RN's Pronouncing Death

  1. It is routine for our Hospice RN's to pronounce in the home, notify primary MD and funeral home (and physician signs the death certificate).

    We recently hired a new executive manager who is reviewing our policy/procedure manuals and she says that only those patients on hospice may be pronounced by RN.

    So what about hh patients with terminal illness, not on hospice, have DNR orders and they die in the home? New boss says state of Michigan does not allow the RN to pronounce in that case. 911 must be called to transport body to ER for pronouncement.

    I cannot find anything on the the web about RN pronouncement regulations.
    Please share any insight you may have on this subject......
    thanks!!!!!!!!!
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  2. 13 Comments

  3. by   ShandyLynnRN
    I don't know the laws, and I'm sure that they are different in each state, but I worked for a Skilled facility a few years ago in a hospital setting, but without Doctors there 24/7..... RN's had to call the doc and get an order to pronounce, with 2 RN's present and charting absence of respirs and heart tones.
  4. by   deespoohbear
    I don't know about Michigan law, but in Indiana if you call 911 the EMS is legally obligated to attempt resuscitation and transport to the ER. If my loved one was on home health and terminally ill (and not with hospice) and didn't want heroic measures, I would be mad as anything if they were coded and transported....I just don't get it...dead is dead....regardless if you are in a hospice, home health patient, or a nursing home. Seems like a lot of unnecessary expenses would be incurred by the family if a body has to transported to ER just for pronouncement. What about the coroner? The coroner in our county (who happens to be an RN) can pronounce death at the scene. Maybe that is who you will need to contact for pronoucement....I will be interested to hear what you find out about this....
  5. by   hoolahan
    I don't think EMS is still legaly obligated if advanced directives and/or written order from doctor are in the home.

    In NJ, as long as we have 1. an order from the doctor to pronounce death, whether hospice or not, 2. a signed order, signed by family too, then we pronounce. We have had a rare few people who for whatever reason just cannot accept the term "hospice" but want to die at home, so in those cases, I will obtain everything we need to do so if the hospice referral is declined by family. I usually will have the hospice nurse meet w family once or more to try to get them over to hospice, but sometimes, people want that "cushion" of going to the ER, or a family mbr may be afraid to go through w death at home, or pt is still on chemo or rad.

    I would think this depends on your nurse practices act, so check w your state board of nursing first. Then it would remain with your own agencie's policy.

    Good question!!
  6. by   sunnygirl272
    Jenny,
    here is a link to a search...sort through and find your state...it should be there....

    http://search.yahoo.com/search?fr=sl...eath%20by%20RN
  7. by   duckie
    It must have to vary between states because I am an LPN and Believe me, I have pronounced more deaths than I would ever like to remember. In LTC, there is hardly ever an RN in the building, so I pronounce, call the MD and make all final arrangements. Also, where we are at, I am the only one, I need no back up signature. In 22 years of nursing, I have never made a "wrong" call. Check out your state regs. Duckie
  8. by   deegal.lpn
    Yep I'm with Duckie, I'm an LPN I pronounce people dead all the time I too have never been wrong yet. LTC
  9. by   jenac
    In my LTC- the policy is for two LPN to verify absence of vital signs. If an RN is handy- all the better, but not necessary.
  10. by   caroladybelle
    To the Powers That Be - what is the physiological difference between a hospice patient and non-hospice patient that permits nurses to pronounce death in one case and not the other.

    Is it that their lives have less merit, do MDs give them less importance, or not want to be bothered?

    I know that I am being picky, but does anyone else see an ethical issue here?

    I recall in situation in which a "No Code" patient was dying - RR of 6 and agonal - where I had an MD that wanted to go ahead and sign the death certificate - and have Nursing fill in the time when it occurred. We briefed him on why that was not appropriate.

    Nurses should be able to pronounce or not be able to pronounce. I don't feel as though hospice/ non-hospice, or at home/LTC/hospital placement should make a difference. Either we can identify death or not. I know that this may not be popular, but it is how I feel.
  11. by   sixes
    i could be wrong but in canada rn's are not allowed to pronounce in my home care experience only a md can. if the death at home is unexpected the opp (police) must be called. if death is expected md must be notified so he can pronounce before the funeral home picks up the deceased
  12. by   renerian
    I usually called the doc and he or she pronounced after hearing the client had no vital signs. WE called the coronor if we had to and the funeral home. State to state does vary.

    renerian
  13. by   Maerzie
    For years nurses have been "pronouncing" patients dead under various different words: e.g. "absence of vital signs", B.P.), TPR 0-0-0." etc. You just don't say THE word "DEAD!!"

    In many areas of our country "CORONERS" are only lay people who have been elected or appointed to the position and have absolutely NO medical training at all! So all the formality and technicalities "required" for nurses are actually degrading to our profession. Obviously if there is room for any doubt a nurse will know that the doctor must appear!! Would that lay person/coroner be wise enough to make that same choice??

    In my experience, "Pronouncing" continues to revolve around semantics and what the primary care doctor/coroner allows and prefers (or demands!) Many doctors would never think of coming out in the middle of the night for an "expected" death. If circumstances are unusual, they are probably there already or they will come in because they like to be there for the family of the deceased
  14. by   Sammie
    Hi
    In Mass. home care nurses do pronoucements only for
    "expected death in the home" patients. They have to have
    current DNRs and documentation of patient/family and MD agreement that terminal care needs will be addressed by the VNA.
    This is usually for our patients who refuse hospice and/or use our pallitative care program.

    We made sure we had the state law, our state nurse practice act and a current policy.

    We also have Comfort Care which the MD can order from their office, the band stays on and it is respected by EMT's as a patient based DNR. Nice program for families and patients who wish to be left alone.

    My grandad took a Sharpie marker and wrote DNR on his chest during his last hospital stay, he wanted to make sure "no fool doctor thumped my chest".

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