Do I pick the chronic illnesses that\nwere documented by previous providers? Or the recent upper respiratory disease\nthat she had and was \u201cimproving from\u201d per nursing staff?<\/p>\n\n\n\n
The Uniform Declaration of Death Act\n(1980) declares that death has occurred when an individual has sustained either<\/p>\n\n\n\n
- Irreversible cessation of circulatory and\nrespiratory function or <\/li>
- Irreversible cessation of all functions of the\nentire brain including the brain stem. <\/li>
- It also states that a determination of death\nmust be made in accordance with accepted medical standards but does not specify\nwhat those standards should be.<\/li><\/ol>\n\n\n\n
When you look at a death certificate, you will see that it includes lots of personal information on the patient. It will consist of the name of the patient, date of birth, address and more. All these questions will need to be completed either by the supervisor in the facility or the practitioner filling out the certificate.<\/p>\n\n\n\n
The doctor, APRN, or physician assistant will need to fill out the cause of death along with intermediate causes, presumed onset and the date of death, and underlying causes. <\/strong><\/p>\n\n\n\n
There will be ancillary questions dealing with tobacco and pregnancy that will need to be answered. <\/strong><\/p>\n\n\n\n
You will need to write in your full name with signature and credentials. Include the date, address of pronouncing provider, and make sure the name is written on the document. <\/strong><\/p>\n\n\n\n
The rest is usually filled out by the medical examiner or staff member. <\/strong> <\/p>\n\n\n\n
Do not do the following when filling out the certificate<\/h2>\n\n\n\n
- Do not use stamps for signatures<\/li>
- No erasing or \u201cscratching out\u201d with a pen<\/li>
- No facsimile signatures<\/li>
- Reproductions or duplicates are not\nacceptable.<\/li><\/ol>\n\n\n\n
The cause-of-death sections <\/h2>\n\n\n\n
According to the CDC, Part I is for\nreporting a chain of events leading directly to death, with the immediate cause\nof death (the final disease, injury, or complication directly causing death). Only\none cause should be written on each line. Line (a) must always have an entry. <\/p>\n\n\n\n
The \u201cintermediate causes\u201d contribute to death such as congestive heart failure or myocardial infarction. <\/p>\n\n\n\n
When possible, include the underlying causes, which may have contributed to the end, such as obesity or coronary artery disease.<\/p>\n\n\n\n
Part II includes other illnesses the\npatient had even if not a direct cause of their death. The other contributing diseases\nwill help with statistical collections. <\/p>\n\n\n\n
Remember that the Center for Disease Control (CDC) wants the \u201cbest estimate of the interval between the presumed onset and the date of death\u201d for each diagnosis listed. The terms \u201cunknown\u201d or \u201capproximately\u201d may be used as well as terms such as minutes, hours, or days. Just do not leave the time estimates blank. <\/p>\n\n\n\n
Do not use the terminal event \u201ccardiac arrest or respiratory arrest\u201d for the line (a). You can use the terminal event when combined with the contributing factor such as \u201ccardiac arrest due to blunt impact to the chest.\u201d<\/p>\n\n\n\n
When listing end-organ failure, make\nsure to include the etiology on the line(s) beneath it. For instance, if the\npatient had kidney failure, was it due to Diabetes?<\/p>\n\n\n\n
Include the following with neoplasms<\/h2>\n\n\n\n
\n\nCDC wants to know as much as possible when reporting a neoplasm as the cause of death. \n\n<\/p>\n\n\n\n
- Primary site or that the primary site is\nunknown <\/li>
- Benign or malignant<\/li>
- Cell type or that the cell type is unknown<\/li>
- Grade of tumor <\/li>
- Part or lobe of the organ affected. <\/li><\/ul>\n\n\n\n
Documentation<\/strong><\/h2>\n\n\n\n
In most states, the death certificate will list the time of death, cause of death, and place of death. <\/p>\n\n\n\n
\u00b7 \nDid\ntobacco use contribute to death? <\/p>\n\n\n\n
\u00b7 If female, was she pregnant at the time of the death? If the female is either too old or too young to be pregnant, check the \u201cNot pregnant within the past year\u201d box. <\/p>\n\n\n\n
\u00b7 \nTake\ncare to make the entry legible and use permanent black ink.<\/p>\n\n\n\n
\u00b7 \nDo\nnot abbreviate conditions<\/p>\n\n\n\n\n
<\/div>\n\n\n\n\nAlways check the Manner of Death <\/h2>\n\n\n\n
The manner of death (Natural, Homicide, Accident, Pending investigation, Suicide, could not be determined) <\/p>\n\n\n\n
Used to:<\/h3>\n\n\n\n
1) Determine accurate causes of death, <\/p>\n\n\n\n
2) Processing insurance claims<\/p>\n\n\n\n
3) Statistical studies of injuries and\ndeath. <\/p>\n\n\n\n
Death with Elderly<\/h2>\n\n\n\n
There are special considerations when it comes to the elderly. According to Henry Hanzlick MD:<\/p>\n\n\n\n
- Elderly people\nsometimes seem to die “with their disease” rather than “of their\ndisease.”<\/li>
- Several diseases\nmay coexist, none of which alone or together clearly caused death.<\/li>
- Death may occur\nmany years after “normal life expectancy” and the relationship of\naging, disease, and death are unclear.<\/li>
- Conditions that\nmay not occur or be fatal in a young person may cause the death of an older\nadult.<\/li>
- Dementia or injury\nmay be overlooked as the underlying cause of death.<\/li>
- A specific\nunderlying cause of death (such as the cause of a “stroke”) may be\noverlooked.<\/li>
- Fractures are\ncommon, and non-traumatic pathologic fractures must be distinguished from\nfractures due to external conditions (injury). <\/li>
- Elderly people\nmay be more susceptible to death because of a pre-existing condition or\n“frailty.”<\/li><\/ul>\n\n\n\n
Do not use these adjectives on the death certificate<\/h2>\n\n\n\n
- Infirmity<\/li>
- Old age<\/li>
- Advanced age<\/li>
- Frail<\/li><\/ul>\n\n\n\n
If you are unable to figure out the\ncause of the disease process, you must document with words such as \u201cunknown,\nundetermined, probable, presumed, or unspecified.\u201d You need to let people know\nthat you didn\u2019t just ignore the cause. <\/p>\n\n\n\n
When to report a death to the medical examiner<\/h2>\n\n\n\n
The medical examiner investigates\ndeaths that are unexpected, unexplained, or if an injury or poisoning was\ninvolved. <\/p>\n\n\n\n
Causes of death that should be reported:<\/h3>\n\n\n\n
Abuse or neglect: All suspected cases of abuse\nshould be reported unless ruled out. <\/p>\n\n\n\n
Inconspicuous\ninjury: When\nthe patient has an unwitnessed fall, traumatic fractures, and other types of\ninjuries you should report the death. <\/p>\n\n\n\n
Suicide: When the non-suicidal cause of death cannot be determined,\nthe possibility of suicide should always be considered and reported. <\/p>\n\n\n\n
Hypothermia\nand hyperthermia: These types of death should be reported because external\nconditions such as injury or poisoning may be involved. If you believe it to be\nrelated to an illness, then document this as an intermediate cause of death and\nlist the underlying cause. <\/p>\n\n\n\n
If the patient was possibly poisoned\nor had an injury resulting in death, you will need to either have a supervisor or\nyourself call the medical examiner\/coroner to report the death. The examiner\nwill then determine if there is a need for a possible autopsy.<\/p>\n\n\n\n
The medical examiner\/coroner will\neither complete the cause-of-death section of the death certificate or waive\nthat responsibility. The medical provider will need to fill out and sign the document\nif the medical examiner doesn\u2019t take on the case. <\/p>\n\n\n\n
If you are in doubt as to whether the\ndeath is reportable, report it.<\/p>\n\n\n\n
Failure to complete the death certificate can be a criminal offense <\/h2>\n\n\n\n
The original death certificate is\ngiven to the funeral home or mortuary. The failure of a physician to\nimmediately submit the required form to the government (to trigger the issuance\nof the death certificate) is often both a crime and cause for loss of\none’s license to practice.<\/p>\n\n\n\n
If you are not going to come into the nursing home to sign the certificate, make sure to delegate the responsibility to another medical provider such as APRN or Physician Assistant. However, it is the ultimate responsibility of the physician to make sure the certificate is completed. <\/p>\n\n\n\n
Distractors from the real cause of death <\/h2>\n\n\n\n
When trying to determine the actual\ncause of death, the complication can sometimes be confused to be the cause.\nSuch as pneumonia, which is reported as an \u201dintermediate cause\u201d of death while\nthe primary diagnosis, such as cerebrovascular disease or chronic lung disease\nis the actual cause.<\/p>\n\n\n\n
Always try to identify the underlying\ncause of death and its related complications, which made the problem worse such\nas sepsis related to neurogenic bladder associated with the main cause of ALS. <\/p>\n\n\n\n
Some examples by the college of\nAmerican pathologist include:<\/p>\n\n\n\n
- Decubitus ulcers are related to some\nunderlying causes such as neurologic illness.<\/li>
- Pulmonary embolism is due to hyperviscosity. <\/li>
- Malnutrition because of an illness such as\ncancer. <\/li><\/ol>\n\n\n\n
So always try to identify the root\ncause of death then add the complications that lead up the death of the\npatient.<\/p>\n\n\n\n
Funeral home director Role<\/h2>\n\n\n\n
The funeral home directors are usually\nhelpful in assisting the medical providers in completing the death certificate.\nOften, they will type in all the information regarding the patient, leaving you\nwith your portion to complete and sign. <\/p>\n\n\n\n
The funeral director often picks up the certificate at the nursing home or even in the doctor’s private practice. When they come to the office, they will often have the \u201cface sheet and diagnosis list\u201d given to them by the facility to assist in making the decision.<\/p>\n\n\n\n
Please be polite and try to be timely\nif filling out the certificate. The director needs your signature to complete work.\nThe funeral director is part of the team and should be treated as such. <\/p>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
If there are not any know causes of death,\npart I may be reported as \u201cUndetermined Natural Causes\u201d while any co-conditions\nare reported in part II.<\/p>\n\n\n\n
Also, do not overlook dementia as the\nunderlying cause of death. This disease process has multiple manifestations\nleading to death. <\/p>\n\n\n\n
You want to take filling out the death\ncertificate seriously. This form is used for many official functions and can\naffect the outcome of court cases and family insurance settlements, etc. <\/p>\n\n\n\n
The cause-of-death statistics continue to be one of the most valuable databases for monitoring health at the local, state, and national levels, and for epidemiological and medical research.<\/p>\n\n\n\n\n
