Death Pronouncement 🕊️
Guide for death pronouncement and certification. Clinical examination, documentation, death certificate, and supporting families.
🕊️ 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
🕒 26 / 05 / 2026 — 12:30 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.