Confirming death

• Right patient → check the wristband against the chart.
• CPR → tried and stopped by the arrest team leader. Any doubt: start CPR and call the arrest team. ACLS resuscitation
• On a ventilator → disconnect it before the observation starts.

Stay with the patient for at least 5 minutes, the whole time.

• Unresponsive → no response to voice or touch.
• No breathing → no chest movement, and no breath sounds with the stethoscope.
• No circulation → no central pulse (carotid or femoral), and no heart sounds with the stethoscope.
• Monitor attached → asystole on the ECG supports the finding; it does not replace the examination.

After the 5 minutes:

• Pupils → fixed, no response to light.
• Supraorbital pressure → no motor response.
• Soon after an arrest → add the corneal reflex: absent.
• Anything returns → start a fresh 5 minutes.

Time of death = when you finish these checks.

• Called → time called, time arrived, identity by wristband.
• CPR → stopped at what time, by whom.
• Findings → 5 minutes: unresponsive, no breath sounds, no central pulse, no heart sounds; pupils fixed; no response to supraorbital pressure.
• Time → “death confirmed at 03:42”.
• Informed → senior or consultant, nurse in charge, family (who, and when).
• You → name, grade, signature.

• Somewhere quiet → sit down, a nurse with you.
• Say “died” → then stop and let them ask. Offer to let them see the patient.
• The time → may be later than the last breath they saw; tell them.

• Senior → tell the registrar and consultant.
• Certificate → the hospital process; hand it over if not yours.
• Infection → notifiable or high-risk: infection control.
• Nurse in charge → death confirmed, last offices can start.

Reviewed October 2026 against the Academy of Medical Royal Colleges Code of Practice for the Diagnosis and Confirmation of Death, 2025 update (section 5, circulatory criteria). It is used because there is no North American bedside standard for confirming death on the ward; the 2023 Canadian clinical practice guideline on the definition and determination of death (Shemie et al., Can J Anaesth 2023) uses the same 5-minute observation but is written for organ donation.