| Yes | No | No documentation | |
|---|---|---|---|
| Parental opportunities in decision | 5 | 0 | 1 |
| Family need assessment | 5 | 1 | 0 |
| Parents aware death during transfer | 4 | 0 | 2 |
| Parents aware child may/may not die post extubation | 4 | 1 | 1 |
| Symptom management discussion | 3 | 0 | 3 |
| Organ donation discussion | 0 | 0 | 6 |
| Advance care plan | 1 | 5 | 0 |
| Completion of LOTA form | 4 | 0 | 2 |
| Infection control issues documentation | 4 | 2 | 0 |
| Special family wishes | 4 | 0 | 2 |
| Equipment/resources/medication for destination | 5 | 0 | 1 |
| Cultural, spiritual practice record during death | 5 | 0 | 1 |