Planning for an
Expected Death at Home
An Initiative of The South East Palliative & End-of-Life Care Network Service
Delivery Committee.
Palliative Care
• Care for those living with
life-limiting, life-threatening illness
• Advance care planning is recommended as
soon as you are able to introduce the topic to
patient & family
Model for Palliative Care
Frank Ferris Oct 2005
Therapies to
modify disease
End-of-life
Care
Hospice Palliative Care
Presentation
Therapies to relieve
suffering and/or improve
quality of life
Death
Bereavement
Care
Planning for a Home Death
• Who pronounces death?
• Who is responsible for certification of death?
• Who does the family contact at time of death?
• What about the DNRC form?
• How do we help families prepare for death?
• Who makes sure everything gets done?
South East Local Health Integration Network Map
We Need a Plan!
Working group established under the direction
of the Palliative & End of Life Care Network
Reported to the Service Delivery Committee of
the Network
Consultation with nurses, case managers,
physicians, EMS, funeral directors
Do not resuscitate
• A plan of treatment is developed that reflects the
expressed wish of the patient (or consent of the
substitute decision maker for the person who is
not capable) that CPR is not in the patient’s plan
of treatment.
• DNRC form is completed providing direction for
EMS practitioners
The Yellow Folder
Yellow Folder Contents
•
•
•
•
•
•
DNRC Form
Yellow Magnet
Algorithm
Guidelines
Brochure When Death Occurs at Home
A checklist for Case Managers in folders at CCAC
What do you do with the magnet?
• The magnet is a signal that the yellow folder is in
the home
• May be very helpful for EMS on a 911 call
• It is meant to be placed on the refrigerator door
The Algorithm
• A tool to assist with planning for pronouncement
and certification of death
• Nurses (RN or RPN) can pronounce death
• Only a physician or RN(EC) can sign a death
certificate
EXPECTED DEATH IN THE COMMUNITY PLANNING TOOL
Will attend
home to pronounce
and certify
24/7
MD
or
RN (EC)
or
Medical Group
Will not attend
home to pronounce
or
not available 24/7
Following discussion with family
and physician indicate/circle plan.
Patient’s Name_____________________
MD or RN (EC)
or Medical Group
will certify as
soon as possible
(within 24 hours
of death)
Nurse
pronounces
MD or RN (EC)
or Medical Group
will not certify within
24 hours of death
Funeral Home will
accept nurse
pronouncement
and
certification within
24 hours of death
Funeral Home will
not accept nurse
pronouncement
and certification
within 24 hours
of death
Name____________________________
Date_____________________________
Explore local options:
Alternate MD or RN (EC)
or Medical Group
to certify within
24 hours of death
Determine how to
get death
certificate to
Funeral Home
after completion
Explore local options:
Alternate MD or
RN (EC)
or Medical Group
to attend home
to pronounce and
certify 24/7
• Avoid calling the coroner unless there are
reasons to contact them
• Avoid transfer of the body to ER for
pronouncement and certification
• It is inappropriate to sign a death certificate prior
to the death
Guidelines/Checklist
Family/Caregiver/Agency at Time of Death
• Completed with family/informal caregiver
• Numbers to call at time of death:
- professionals
- family/friends
• Cultural considerations at time of death
Brochure: When Death Occurs at Home
• Guide for informal caregivers
• What to expect; what to do
• Information re: appetite, swallowing, sleep,
confusion, breathing, bladder & bowel function,
skin colour and temperature
• What will happen at the time of death
Who Introduces the Yellow Folder
• CCAC case manager
• Visiting nurse
• Consider PPS level & initiate discussion
Developed by Victoria Hospice Society
Who coordinates the process?
• The CCAC Case Manager will have a checklist
of tasks to be completed.
• As each part of the process is completed, the
Case Manager will record it on the checklist
• The Case Manager will address any gaps in the
process
• Community Nurses to inform CM when yellow
folder is in the home
Client Label
PALLIATIVE CARE PLANNING CHECKLIST FOR EXPECTED HOME DEATH
DATE
(dd/mm/yy)
TIME TASK
YES NO N/A
1. Case Manager confirms which funeral home to use, and has permission to
phone
a)Funeral Home _____________________ Phone# ___________________
b)Funeral Director ___________________
c)Alternative Out of Area Arrangements____________________________
_____________________________________________________________
2. Funeral home is aware that care plan includes home death and has
directions to the home
3. Funeral Home agrees to remove body without a completed death
certificate*
* If answer is “No” a physician or RN (EC) must agree to go to home to
certify death.
4. Physician or RN (EC) agrees to go to home to certify death
Physician or RN (EC) ____________________Pager # ________________
Phone # _____________________ After Hours # _____________________
Substitute Physician or RN (EC)_________________Pager # ___________
Phone # _____________________ After Hours # ____________________
On Call Physician_____________________ Phone #__________________
5. If answer to #4 is “No”, physician or RN (EC) agrees that the nurse will
pronounce death, allowing removal of body to funeral home. Physician or
nurse practitioner agrees to provide death certificate to the funeral home
within 24 hours (Record contact information in #4 above).
6. Physician or RN(EC) agrees that if all efforts to make contact fail at time
of death, the process for the nurse to pronounce death will occur, as in #5
above. * Not applicable if answer to #3 is “No”.
7. Case Manager has confirmed the plan with the nursing service provider
8. Case manager has shared the plan with all other service providers
9. A) Brochure “When Death Occurs at Home” provided to family
B) Family member/caregiver understands the procedure for home death
10. A) Client/family directives regarding resuscitation addressed
B) Client’s advance directives, if available, are documented and
communicated
11. Confirmation that DNRC is completed and in the home
12. Copies of checklist to appropriate service providers
Physician
Funeral Home
Service Providers
CASE MANAGER___________________________
1 of 1 Sept 2009
PHONE # _________________ FAX # ___________________
Facilitation of planning for expected
death in the home will result in:
• DNR status identified appropriately
• Plans for pronouncement & certification in place
• Family is supported through the dying process
• Avoidance of unnecessary calls to EMS
Questions?
Thanks!