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Evaluation of the Pronouncement of Death Policy Implementation and Outcomes

Implications for Advanced Practice Nursing

Jackson, Hazel Anita, DNP, RN-BC, ACNS-BC, CHPN; Oliver, JoAnn S., PhD, RN, ANP-BC, CNE; House, Kim, MD

Journal of Hospice & Palliative Nursing: April 2019 - Volume 21 - Issue 2 - p 139–143
doi: 10.1097/NJH.0000000000000504
Feature Articles

In 2011, the Veterans Health Administration mandated that Veterans Affairs (VA) Medical Centers develop and implement a policy that allowed registered nurses (RNs) and advanced practice registered nurses (APRNs) to pronounce the death of residents who die in Veterans Affairs community living centers, previously known as nursing homes, provided that there is a written do-not-resuscitate order in their medical record. The purpose of this quality improvement project was to determine the extent to which the implementation of the RN/APRN death pronouncement policy affected death pronouncement time for residents who die after 5 PM and before 7:30 AM, on weekends and holidays. This project is significant because the previous physician-only death pronouncement policy was found to cause unnecessary delays in death pronouncement. A chart review of the medical records of all veterans' deaths pronounced by physicians 3 years before the implementation of the policy and 4 years after the RN/APRN policy was reviewed and implemented. The data analysis was conducted using descriptive analysis. A significant difference was found in the results (P < .05). The maximum for prepolicy deaths was 125 minutes. The maximum for postpolicy deaths was 7 minutes. The results supported the assumption that RN/APRN pronounced death without delay.

Hazel Anita Jackson, DNP, RN-BC, ACNS-BC, CHPN, is hospice case manager/pain resource nurse, Atlanta VA Medical, Decatur, Georgia.

JoAnn S. Oliver, PhD, RN, ANP-BC, CNE, is professor, University of Alabama Capstone College of Nursing, Tuscaloosa.

Kim House, MD, is attending physician/medical director, Atlanta VA Medical Center, Decatur, Georgia.

Address correspondence to Hazel Anita Jackson, DNP, RN-BC, ACNS-BC, CHPN, 1429 Oak Knoll Dr NE, Conyers, GA 30012 (

The authors have no conflicts of interest to disclose.

© 2019 by The Hospice and Palliative Nurses Association.