Death confirmation is a topic sometimes assessed in OSCEs and it’s something you’ll do fairly regularly once you hit the wards. Although the process is relatively simple, ensuring you apply a methodical approach to both your assessment of the patient and the documentation is absolutely essential.
Indicate you would check the resuscitation status of the patient before doing anything else:
If the patient is not for resuscitation, continue to confirm the death
If there is uncertainty as to the resuscitation status, CPR should be commenced whilst this is clarified
Ask the ward staff about the circumstances surrounding the death as you will need to document this in the notes.
Ask for the patient’s notes:
Confirm the resuscitation status of the patient
Read the patient’s notes for some background on the patient
If family or friends are present:
Offer your condolences
Explain the need to confirm the death
Offer the family the opportunity to wait outside – respect their preference
Ask if the family have any concerns or questions
1. Wash hands
2. Confirm the identity of the patient – check the wrist band
3. General inspection – skin colour / any obvious signs of life
4. Look for signs of respiratory effort
5. Does the patient respond to verbal stimuli? – “Hello Mr Smith, can you hear me?”
6. Does the patient respond to pain? – press on fingernail / trapezius squeeze / supraorbital pressure
7. Assess pupils using pen torch – after death they become fixed and dilated
8. Feel for a central pulse – carotid artery
Listen for heart sounds for at least 2 minute
Listen for respiratory sounds for at least 3 minutes
(The recommended times for each of these vary, so adhere to your local hospital policy. The only official guidance on this matter can be found here¹ , which advises a minimum of five minutes total to establish that irreversible cardiorespiratory arrest has occurred)
10. Wash hands and exit the room(ensuring the door is closed and curtains are drawn)
Confirm the identity of the patient by checking their wrist band
Inspect for any obvious signs of life (e.g. respiratory effort)
Assess for response to painful stimuli (e.g. trapezius squeeze/supraorbital pressure)
Assess pupillary reflexes (after death they become fixed and dilated)
Palpate the carotid pulse
Auscultate for heart sounds for at least 2 minutes
Auscultate for respiratory sounds for at least 3 minutes
Once you have completed the above, document your assessment clearly.
Ensure you adhere to hospital documentation guidelines (date / time / your name / grade / contact number / professional registration number).
Document each of the examination steps you performed and the result of each step.
Finally, document that you are confirming the death and the time at which you did so.
Sign and print your full name, grade, registration number and contact number.
To see how to document death confirmation you can check out our guide here.
Document your assessment in the patient's notes
To complete death confirmation
Inform nursing staff that you have confirmed the death:
They will then inform next of kin, if not already present
They will also contact the porters to arrange transfer of the body to the morgue
Consider if this death needs a referral to the coroner, as if this is the case a death certificate cannot be issued –this will require discussion with the consultant responsible for the patient.