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?

[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?)

[star2nite2000]

At the previous facility I worked at, a woman passed away and I called the family and the physician, etc. When I called the physician (which was around 2am) he whined and said 'I don't have to come there do I? Just record the time of the death on the telephone order that you write for releasing the body to the funeral home'. As much money as these physicians get paid, they can at least come do their job. I don't care what time of day it is. Plus it would have been nice had he done so, considering he was the in house physician and the woman had been his nurse when he first started practicing!!

[nightmare, RN]

In the Nursing Home we,RN's,verify time of death when we have checked that all vital signs have ceased. During the night especially you can't call out a doctor just because someone has died! During the day they verify death but call the doctor so that death certificate etc can be issued.

[marjoriemac, LPN]

Yeah most times someone has died in homes I have worked, the nurse would proclaim the TOD. Doc would come to verify but that isn't always quick, so he usually writes TOD on his documentation as when the nurse states!

[sofaraway04]

Where I work, on our resus status forums there is a section where the doctor can sign that a nurse can verify death (we have to go on a course first). If that happens and a pateint dies the nurse can verify and we call the funeral directors to come and collect. the doctor will then go to the funeral directors to sort the death certificate etc.

If no-one is on duty that can verify death, then we call the out of hours doctors service and i'm told they will send a paramedic to verify death (haven't had to do this yet).

I would put the exact time that you assessed the pateint, you coudl always add to your documentation that the family reports patient had died 10 minutes prior to informing nursing staff

[Sabby_NC]

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.

Agreed- In Hospice it is when WE assess for no signs of life. It is sometimes hard for family members to get around this as they will always state the time their loved one died in front of them.

I explain to them that legally it has to be the time I assess their loved one for my records.

[txspadequeenRN, BSN, RN]

time of death should be recorded as the time you as the nurse walked in and found them without a heart rate and not breathing.

[mahoganybbw]

Speaking of pronouncement of death, I have worked in hospice for several yrs now and have been allowed to pronounce death of patients. Recently i was told that LPN's are not allowed to pronounce even in the hospice sector. I have emailed AZ board of nursing but have not gotten a response yet. So i guess my question is, is there a difference because it is a hospice patient or was i wrong in attending the deaths i attended for previous hospice company?

[bluegeegoo2, LPN]

Speaking of pronouncement of death, I have worked in hospice for several yrs now and have been allowed to pronounce death of patients. Recently i was told that LPN's are not allowed to pronounce even in the hospice sector. I have emailed AZ board of nursing but have not gotten a response yet. So i guess my question is, is there a difference because it is a hospice patient or was i wrong in attending the deaths i attended for previous hospice company?

Another LPN and I just pronounced someone this evening in my facility. We have to have 2 nurses pronounce, regardless of their title. It's a facility policy thing. Seems some time ago someone sent a res to the morgue who wasn't quite ready yet.:imbar I'm really don't know if we can pronounce in a home hospice setting, but we do have LPN's that are hospice nurses so I would suppose they could. I'll ask next time I see one of them.

[rmarz]

I only chart absence of vitals in Kansas

[caliotter3]

This issue has come up for me. I am in CA and have been assigned a hospice client who is expected to leave us at any minute. I was told to call the hospice nurse, who works with a different agency. I'm hoping that nobody jumps all over me no matter what it is I do because it has been so long since I worked when a patient passed. If I were in a facility, I would know to call the doctor to get the order to move to the morgue. I'm relying on the hospice nurse with this one.

[SuesquatchRN, BSN, RN]

In NYS an RN can pronounce. An LPN cannot. Only a physician can sign a death certificate.