So, last night, we had a resident that was DNR expire. We did all the things we know how to do, RN super pronounced, notify MD, notify family, notify DON, call police to do their thing. Anyways, when the police came, they wanted to know where EMS was and why we hadn't called them to pronounce. I say we've never had to call them to pronounce before, as the RN in the house always pronounces, and the house docs have filled out a form agreeing to sign the death cert. for anyone that dies in the facility.
That wasn't flying with these guys and we actually had to call the EMS to come pronounce. (family showed up while we were waiting for EMS to get there).
The policeman said new p&p dictate EMS must always be the one to pronounce per Medical Examiner.
Anyone hear about this or was this cop just being a PIA?
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Your admin might need to call the Medical Examiner's office and get the real skinny. Might just be a rookie cop making up rules that sound good. Or he saw on TV.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Different states and counties have different rules.
If one of our patients in Detroit dies in his home, we (nurses) visit, pronounce, call the local PD (county rules) AND the ME to qualify the death as expected and uneventful. The ME sometimes takes the case but it is rarely because of the circumstances of the death, more often because of something in the pt history that requires his/her investigation (hx of MVAs, fx's, gun shots, etc). Do you provide the local PD with a copy of the hospice DNR at time of admission? We do - name, address, diagnosis, DNR with the name of the hospice agency for those counties that require police notification.
Calling EMS seems a needless expense and the veracity of that request should be investigated.
Specializes in Telemetry, ICU/CCU, Specials, CM/DM.
In the hospital that I worked in FL, if the patient was DNR or Hospice, the nursing supervisor could pronounce. If it was a code, the Doctor would pronounce. If it was deemed to be a ME case, the ME was called. We never called EMS to pronounce, just the family, admitting physicians (sometimes the consults also) and funeral home. The only time that I could think that the PD would be contacted is if foul play was suspected. I never had to call the PD at all.
in new jersey, i pronounce (as a floor ltc nurse) if the patient has a signed dnr order. i don't call the police or ems. i initiate the electronic death registration system (edrs). i call the doc and doc signs death certificate electronically (within 24 hours).
For a DNR, we call the doctor and the funeral home and family, and that's it. I have seen police involved, but I think that was for unexpected deaths. The doctor will pronounce when we call with our assessment. Quick and easy, really.
Specializes in Gerontology, Med surg, Home Health.
in new jersey, i pronounce (as a floor ltc nurse) if the patient has a signed dnr order. i don't call the police or ems. i initiate the electronic death registration system (edrs). i call the doc and doc signs death certificate electronically (within 24 hours).
electronic death registration system? sounds like something out of soylent green or logan's run.
Specializes in LTC, assisted living, med-surg, psych.
It's different from state to state. In Oregon, RNs have some authority to determine that death has occurred, but it also varies by setting. LTC nurses pronounce "unofficially" all the time. We document the death something like this: "Resident found in bed @ 2215 without pulse or respirations, pupils fixed and dilated" etc., then call the MD and get an order to release the body to the funeral home. (This is in the case of DNR; of course full-codes get the entire 911 experience.)
If the death is unanticipated, e.g. resident isn't on hospice or known to be in imminent danger of dying, we have to call EMS and the police so they can verify that it's not a case for the medical examiner. I hate the rare occasions when I have to do that, because it's usually upsetting enough to the family and the staff even WITHOUT having cops milling around in the room and the hallway.
A few months ago, one of our residents went to bed at her usual time and simply forgot to wake up again. She'd been a health nut all her life, and at 85 she still walked at least two miles a day, six days a week, and went out dancing every Saturday with her gentleman friend. Nobody saw this one coming, but we all had to agree she went the way everyone wants to go someday---just went to sleep and didn't wake up again till she got to the Promised Land.
Still, her family and friends were shocked at her sudden passing, so they gathered in her small apartment to pay their respects........and were utterly dismayed when the police showed up! They (quite understandably) wanted to know if foul play was suspected, and if not, why were the cops needed? The administrator and I were in there all morning, answering their questions and fielding comments and questions from the police, the EMTs, other residents, and staff members as well.......ah, it was a mess, and it didn't really need to be. Stupid bureaucracy.
electronic death registration system? sounds like something out of soylent green or logan's run.
yup. this is so much better. everybody can sign it electronically (your license # pre-filled already) including the rn, md, me, and the funeral director. new jersey just implemented this electronic death registration system i think last year.
i had to look up soylent green and logan's run. i was not born yet when those movies came out.
here is the link if anyone wants to check out the interface. you need to be registered though in order to see the whole thing: https://edrs.nj.gov/
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fallinnstyle
146 Posts
Police come in, take report, make sure there wasn't foul play, and call the medical examiner to report the death.