Death note

Death: Pronouncing a patient’s death: You may get paged to go to a patient’s room to pronounce their death.

  • Brief PE should include: “Heart and lung sounds are absent. No spontaneous cardiac or respiratory activity. Patient is not responding/nonreactive to verbal or painful stimuli (rub sternum with knuckles). Reflexes absent (ex: corneal blink reflex absent). Pupils fixed and dilated.”
  • Consider asking the nurse to run an EKG to have asystole documented in the chart.
  • Document when paged by nurse to pronounce death of patient. “Called by nurse at  (time) .”
  • Document when you completed final assessment of death. “Patient seen and examined at  (time) .”
    1. Time of death, including the date (when you examined the patient.)
  • “Those present include (nurse, family, etc.).”
  • Place communication orders to nurse:
    1. “May release to funeral home of choice.”
    2. Nurse is to notify patient’s attending.
  • Additional info: Brief history of events prior to code, refer to code sheet for resuscitation specifics, time of death, document communication with survivors or delegation to PCP, suspected cause of death

“Called to patient’s bedside to pronounce that [name] has died.” “Patient laying motionless. Patient is unresponsive to verbal/tactile stimuli. Pupils fixed and dilated. No spontaneous breath sounds. Absent peripheral pulses. No heartbeat on auscultation.”

Also address:
Family in room? Family aware of death? Post-Mortem Services (autopsy) offered? Chaplain services offered? “Patient’s major medical illness: _____” “Time of Death:_____”

 

Example death note:

“Death Note: Notified by the nurse that the patient was having PEA, which became asystole, at ____ on _____. Patient is DNR/DNI on comfort care.

Patient seen and examined at ____ on _______. Patient was unresponsive to painful stimulation.

Heart and lung sounds are absent. No spontaneous cardiac or respiratory activity. Patient is not responding/nonreactive to verbal or painful stimuli. No corneal pupillary reflex present. Pupils fixed and dilated. Veteran was pronounced dead at ____ on ____. Cause of death: _____.

Patient’s family and patient’s nurse were present in the patient’s room.

Spoke with family in the room. Family does not want the patient to be cremated and does not want the patient to have an autopsy. Chaplain has been contacted to speak with the patient. Condolences were provided to the patient’s family.”

 

Example death note:

“Called by nurse about patient being unresponsive and in asystole. Patient seen at bedside. On examination, patient was unresponsive, bilateral pupils dilated, non-responsive to light, no bilateral conjunctival reflex present, no heart sounds auscultated, no spontaneous breath sounds present, no peripheral pulses present. EKG showed aystole. Patient pronounced dead at 12:50 hours on ______. Attending, Dr. ______, informed regarding patient’s status. No family present at bedside. Dr. _____ informed patient’s son, _______ and condolences were offered.”

 

***Don’t forget: Patient still requires Discharge Summary.

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