Fast Fact and Concept #4: Death Pronouncement

Title: Fast Fact and Concept #4: Death Pronouncement

Author(s): Weissman, D.; Heidenreich, C.

The "Fast Fact and Concept" provided here in its entirety provides an overview of the procedure of Death Pronouncement in a hospital setting. Can be used for discussion during teaching rounds or as a handout to start a teaching conference.

Educational Objective(s)
Review the steps of Death Pronouncement.

Residents have traditionally had little formal training in examining patients to determine death, notifying families, and in recording proper documentation.

The Phone Call: "Please come and pronounce this patient"
1. Find out the circumstances of the death - expected or sudden?; is the family present? What is the patient's age?

2. Preparation Before You Enter the Room

3. Get the details on the circumstances of death from the RN.

4. Find out if the attending physician has been called. In general, see the patient before you call the attending, unless there are unusual family dynamics or details surrounding the death that you should discuss prior to seeing the patient or family members in the room.

5. Has the family requested an autopsy? Do you see a value in requesting an autopsy?

6. Determine if the patient/family has already been contacted by the Organ Donor Network.

7. Review the chart for important medical (length of admission, cause of death) and family issues (who is family?, faith?, is there a clergy contact?).

In the Room
1. You may want to ask the nurse or chaplain to accompany you; he/she can give you support and introduce you to the family.

2. Introduce yourself (including your relationship to the patient) to the family if they are present. Ask each person their name and relationship to the patient.

3. Empathetic statements are appropriate: "I'm sorry for your loss..."; or "This must be very difficult for you...".

4. Explain what you are there to do. Tell the family they are welcome to stay if they wish, while you examine their loved one.

5. Ask if the family has any questions; if you cannot answer, contact someone who can.

The Pronouncement
1. Identify the patient by the hospital ID tag; Note the general appearance of the body.

2. Ascertain that the patient does not rouse to verbal or tactile stimuli. Avoid overtly painful stimuli especially if family members are present. Nipple or testicle twisting, or deep sternal pressure are inappropriate.

3. Listen for the absence of heart sounds; feel for the absence of carotid pulse.

4. Look and listen for the absence of spontaneous respirations.

5. Record the position of the pupils and the absence of pupillary light reflex.

6. Record the time at which your assessment was completed.

Documentation in the Medical Record
1. Called to pronounce (name); Chart findings of physical examination.

2. Note date and time of death; Note if family and attending physician were notified.

3. Document if family declines or accepts autopsy; Document if the coroner was notified.

Also See:
Fast Fact #64: Informing significant others of a patients death

References: 1)Marshall SA, Ruedy J. On Call: Principles and protocols. Philadelphia, Saunders, 2)Marchand LR, Kushner KP. Death Pronouncement: survival tips for residents. American Family Physician, July 1998. www.aafp.org/afp/980700ap/rsvoice.html 3)Magrane BP, Gilliland MGF, King D. Certification of Death by Family Physicians. American Family Physician, October 1997, 1433-8.

Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.

Contact: [email protected]

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #04: Death Pronouncement. June, 2000. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 1/2000

Format: Handouts

Purpose: Instructional Aid, Teaching

Audience(s)

Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice

Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery

Non-Physician: Nurses

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Adult, Age, Autopsy/organ donation, Caring for families, Communications skills, Death pronouncement, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Pediatric, Personal reflection, Prognosis

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).