Death of any hospital patient requires formal certification and documentation, even if the patient dies in front of you.

Clinical confirmation of death

Observe for any sign of life for at least a minute. Confirmation of death can be made on the basis of:

Absent central pulses.
Absent heart and breath sounds.
No respiratory effort.
Fixed and dilated pupils (and/or absent corneal reflex).
Asystole (if cardiac monitoring in place).

Documentation of death

Confirmation of patient death:

Date and time of examination.
Method of patient identification: patient known to writer or hospital wristband.
Examination findings (as above).
Note if the death was sudden or expected.

Document time of death.

The time of death is recorded as the first time death was confirmed, even if you are seeing the patient hours later.

Document the people notified.

In New Zealand hospitals

MoH guidelines require confirmation of death two times, at leat ten minutes apart. In practice, the first is usually by ward nurses or by a clinician present at an unsuccessful resuscitation.

Complete the requisite forms (both can now be done online):

Medical Certificate of Cause of Death HP4720
Cremation certificate

Tell you boss at a reasonable hour. The GP should also be notified and sent a discharge summary.

Unexplained or unexpected deaths usually require reporting to the coroner. See here for a complete list. This can be done on Death Documents as well. Where a death is referred to the coroner, the scene is not really a crime scene but it should be treated as one. Nothing should be touched or removed; all lines and tubes should be clamped or capped and left in place; cordon off the area until it is released by police.

Docs

Recent Notes

Haemophagocytic lymphohistiocytosis

27.03.2025-do-1243PM.txt

Iron studies

Explorer

Certifying death