be related to an accident or injury (accident or injury involving any type of fractures), either old or recent, in whole or part and death following an injury or accident.

6. When there is suspicion that the death was caused by the criminal act of another.

7. All violent, sudden or unusual deaths.

8. Deaths related to or following known or suspected self-induced or criminal abortion.

9. Deaths due to drowning, fire, hanging, gunshot, stabbing, cutting, exposure, starvation, alcoholism (as an acute lethal dose), drug addiction, strangulation or aspiration.

10. Deaths associated with a known or alleged rape or crime against nature.

11. Deaths known or suspected to be due to contagious disease and constituting a public hazard, such as HIV, AIDS and Hepatitis Infections or those that may present a public health hazard.

12. Death from occupational disease or occupational hazard.

13. Deaths occurring on the operating table before the patient's recovery from anesthesia.

14. Patients who are dead on arrival.