Death Pronouncement 🕊️

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🕊️ Overview & Tone

  • Pronouncing a death can be emotionally challenging — aim to appear professional but empathetic.
  • Before entering, ensure you’re prepared with essential items.
  • Confirm the patient was not for resuscitation (DNAR in place). If in doubt, call an arrest.
  • Allow the family some time with the deceased before entering. If a chaplain is present, wait respectfully.
  • Nursing staff will often notify the family you need a few minutes alone — if they wish to remain, do not object.

🧰 Items to Bring

  • Stethoscope – essential for confirming absence of breath and heart sounds
  • Pen torch – check for pupillary response
  • Pen – for documentation
  • Watch or timer with second hand – for timing assessments
  • Hospital ID badge – maintain professionalism
  • Documentation materials or EHR device
  • Bereavement pack – if available

🧠 Key Concepts

  • Death should only be pronounced by a clinician who is competent and confident.
  • Documentation must be prompt, clear, and legally accurate.
  • Confirm with nursing staff if the patient is expected or unexpected death.

🩺 Clinical Assessment

  • Introduce yourself to the family if present and confirm patient identity.
  • Politely ask if they are comfortable stepping out — allow them to remain if they wish.
  • Check for response to voice and pain: Call the patient’s name, then apply a gentle sternal rub with your knuckles.
  • Feel for radial and carotid pulses – for at least one full minute.
  • Listen for heart and breath sounds with your stethoscope – for at least one full minute.
  • Check pupils: both eyes should be fixed and non-reactive to light using your torch.
  • Confirm absence of neurological response, circulation, and respiration.

📝 Documentation

  • Clearly state location, time of assessment and pronouncement.
  • Document clinical findings: no heart sounds, breathing, pulse, responsiveness.
  • Note pupils non-reactive and fixed.
  • Document who was present (e.g. nurse, family).
  • Include date, your name and grade, and bleep if relevant.
  • Do not complete death certificate — this is the responsibility of the senior team.

📌 Special Considerations

  • If death is unexpected, escalate to senior and consider Coroner involvement.
  • Do not remove lines/devices until discussed if unexpected or under investigation.
  • Family should be informed with sensitivity if not already aware.
  • Do not complete death certificate if unsure of cause — discuss with senior.

🔗 After Pronouncement

  • Inform nursing staff and next of kin.
  • Ensure all valuables are documented and returned or secured.
  • Complete any necessary hospital bereavement paperwork.
  • Support available via chaplaincy and bereavement teams.

Note Template

Ready-to-use clinical note structure

🕒 21 / 11 / 2025 — 03:10

Location: [Ward/Room]
Bleep: [Your Bleep Number]
Patient: [Full name]
DOB: [DD/MM/YYYY]
MRN: [Hospital Number]

Asked to review the patient. 
DNR status: [Yes/No]

🩺 Clinical Assessment:
• No response to verbal or painful stimuli (sternal rub applied)
• No palpable carotid or radial pulses
• No audible breath or heart sounds for one minute
• Pupils fixed and unreactive to light

Mr/Mrs [Surname] has passed away. May they rest in peace.

🕓 Time of Death Pronounced: [HH:MM]

👤 [Your Full Name] (PRINTED)
Signature: ____________________
IMC: _______

📌 Additional Action:
Please notify the patient’s GP if within surgery hours. If not possible, ensure the team follows up the next working day.
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