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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
      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.


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