Charting Time of Death

  1. 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?
    •  
  2. 29 Comments

  3. by   suzanne4
    In a hospital, the time of death is recorded when the physician pronounces them. Same thing should go for you. Even if it takes that person 20 minutes to get to the room, it is the time that they are actually verifying the time of death.
  4. by   April_LPN
    I would personally go with the time that I assessed them.
  5. by   LisaG21
    Ditto to april....you wouldn't say you bathed someone at 10 when you really did it at 11 cause you got held up would you?
  6. by   jkaee
    The TOD that I put on the death certificate was always the time I physically went into the room to pronounce.
  7. by   truern
    http://biotech.law.lsu.edu/map/Page41.html
    Declaration of Death
    Generally a physician must make the determination that a person is dead. The physician then makes a formal declaration of the death and a record of the time of death. In a hospital setting, the physician who declares the death may not be the one who signs the death certificate. A resident or the physician covering the emergency room may be asked to pronounce the death of a patient who was under another doctor's care. The attending physician would be expected to determine the cause of death and file the death certificate. The physician who pronounces the death must simply determine that the patient is dead.
    If the determination of death is difficult, a physician should consult with others and know the legal definition of death in the state. A patient may be legally dead because of lack of brain function but still have a heartbeat when on a mechanical ventilator. There is no point in ventilating a dead patient, but stopping the ventilator before the legal criteria for death have been met may involve the physician in both civil and criminal proceedings.
    The legal time of death may be a long time after the death actually occurred. Many accident victims are obviously dead at the scene of the accident but are pronounced dead officially on arrival at a hospital because no physician was at the scene. When homicide is suspected or in large cities where the police handle large numbers of accidental deaths, a medical examiner may be on call to pronounce death at the scene and to determine the cause of death.
    The time of death may be important because of survivorship clauses in wills. For example, a man may leave all his property to his wife unless she does not survive him by at least 30 days, in which case the property goes to a hospital fund. The wife might have a will that leaves everything to her son. If they are in a common disaster that kills him outright but leaves her comatose for 30 days, the determination of the time of brain death may well decide whether the hospital or the son receives the property. In such a case, a physician who had an interest in the hospital might be considered to have a conflict of interest in determining death.

    ************************************************** ********

    Am I correct in assuming that in long-term care the MD is not the one to call TOD, that the nurse does it??

    ************************************************** ********

    Never mind...I found this: http://www.cno.org/docs/prac/43001_Resuscitation.pdf

    which clarifies that "When clients are expected to die and their care plans do not include resuscitation, nurses have the authority to pronounce death. There is no legal definition of pronouncing death and no legal requirement for a physician to pronounce death.

    Learn something new everyday on allnurses
    Last edit by truern on Sep 17, '05
  8. by   suzanne4
    It is up to the state on who can pronounce a patient. This will vary. In some, the police can make a determination of death, paramedics in many states can.

    The nursing home normally doesn't have a physican in house most of the time.

    But it is the state that makes the final determination as to what they will and will not accept.
  9. by   suebird3
    When we have a DNR patient die at our LTC, we call MD & coroner. Coroner takes the time we found pt. unresponsive, "heartbeat, resp and BP unobtainable...." We "aren't" declaring death, but.....we are pretty much believed.

    If patient is Hospice, the Hospice takes over.

    Have had to call when my aunt died several years ago... ...the TOD was exactly what I called it at!!
  10. by   JoBug
    I work in LTC, and tonight in fact I had a hospice death. Normally, the family will call us to the room and say " I think mom is gone", and then I will go assess and determine, if soandso is in fact gone. Family members can often be wrong, if they have no knowledge of apnea, ect..
    so here in Iowa in LTC, us nurses, even us LPN's, call TOD. It gets charted as vital signs ceased, no BP, Resp, or AP. And we then call hospice, or the doc on call if needed to inform themn and get the okay for release of body.
    JoBug
  11. by   LPN01112005
    RN's declare death in our facility. The time of death recorded is usually the time that the charge nurse assesses the resident to be without vital signs if the RN isn't on premises. If the RN is in the facility, then the time of death is recorded as the time that she assessed the resident to be without vital signs.
  12. by   Mississippi_RN
    when we walk in and find a pt unresponsive, then we check for vital signs. if none, we chart "walked into room, pt lying on bed, no resps found, pulse and bp unobtainable, family in room/family not in room", etc. then, we go call the patient's personal doctor...he/she will either tell us they will be coming or they want us to call the er doc on call and have them come up and pronounce. the doctor, whenever they get there, writes the tod.
  13. by   debRN0417
    In Virginia only an RN can "pronounce".
  14. by   seasonedlpn
    Home Hospice is a whole new ball-game! Needless to say, no Doctor is around to pronounce. The family calls the answering service, then the service calls the nurse on call. At two in the morning, it takes a while to get up and moving...then a bit longer to get on the road and to the patient. Depending on the distance, it takes at least an hour to arrive at the house. By then, the family has usually called the other family members and announced the death. In my opinion, it would be cruel to set TOD as the moment the nurse pronounced...I usually ask the family what time they noticed the death, and that is the time I put as TOD. I am still pronouncing death...but the time I saw the patient is not the TOD I use. (does that make sense?)

close