Reviewed and updated September 2010
INNER CITY HEALTH Inc
POLICIES AND PROCEDURES MANUAL
PRONOUNCING DEATH
ARTICLE 1 - POLICY STATEMENT
Registered Nurses are authorized by the College of Nurses of Ontario, Standards of
Practice, to pronounce the death of a patient when death is expected and in the opinion of
the health team, the patient is irreversibly and irreparably terminally ill.(1)
Pronouncement of death is not a legal entity but rather is a declaration that death has
occurred as evidenced by absence of pulse, respiration, fixed dilated pupils and no
response to painful stimuli.
ARTICLE 2 - CRITERIA
1. The physician has clearly written in the progress notes that the patient’s death is
expected.
2. There is a current DNR order.
3. The patient, the family and the Health Care Team anticipate the death.
4. A family member is designated to receive notification of the death.
5. Consent for autopsy is denied following discussion with the patient and legal
next of kin.
6. Consent for organ retrieval and tissue for transplantation is denied following
discussion with the patient and legal next of kind.
7. The death may meet the criteria for a Coroner’s case as defined in Section 10 (2)
Coroner’s Act.
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POLICIES AND PROCEDURES MANUAL
ARTICLE 3 - PROCEDURE
1. Ascertain that death has occurred as evidenced by:
• Absence of apical pulse
• Absence of respirations
• Fixed and dilated pupils
• No response to painful stimuli
2. Document nursing assessment and the exact time of death on nursing record/
3. Notify:
• The MD of the death and confirm that the patient will be pronounced by
nursing and certified by the physician.
• Notify Mission front desk, health manager and Executive Director.
• The Coroner if it has been determined it is a coroner’s care as per policy.
• Notify the designated family member, significant other, or legal next of
kind.
• The priest or minister if requested by the client and/or the family, or the
legal next of kind.
• Family doctor the next working day (if death happens during the night)
• Home Hospice Team
• Staff from other shelters who cared for the client
4. Determine if family wishes to view the body.
5. Complete the preparation of the body as per article 4.
6. Arrange for transportation of body to funeral home as per family choice or
Kelly’s Funeral Home
7. Ask Mission Staff to arrange Social Services payment.
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Reviewed and updated September 2010
INNER CITY HEALTH Inc
POLICIES AND PROCEDURES MANUAL
ARTICLE 4 – CARE OF THE BODY
1. Close door and lower the bed to a horizontal position.
2. Leave one pillow under the head, close the eyelids, and straighten the limbs. Lift
the chin and hold with facecloth.
3. Cover the patient with a sheet, excluding the face. Await information determining
if it is a coroner’s case, or confirmation that the family is coming in.
4. IF DEATH IS A CORONER’S CASE OR IF AN AUTOPSY IS TO BE
PERFORMED, DO NOT REMOVE ANY TUBES, DRAINS AND
CATHETERS, ETC, tie them off.
5. Bathe the patient if necessary, and cover any open and draining wounds with a
clean gauze covered with waterproof tape. Diapering with waterproof pads may
be a necessity in some cases.
6. Open window.
7. Dress the patient in a clean gown and cover with a sheet; the body should appear
comfortable and peaceful.
8. Tidy the room. IF DEATH IS A CORONER’S CASE, do not remove equipment
until permission is given by the coroner.
9. Photocopy death certificate. Put original in an envelope to send with the body
ARTICLE 5 – VALUABLES
1. Ensure that the patient’s jewelry and other valuables are processed as per policy.
2. In the unusual circumstance that a ring, for example, could not be removed, make
a note in the “Nurses’ Notes” describing the ring and stating that it could not be
removed and was sent with the body.
3. Do not send valuables to the funeral home with the body. Pack them up for the
family.
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Reviewed and updated September 2010
INNER CITY HEALTH Inc
POLICIES AND PROCEDURES MANUAL
ARTICLE 6 – PERSONAL EFFECTS
1. Place the client’s clothing and other personal effects in a patient garment bag.
Write patient’s complete name on bag or use an I.D. sticker.
2. Inform family, significant other or legal next of kind where to pick up valuables
and personal effects and document on the “Nurses’ Notes” to whom the
belongings were given.
ARTICLE 7 – DOCUMENTATION
1. There must be an entry in the “Nurses’ Notes” to indicate whether an autopsy is to
be done or not, or whether it is a coroner’s case or not.
2. The nurse is to make sure that 2 copies of the death certificate are made prior to
the original death certificate being picked up by the funeral home. If the patient
has HIV/AIDS (irregardless if it is the cause of death) an HIV/AIDS reporting
form must be completed and sent to the main office. The office will forward the
form to the health department once a copy is made for the chart.
3. Time patient pronounced dead must include:
• No apical pulse
• No respiration
• Pupils fixed/dilated
• No response to painful stimuli
• Name of Physician notified
• Name of family member, significant other, or legal next of kind notified.
• Signature of nurse pronouncing death.
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INNER CITY HEALTH Inc
POLICIES AND PROCEDURES MANUAL
ARTICLE 8 – HEALTH RECORDS
1. If there is no autopsy, the current chart is completed and returned to the Main
Office for filing
2. If there is a post-mortem examination, for whatever reason, the current and old
charts, with forms pertaining to death and forms “Consent for Post-Mortem
Examination” or “Warrant for Post-Mortem Examination” must go to the coroner.
Notes:
(1)
(2)
(3)
(4)
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College of Nurses Communiqué (1996) “ Standard on the Nurse’s Role in Pronouncing Death when
Death is Expected” April, p.21-22
Refer to Coroner’s Case 50-IV-13A
Regional Coroner – Dr. Ben Bechard – 613 239 1251
When death occurs between 07.00 and 23.00 hours, every effort to complete the Death Certificates forms
1 and 16 within a minimum time will be made so the body can be released to the family if that has been
asked.
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