Charting Time of Death

suzanne4, RN · Sep 18, 2005

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.

April_LPN · Sep 18, 2005

I would personally go with the time that I assessed them.

LisaG21 · Sep 18, 2005

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?

jkaee · Sep 18, 2005

The TOD that I put on the death certificate was always the time I physically went into the room to pronounce.

truern · Sep 18, 2005

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

suzanne4, RN · Sep 18, 2005

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.

suebird3 · Sep 18, 2005

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... :crying2: ...the TOD was exactly what I called it at!!

JoBug · Sep 18, 2005

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

LPN01112005 · Sep 18, 2005

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.

Mississippi_RN · Sep 18, 2005

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.

debRN0417 · Sep 19, 2005

In Virginia only an RN can "pronounce".