Charting Time of Death

[SouthernLPN2RN]

In LTC, when family comes and says "mom died ten minutes ago" and you go assess them and confirm, would you call the TOD as being when YOU actually assessed the pt or when family says? I feel that it's more appropriate to go by the time I assessed the pt since I can't very well say they were truly deceased if I didn't observe them. What do y'all think?

[DPRN]

In my PA LTC facility, the RN's are the ones to pronounce a death. LPN's can not pronounce a death. The nurse then notifies the physician and requests an order to release the body.

[caliotter3]

I read elsewhere that a hospice LVN can pronounce in CA. However, I am not a hospice employee and nobody bothered to give me the answer at my agency. All I got was "call the hospice nurse" after "tell the parents, they will make the decision to call the hospice nurse". I am busy trying to look things up to get myself ready for my shift that begins in six hours. I hope I can figure something out before anything important happens and I'm caught with my scrub pants down!

[SuesquatchRN, BSN, RN]

Gah. I hate not knowing the rules.

[shunkio]

I have worked in LTC for three years and two of those years have been on 6p-6a when there really is not an RN present with a building full of LPNs and CNAs. I have always written the order for either a coroner or RN to pronounce death at the time I'm charting the evaluation of the patient and then when they come in, I usually ask them what time or just chart that the coroner or RN is currently at bedside and blah blah blah.

[tewdles, RN]

I am in Michigan, in home hospice...

I believe that LPNs may verify and pronounce death in some settings in this state. The hospice agencies I have worked for only use RNs for pronouncement of death. The agency I currently work for allows us to use the reported time of death, if that death was witnessed by two (reliable) family members rather than the time the hospice RN arrived and verified death.

Having said that, I most often use my own time of assessment as the TOD as I believe this to be the road with the fewest possible pot holes. Most families understand this requirement and have no problem with the fact that the times may be different (last breath vs. pronouncement).

[Hospice Nurse LPN, BSN, RN]

In Louisiana an LPN working in hospice is allowed to pronounce. When one of our pts passes, the family calls and says, "I think Mama passed." I chart the TOD when I assess and note no VS, etc. I always explain to the family that even though mama quit breathing before they called me, I have to use the time that I assess. The always understand. The coronor is called and he releases the body.

There was one exception though. Several years ago, I was at a LTC facility checking on a pt. It was about 1130 pm. I was sitting in the nsg station charting and visiting with the night nurse. About 1158 pm, the call light came on for another pt (also one of mine). The nurse asked, "how can I help you?" and the daughter, who we didn't realize was there, stated, "I think daddy passed". Both myself and the night nurse went down the hall and sure enough, the pt had passed away. The TOD was noted as 1202 am. I did my thing yada yada. About 3 weeks later I get a call from this daughter who is IRATE. She said that the date is wrong on her fathers death cert. I pulled the chart and confirmed the date. She said, "No. Daddy died before midnight". I explained to her that the TOD is when a nurse or doctor confirms that the pt is deceased. She demaned the death cert be changed because she put on the headstone one date and the death cert had another date. I felt sorry for her, but there was nothing I could do. I referred her to the coronors office. They couldn't change the date either. From then on, I've always made SURE my families understand the TOD especially if it's closed to midnight.