The Death Pronouncement

Victoria Trulove

Overview

This approach to the death pronouncement is based in part on the AAFP’s “Death Pronouncement: Survival Tips for Residents.”

Before Entering

  • Familiarize yourself with the most important points of the pt’s hospitalization and recent events. Be aware of the circumstances of the pt’s death, particularly whether death was expected or sudden.
  • Inquire as to which family is present including whether the POA is currently at bedside.
  • In general, it is best to enter accompanied, ideally with the pt’s nurse.

In The Room

  • Mutual introductions between yourself and the family.
  • Be empathetic (consider only short statements such as “I am sorry for your loss”) while focusing on the task at hand.
  • Find a working clock when you enter; your watch is ok; avoid looking at your
    smartphone for time of death.

The Exam and Pronouncement

  • Identify the pt by wrist band. This is a good time to check the pulse.
  • Confirm that the pt does not respond to stimuli. One discreet way to confirm a lack of response to tactile stimuli is to hold the hand, and apply pressure to a nailbed.
  • Confirm the absence of spontaneous respirations and absence of heart sounds for one full minute.
  • Check pupillary light reflex.
  • Note the time at which your examination is completed; this is the time of death.

Make sure to ask if the family would like an autopsy to be performed.

Notify the attending of record and complete EMR documentation.

*Please see further VA- and VUMC-specific guidance below.

Death Process in EPIC

Complete all components in the “Discharge as Deceased” tab under the Transfer-Discharge screen.

  • Cardiopulmonary Death Charting → Select “New Reading” and complete.
  • Cardiopulmonary Death → Select “+Create Note.
  • Medical Examiner Criteria → Select “+New Reading.” Criteria requiring notification of ME is listed in a drop-down menu in the navigator. Includes accidental deaths, threats to public health, suspicion for foul play, etc. The Vanderbilt Operator can assist with connecting you to the ME; alternatively, you can call 615-743-1800 during business hours (M-F 8am – 4:30pm) or the after-hours pager at 800-216-0107.
  • Autopsy Criteria → Select “+New Reading.
  • Preliminary Cause of Death and Date/Time of Death → Rather than list “Cardiopulmonary arrest,” be specific (e.g. Pulmonary Embolism, Myocardial Infarction, Metastatic Colon Cancer, etc.)
  • Deceased’s Info – Report of Death.
  • Report of Death Note → Select “+New Reading” and complete.
  • Complete Synopsis + Hospital Course and then at the very bottom under Summary of Death select “+Create Note.”

Death Process at the VA

Death Pronouncement Process (Updated June 2021):

  1. Nurse will notify physician at time of death for pronouncement with a text page, indicating physician should arrive within 15 minutes or ASAP.

  2. Physician will arrive to pronounce patient’s death within 30 minutes of notification by nursing staff, preferably within 15 minutes. Physician will alert nursing staff if there will be a delay in arrival to pronounce.

  3. Physician to examine patient and pronounce death offering family chaplain support and informing family of death. Family is not required to remain at the bedside or come to the hospital if not at bedside at time of pronouncement. Family can complete documentation/consent forms with decedent affairs clerk at later time by phone.

  4. Physician at time of pronouncement will ask family regarding VA benefit of autopsy either by phone or if present at the bedside. VA pays for the autopsy and this is provided as a benefit to the family if requested. Physician will document if the family agreed to or declined the autopsy and will inform the nursing staff regarding the family’s decision. Please also inform nursing staff of time of death as soon as possible. Page Pathology Resident on call to notify them of any Autopsy request. Additionally, work with Decedent Affairs (DA) during business hours or the Administrator on Duty (AOD) to complete the autopsy consent located in iMed Consent.

  5. Physician will document the death pronouncement using the Death Note-Inpatient template in CPRS. Death notes should be completed as soon as possible, preferably within one hour of pronouncement.

  6. Nursing staff calls and notifies TN donor services of death within 60 minutes of a death and after receiving the time of death from the physician pronouncing death.

  7. The family of the patient is allowed time to grieve and receive emotional support from various staff, including chaplains who are on call 24/7. Once the family is ready to leave the patient’s room, nursing staff will call the Decedent Affairs Clerk during business hours or the AOD if death occurs after business hours such as on weekends, nights, or holidays.

  8. The patient’s remains are removed from the room within four hours of death and taken to the morgue to await transfer to the families’ choice of funeral homes.

  9. The physician will complete a death summary, which is a Discharge Summary (Med/Neuro/Surg) with option of Death Summary that will summarize the hospital course and the death event. This should be completed within 24 hours.

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