Pronouncing Patient Death
- Things to think about before entering the room:
- Was the death expected or unexpected?
- If the family is present, inform them of what you are doing and ask if they would like to be present for the examination.
- Approach family or friends present with humility and sensitivity.
- Ask the family if they would like to request or decline an autopsy.
- How to pronounce a death:
- Identify the patient by ID tag.
- Assess for response to tactile or verbal stimuli (avoid overtly painful stimuli, particularly in the presence of family).
- Listen for absence of heart sounds and feel for the absence of a carotid pulse for a minimum of 60 seconds.
- Look and listen for the absence of spontaneous respirations for a minimum of 30 seconds.
- Record the position of the pupils and the absence of a pupillary light reflex.
- Who to notify:
- The attending physician
- Organ Donor Network
- Medical Examiner
- A death note must be documented in the chart. Below is a sample of information that should be included:
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Called at _____ by _____ to pronounce _____. On exam, no heart sounds or breath sounds were noted after 1 minute of auscultation. Pupils were fixed and dilated without pupillary light reflex. Patient was pronounced dead on --/--/---- at --:--. Attending Dr._____ was notified. Family _____ was present/notified by phone and condolences were offered. The organ donor network was notified and the case was accepted/declined. The case was/was not reportable to medical examiner. Autopsy was requested/declined. |
Sunset Rounds
Sunset Rounds: a framework for post-death care in the hospital
As soon as possible after death, gather as a multidisciplinary care team* for an interprofessional timeout to develop a plan and assign a responsible party for each of the following aspects of post-death care:
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Notification of Survivors |
Determine the most appropriate patient contact and the team-member best suited to disclose. Consider saying a few closing words honoring the patient. |
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Coroner/Medical Examiner |
Contact the Coroner or Medical Examiner if required. Not all deaths must be reported; check your state guidelines.** |
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Organ Donation |
Contact the local Organ Donor Network*** who will determine donor eligibility and coordinate outreach if appropriate. |
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Autopsy |
Introduce autopsy as a standard part of the death process. Provide an informed discussion of autopsy procedure including possible harms and benefits. |
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Death Certificate |
To be completed by the attending physician of record. Timely completion is necessary to allow for transfer of patient body to the mortuary and accuracy aids in studies of mortality. |
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From Bedside to Morgue to Mortuary |
Inquire regarding post-death cultural preferences and practices. Be specific with survivors regarding the amount of time they have at bedside and the sequence of next steps. Describe how the patient will be transported from the hospital morgue to the mortuary once designated by surviving family or friends. Provide them with decedent affairs team’s contact information. |
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Bereavement |
Secure contact information to provide follow up. Ask survivors if they are interested in receiving information on counseling or group services. |
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Team Debrief |
Contact patient’s outpatient primary care providers and other inpatient healthcare providers involved during patient’s hospitalization. Debrief as an inpatient care team: consider taking a moment of silence. Reflect on the patient and their hospital course. Identify aspects of care that went well or that you are grateful for. Elicit unresolved emotions, questions, or concerns. |
*Care team should include primary physicians and nurses, relevant consultants (e.g., palliative care), spiritual personnel, and decedent affairs team members.
**State reporting guidelines can be found at: https://www.cdc.gov/phlp/publications/topic/coroner.html
***Local Networks can be found at: https://www.organdonor.gov/awareness/organizations/local-opo.htm