The phone call (what you need to find out before you go to the bedside)

Determine the patient's location.

Find out if the family is present.

Ask the patient's age.

Find out the circumstances of the death (expected or sudden).

Ask if you need to be there immediately.

The patient floor (what to determine before you go into the room)

Interview the nurse: get details on the circumstances of the death, especially if the death was unexpected.

Find out if the attending physician has been called.

Ask if an autopsy is desired.

Determine if organ donation was discussed earlier with the patient and family.

Review the chart for other medical and family issues.

In the room

If the coroner is not involved and the family is not yet present, remove tubes and clean the body before family arrives.

Introduce yourself to the family.

Empathetic statements are appropriate, but do not overpersonalize them: For example, say, “I'm sorry for your loss . . .” or “This must be very hard for you.” Avoid saying, “I know what you are going through.” or “He's with God now.”

Try not to say too much; this is a time to be quiet and comforting.

Touching or hugging a family member may be appropriate.

Explain the pronouncement to the family; ask if they wish to be present.

Ask if they have any questions.

The pronouncement

Identify the patient (hospital identification tag).

Note general appearance of the body.

Note no reaction to verbal or tactile stimulation.

Note no pupillary light reflex (pupils will be fixed and dilated).

Breathing and other lung sounds will be absent.

No carotid pulse or heart sound can be heard.

Documentation

Called to pronounce___________.

Chart findings of physical examination.

Note date and time of death pronouncement (the physician time of pronouncement is the official time of death—do not delay unnecessarily).

May note that the family and attending physician were notified.

Document if the coroner was notified.

Chart if the family accepts or declines autopsy

When to call the coroner

Call if the patient was in the hospital less than 24 hours.

Call if the death had unusual circumstances.

Call if the death was associated with trauma regardless of the cause of death.