Pronouncing Death

[lumbarpain, ADN, RN]

I have been out of the Nursing scene for a few years....and would like to know what the RNS exactly do when someone passes away at their facility....from the time of death , to calling the MD, poa, family. and funeral home to what the CNAs do. How and what do you say to the family, besides I am sorry....... What do you document in the medical record . Its been awhile for me and I am somewhat rusty. I am finding this more difficult to do as I get older.

[CapeCodMermaid, RN]

We get an MD order to pronounce. We check for respirations, pupillary response and any pulse or heart beat. We express our sympathies to the family if they are present at the time of the death. Then we get an order to release the body to the funeral parlor. Sometimes the family wants to spend time with their loved one before the funeral parlor comes. Sometimes they don't. Then we call the funeral home, fill out the paper work, write a note, and say good bye.

[chrisrn24]

Same as CCM. Confirm death, call family (most know that their family member is near death and aren't surprised. I just say "I'm sorry to let you know that X just passed away"), call for an order to release the body, call the funeral home.

And then I chart all that.

"X passed away at 2030. No pulse, no respirations. Daughter notified via telephone. Received order at 2040 to release body per Dr. Y. Funeral home called and arrived at 2145 to pick up body, left with body at 2155."

I would also chart if you sent any dentures, glasses, jewelry with.

[lumbarpain, ADN, RN]

thank you for helping me out.....I had just returned back after a stressful sabbatical from Nursing and found it more stressful returning

back again.......I wanted a change from the LTC/Sub Acute I did for many years....just wanted to get into a doctors office at this time of my career.

I had wrote the proper documentation but you have confirmed it and I feel much better..........but I am learning fast......nursing can be a very lonely profession also . Thanks.

[amoLucia]

When I get report from 3-11 that someone's in very poor condition, my first question is to ascertain DNR/code status. I then ask 'does family know' as they may wish to come in. I check the chart to see if we have a designated funeral home.

I hate those phone calls at 2 am because regardless how much a death has been expected, it is still very upsetting to be told of an expiration. I am most sensitive when the next-of-kin for an 82 y/o woman is her 85 y/o husband - those phone call are the toughest. (That's why I check for a FH designation because family is freq too shaken to think straightly at 2 am.) I may call the next on the list (offspring) if I think the spouse is really shook up too much. I need to know if family will be coming in to view the pt before I send them to the FH which I confirm with the offspring.

My CNAs will prepare the body for viewing/pickup and I make a "death note with pronouncement" assessment chart entry. I do offer the MD to call the family if they choose, but only one physician has ever wanted to make the family calls himself. I do remind MD that the death certificate will need to be competed electronically. Because of the time, I try to make my family phone call as comforting as poss - ie. that the "pt passed away quietly in no visible distress and had not been in observed discomfort when last checked by staff for routine care". It seems to soften the phone call. And I make sure that call is made very close to the recorded time of death.

Another important phone call is to Hospice - they usually have an on-call person call back. A rare phone call may be nec to a court-appointed State guardian or a lawyer executor. Nothing they have to do, but my phone call is made according to 'timely notification' requirements.

The actual pronouncement is not much except the death certificate and charting that mat may require some extra things/copies as per facility policy. Some places want you to call the DON and don't forget to fix your census accdgly.

Now for all you RNs out there who have had to do pronouncements, do you ever have that gnawing fear that you've 'mis'diagnosed the expiration too early?!? I have --- I keep going back checking and checking and checking ... Philadelphia area just had a case of a pt who 'woke up' in the FH just before he was about to be prepped. I do so worry ...

[noc4senuf]

Depending what state you are in, an RN can pronounce in some states. The notification calls to MD, family, etc would happen after the RN pronounces. Other states, the time of death is listed as to when an MD actually is contacted and given the info, which could be quite a while after the actual fact.

[Havin' A Party!, ASN, RN]

Don't forget to call the Coroner's Office.

[CapeCodMermaid, RN]

I don't call the coroner or the ME's office for every death. I would call if the death were from a fall in the facility or if the resident died within the first 24 hours after admission--unless they were admitted on CMO or hospice and expected to die. I've never had the ME want to take the case. They usually ask why I think the person died. After I explain that it is outside the scope of practice for RNs in Massachusetts to determine cause of death, the ME says 'Yah..I know, but why do YOU think they died?" It doesn't happen very often.

[systoly]

also adjust census and notify other departments

ask family what to do with rings, hearing aids, etc.

[lumbarpain, ADN, RN]

Thanks everyone for your help......I usually WATCH these people closely. I take Full vitals on my shift although some nurses think this is a joke....I don't.....but it tells me that something is on its way or in the process and then I am somewhat prepared. My aides are cued to the patients needs and comfort care is provided totally.

...and If I feel the need necessary that vitals have dropped considerablely I would call the poa or next of kin to see if they would want to come to see them if possible. But this type of thing can be heartwrenching if the family JUST MISSES them passing away when they think they will see them still alive. I get my death certificate ready for the Mortician......I have never called the Coroner for anyone in all the years of my nursing. Most of my patients were on Hospice.....I only called the Hospice nurse , the poa, or family member and Doctor and mortician.. The body would be cleaned and any jewelry/hearing aides, etc, taken off and stored and labeled properly in locked up medical cart until the famil comes to pick it up. All is documented. Dentures are left in. Tubes are disengaged, 02 shut off. any foley bags or whatnot is disconnected also. This is all documented in the death note on the EMR. The Mortician is called to pick up the body and they are taken to the funeral home...I say my goodbyes and sincerely hope I made their last days on earth fairly comfortable for them.

[Havin' A Party!, ASN, RN]

I don't call the coroner or the ME's office for every death...

In some States, all deaths need to be phoned into the ME's office. The office will then advise if the body can be released.

[Not_A_Hat_Person, RN]

Don't forget to call the Coroner's Office.

In my state, the Medical Examiner has to be called only if the resident's death was unexpected.