Pronouncing Death

Although other emergencies take precedence over pronouncing a patient dead, try not to postpone this task for too long, as the time of death is legally the time at which you see and then pronounce the patient dead. It also allows the nursing staff to begin organising the numerous notifications and procedures required once death has been certified.

Expected Deaths

1. Review the medical notes to obtain the background to this event
2. Identify the patient by the hospital identification tag worn on the wrist or leg
3. Ascertain that the patient does not rouse to verbal or tactile stimuli (some central painful stimulus)
4. Look and listen for absent spontaneous respirations
5. Listen for absent heart sounds and feel for an absent carotid pulse
6. Look for absent pupillary reactions to light
7. Record the time at which your assessment was completed
8. Document your findings

EXAMPLE

Called to pronounce Mr X deceased. Patient unresponsive to verbal or tactile stimuli. No heart sounds heard, no pulse felt. No spontaneous respirations observed and no air entry heart. Pupils fixed and dilated. Patient pronounced dead at 20:30 hours, 11 December 2024

XXX[your name] (MO [your role])
Asked to review patient re: no signs of life

Examined patient:
- No response to verbal or painful stimulus
- No carotid pulse
- No breath or heart sounds over 5 minutes
- Pupils non-reactive to light
- No motor (withdrawal) response or facial grimace in response to painful stimulus

Time of death: _

Nursing staff/I have already attempted to contact family/NOK

Cause of death: _

Plan:
1. Cremation certificate completed
2. Coronial checklist completed
3. Death certificate completed
4. Patient death checklist completed
5. Team to complete Discharge Summary (if not the team) or Discharge Summary Completd (if team)
6. I will update Dr _ (AMO)
7. Will attempt to contact family or Family notified
8. Please leave patient on Ward until family have been given option of visiting patient in room

9. Decide if the death is reportable to the coroner (use the IB2010_058 - Coronial Checklist)
   • Reportable death - Died a violent or unnatural death
     • Died a sudden death the cause of which is unknown
     • Died under suspicious or unusual circumstances
     • Died without having been attended by a medical practitioner in the six months immediately before their death
     • Died after a health related procedure where death was not the reasonably expected outcome
     • Died while in, or temporarily absent from, a declared mental health facility
   • Person in custody
     • While in the custody of a police officer, or in other lawful custody
     • While escaping, or attempting to escape, from custody
     • As a result of, or in the course of, police operations
     • While in, or temporarily absent from, a detention centre, correctional centre, or lock up
     • While proceeding to a detention centre, correctional centre, or lock up to be admitted as an inmate
   • Child (<18 years) if
     • Died in care
     • Died with child protection report being made within the last three years for the child or a sibling
     • Whose death may be due to abuse or neglect
     • Whose death occurred in suspicious circumstances
     • As a general rule, discuss all child deaths with a more senior doctor to decide whether the death is reportable
   • Person aged ≥72 may not need to be reported to the coroner if they
     • Sustained an injury from an accident that was attributable to their age
     • Even if the person died a violent or unnatural death
     • But the death must be reported to the coroner if:
       • Sustained the injury from an accident that was attributable to an act or omission by any other person
       • Died a death that is reportable under any of the other criteria in the reportable death section above
       • If a relative objects to you writing the medical certificate of cause of death
   • If reportable notify the attending medical officer (consultant in charge of the patient) and discuss the matter with them
   • If a death is reportable, notify NSW police and complete report of death of a patient to the coroner form
     • Inform the nursing staff of this and the requirements to do nothing to the body
   • If you are unsure whether a death is reportable
     • Do not complete medical certificate cause of death
     • Consult with a senior team member or the director of medical services; if that fails then
     • Contact the office of the NSW state coroner; if that fails then
     • Notify the NSW coroner’s office
   • Deaths related to the administration of anaesthetics or sedative drugs must be reported to the Special Committee Investigated Deaths under Anaesthesia (SCIDUA) within 24 hours of administration
     • Sometimes you may only need to report to SCIDUA and not to the coroner
   • If not reportable
     • Complete the medical certificate of cause of death form
       • Usually completed by the medical practitioner who the person after death always within 48 hours
       • Place the completed form in the medical records accompanying the body
       • For the body to be cremated, complete the attending practitioner’s cremation certificate
         • Complete it at the same time as the medical certificate, in case it is required later on
     • For question 18 ‘Place of death’ the hospital name will suffice; you do not need to specify ward and bed numbers
     • Recording cause of death
       • Be as specific as possible; do not write ‘cancer’, instead write ‘metastatic non small cell lung cancer’
       • Do not write the mode of death (cardiac or respiratory failure). Better to write myocardial infarction (and below it) arteriosclerosis
10. Informing the family
    • When the death is expected, the relatives will usually have been notified to come to hospital
    • Notify the next of kin as soon as possible unless documented otherwise
    • It is best to call the family in to the hospital to break bad news but if the death was expected to occur, a phone call may be reasonable
    • If possible, a doctor familiar with the patient, or a senior nurse who knows the family well, should notify the next of kin
    • Breaking the news over the phone:
      1. First familiarise yourself with the patient’s medical history and cause of death
      2. Speak to the nursing staff who are familiar with the family in case there are difficult family situations or potential problems
      3. When calling, identify yourself and ask for the immediate next of kin
      4. Deliver the message clearly: I am sorry to inform you that your husband died at 8:30 this evening
      5. Say that the relative has died peacefully: As you know, your husband was suffering from a terminal illness. Although I was not with your husband at the time of his death, the nurses looking after him assure me that he was comfortable and that he passed away peacefully
      6. Ask the next of kin if they wish to come to the hospital to see their loved one for one last time and encourage them to do so. Inform the nurse of this decision
      7. Questions pertaining to funeral arrangements and the patient’s personal belongings are best referred to the nurse in charge or to the social worker to be sorted out in the morning
      8. Autopsy or tissue donation should be introduced during face-to-face contact and could be deferred to the patient’s usual medical team in the morning

• Can attach a summary of care to the form and say refer to summary of care