RN Pronouncement of Death in Nursing Homes and CCRCs

The November 6th CareConnection contained highlights of the recently released Centers for Medicare and Medicaid Services (CMS) S&C Memo 14-01-NH, “Cardiopulmonary Resuscitation (CPR) in Nursing Homes,” providing direction to facilities regarding the initiation of Cardiopulmonary Resuscitation (CPR), facility CPR policies and surveyor implications.  As a follow-up to the article, we have been asked to remind members that the Code of Virginia specifies those circumstances under which an RN can pronounce death when the person is deemed medically and legally dead.  The following section of the Code 54.1-2972.B states:

A registered nurse or a physician assistant who practices under the supervision of a physician may pronounce death if the following criteria are satisfied: (i) the nurse is employed by or the physician assistant works at (a) a home health organization as defined in § 32.1-162.7, (b) a hospice as defined in § 32.1-162.1, (c) a hospital or nursing home as defined in § 32.1-123, including state-operated hospitals for the purposes of this section, (d) the Department of Corrections, or (e) a continuing care retirement community registered with the State Corporation Commission pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2; (ii) the nurse or physician assistant is directly involved in the care of the patient; (iii) the patient's death has occurred; (iv) the patient is under the care of a physician when his death occurs; (v) the patient's death has been anticipated; (vi) the physician is unable to be present within a reasonable period of time to determine death; and (vii) there is a valid Do Not Resuscitate Order pursuant to § 54.1-2987.1 for the patient who has died. The nurse or physician assistant shall inform the patient's attending and consulting physicians of his death as soon as practicable.

Please note that LPNs are not authorized to pronounce death in hospitals, nursing facilities or CCRCs.