Question:
Dear Nancy,
My sister's father-in-law died at home. The hospice nurse was called at 10:00 a.m. but said she couldn't come for four to five hours. This was appalling to me. Could I, as a registered nurse, have pronounced this or called his doctor and noted the absence of vitals, as I do in my hospital job? Or should we have called 911, stated it was a nonemergency, and had emergency medical personnel pronounce it? The funeral home wouldn't accept the body without a pronouncement of death, which I understand. What should have happened?
Thank you,
Leslie
Nancy Brent replies:
Dear Leslie,
It is difficult to understand why the hospice nurse couldn't come for four to five hours after the call, informing them of the death of one of their patients. However, without knowing more, it's difficult to determine what your role would be in this situation. Certainly, calling the physician and describing what you noted, the absence of vitals, might have been a good idea.
A better approach, and one more legally sound, would be to call the paramedics. You, as a nurse and family member, could describe your assessment and have them come as quickly as possible and have them make a determination of the patient's passing. Then, the patient's body could be taken to the funeral home.
The key to the situation is what your state law allows a nurse to do when making a determination of death. There are about 20 states that allow nurses to do so (e.g., Nevada, New York, California, and Florida), but the laws differ considerably. For example, the law may require that two nurses do the pronouncement or that it can occur only when a physician has given an order to that effect and the state nurse practice act or other statute allows it.
The place of death also differs in these laws. Again, as an example, it may be that the statute only allows a nurse to pronounce a death in an acute care facility, where no physician is available, or it may only be allowed in nursing homes or home care settings. The other factor that may exist in these laws is that they may apply only to a nurse caring for the patient who has expired and/or the nurse is an employee of an acute, long-term care facility, hospice, or home healthcare agency.
It is unfortunate that this situation had to be faced by your sister and her family after the death of her father-in-law. At a minimum, it seems that some discussion about this unfortunate development should take place with the hospice. If a hospice cannot fulfill its obligations in a reasonable manner and timeframe, it shouldn't accept patients into its program.
Cordially,
Nancy
