Summary: NICU Checklist for Infant Death
These are some helpful guidelines in the event of the death of a NICU infant.
Also, please refer to the Bereavement Notebooks #1 and #2 for specific information on Bereavement issues.
Any member of the Bereavement Committee will be of assistance to you, those names are posted in the
conference room and located in Bereavement Notebook #1.
1. At the time of impending death :
___Chaplain is informed
___Social Worker is informed
___Primary Nurse is informed
At the time of death:
___Decedent Affairs is called - Pic#1405 Contact # 924-5018 (David Haugh)
__ LIFENET is called - 1-866-543-3638 (call with any death, not only organ donation)
2. ___Obtain Death Packet (located in family room off A&B Pods, locked Bereavement cabinet labeled
PINK & BLUE)
3. ___Remove lines ie., PIV's, PAL, ETT,
with Exception of Central Lines, which are not to be removed ie.UAC, UVC, ECMO Cannulas,
Chest tubes, PIC and surgically placed Central lines
4. ___Obtain footprints of infant on footprint card, handprints or earprints may also be obtained on an
index card. Cut a lock of hair and place in plastic bag or tape it to the weight and length card
provided in death packet.