Who pronounces the death? - page 2
by NICU_babyRN | 9,745 Views | 19 Comments
The quote below is from another thread and it raised an eyebrow! I didn't think it was legal for an RN to pronounce anyone person dead. I do believe it is an MD or Paramedic (with more than a basic EMT) who has to... Read More
- 1Mar 4, '08 by Pepper The Cat, BSN, RNQuote from loriangel14yep I have pronounced many deaths. In fact, if a death is expected and happens at 2:00 in the morning, we don't even call the doctor until around 6 or 6;30 - unless they are a coroners case. But even then, I can pronouce.Where I work in Ontario the RN can pronounce but the MD has to sign the certificate.
The MD has to do the death certificate though.
- 1Mar 4, '08 by fussterI work at a hospital (acute care) in Michigan. RN's at my hospital can pronounce if the pt is a full DNR. 2 RN's have to do the death pronouncement, checking for heartbeat, carotid pulse, respirations, etc. Plus I work on telemetry, so we can record a rhythm strip showing asystole (although that isn't mandatory). The MD still has to sign the death certificate, though.
- 0Mar 4, '08 by spider11I'm an LPN in Indiana and work in a hospital. All the nurses can pronounce as long as it's verified by another nurse and the pt is a DNR. We frequently have hospice pts or many other DNRs on the floor. Of course we don't pronounce in a code situation, the ER doc is called up for the code. We fill out all paperwork and the MD signs it.
- 0Mar 4, '08 by not nowHere an RN can pronounce if the MD has charted that "death is imminent, RN to pronounce." If they are DNR and die the MD still has to come up and pronounce if "death is imminent" wasn't charted.
When I worked LTC an RN could pronounce after talking to the MD, even on the phone.
- 0Mar 5, '08 by johnwaynehairConcurr c Mianders; usually the MD writes an order "RN to pronounce" for the DNR pts. 2 RNs will palpate/auscultate for pulses; auscultate for respirations, confirm EKG asystole, call time of death, and document. If pt is vented then the MD must order for the pt to be placed on a T-piece-- we can't extubate. If no T-piece order is in place, then the ER doc has to come up to the Unit.
- 0Mar 6, '08 by caroladybelleIn hospice, in many areas, RNs can pronounce death.
In some states and facilities, RNs pronounce uncomplicated deathes. My current facility allows us to do so, but in others, the ER MD comes up at his leisure to do so....which can be a lapse of hours. In cases of PEA, I really to prefer to have the MD determine time of death, as it more "complicated", as are coroner's cases, codes, and cases with legal ramificatons.
Now, signing the death certificate/cause of death...that is generally reserved for MDs. As those requires a certain amount of medical diagnosis issues.
- 0Mar 6, '08 by Cardiac-RNQuote from elkparkAgreed. Check your state law/ practice acts.This isn't an ethical issue, it's a legal one -- state law specifies who can pronounce, and, like everything else, the regs vary from state to state. It's important to be aware of what is and isn't within your scope of practice where you're practicing.
I believe there are a number of places where RNs can pronounce under lmited circumstances -- like, in LTC settings.