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01.02 Postmortem care

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Overview

Post mortem care is essential when a patient dies. Whether it is in an acute care setting or hospice, preparing the body for transport to the morgue is something nurses are responsible for. As long as that body is in their care, nurses must follow facility protocols and address all concerns.

Nursing Points

General

    1. Post mortem care:
      1. Depending on the facility
      2. Expected or unexpected death
      3. Notify
        1. House supervisor
        2. Justice of the peace
        3. Chaplain
        4. Funeral home
        5. Transplant services
    2. Preparing the body for transport:
      1. Allow family as much time as they need with the deceased
        1. Be respectful
      2. If an autopsy is required
      3. Follow facility protocol
        1. Leave everything in the body
        2. Clean the body
      4. If no autopsy is required
      5. Follow facility protocol
        1. Remove everything
          1. IV
          2. Urinary catheters
          3. ET tube
          4. PICC lines
          5. Arterial lines
        2. Clean the body
        3. May defecate
    3. When transferring the body
      1. May blow out air
      2. May pass gas
      3. May twitch
      4. May open eyes
      5. DONT FREAK OUT!!

Reference Links

Video Transcript

Hey guys, in this presentation we’re going to talk about post-mortem care. Every nurse at some point has had a patient that dies. So these are the basics of what to do when that happens. So it’s, you know, just the stuff that the textbooks don’t teach you of what you do with the body when your patient dies. So let’s talk about it. So when a patient dies, nurses, we are still responsible for post-mortem care. We are still responsible for the body until transportation or somebody picks them up and they get transferred to wherever they need to be. Usually that’s the morgue in the hospital and then they go to a funeral home. Now, if, and that’s in an acute care facility, if you work in a hospice or longterm care facility, for the most part, they don’t have their own morgue. They just go straight to the funeral home. 

So we are responsible for that body, for post-mortem care, for everything until that patient or that body leaves our care basically. So there are several steps that nurses must implement when the patient dies. And again, we’re going to go ahead and talk about those. This is just kind of like the real-world experience, the textbooks teach you about cultural sensitivities and what to do if a patient of this particular race or culture were to pass and how to prepare the body. And yes, that happens. But for the most part, it’s when the body’s prepared for burial, which we don’t necessarily have anything to do with that. These are just the basics of what we do. So let’s get started. So again, post-mortem care for the most part, can or cannot depend on the facility and the protocols that they have on what you do when the patient dies, but if it is an expected or an unexpected death, that makes a big difference because if you have a patient that’s coded or a patient that is on hospice for example, the family has chosen to turn everything off obviously that can be an expected death.

So it’ a little different, but either way, you have to notify several people when you have a death. You have to call the house supervisor, You have to notify the justice of the peace for whatever city you live in. Hopefully you have a chaplain available. You can call the chaplain and have them come talk to the family. They are pretty good about helping out with all the paperwork because there is a lot of paperwork involved and they’ll find out the families’ wishes on the name of the funeral home that the body will be transported to. So I’m at my hospital chaplain is very good cause they take care of a lot of this stuff for us, especially with talking to the family and staying with the family and finding out what funeral home the body would need to go to.

So again, it is a lot of paperwork. I mean we usually have about five different pages of paperwork. And remember this does not include the EMR, the electronic medical record. You still have to document in the patient’s chart if it was a code and what happened or if they were in hospice and they passed. So you have to document all of this and you have to do all this extra side paperwork. So it’s part of it. Unfortunately it is a lot of paperwork. So as far as preparing the actual body, one of the most important things that you can do as a nurse is allow the family as much time as they need. If the patient has just coded and the family wants to see them, just clean the body up. Make it presentable, if there was blood coming out of everything, we’ll just clean them up really quickly so that the family can come in there and please be respectful.

Please let them take as much time as they need. I work in a cath lab. I also work in CV ICU. We recently at one o’clock in the morning, got paged for a STEMI. We worked a code about two or three hours. Finally we took the body to a room. It was probably around three something in the morning, the family wanted to see them. So the family spent about two, two and a half hours with them. All we had to do was wait. There was nothing else. You need to be respectful and don’t rush that family. Now once you find out if an autopsy is required, and again, usually it depends on the cause of death or if they’ve been admitted within less than 24 hours or if the family chooses to have one. Then this kind of changes a little bit on how you prepare the body and always follow up facility protocol.

So if an autopsy is required at my facility, we leave everything in the patient. So basically you have somebody that just got admitted and then they coded and you and we don’t know why and the family wants an autopsy. Well, if we intubated them, if we put in a catheter, if we put in a PICC line, if we put in an art line, all of that stays in place and you just clean the body up and transport them to the morgue or the funeral home whenever that happens. Because they want to see the cause of death, that makes a big difference in our facility. Again, the most important thing you can do is clean up the body. Make it look presentable a lot of the time when people pass, there’s blood everywhere. Sometimes they have feces sometimes they urinate on themselves.

And so if that is the case, clean them up, make them look like they’re just a sleeping clean person there. So other things, if there is not an autopsy that is required follow facility protocols. Usually after the family leaves, then we start preparing the body and we clean them. So you would remove everything, if they have an IV, if they have a PICC line, if they have an art line, if they have any catheters, if they have an NG tube, anything that is in them that we put in we would take out. Now if they have something like a permanent pacemaker, you’re not going to go cut them open and take that out. It’s just whatever you would have done for a code, basically to save their lives, take it all out and make sure that you get all their belongings. Put all their shoes or clothes, wallet, try to give it to the family before they leave. But if there’s no family, make sure that you mark all that with patients’ information on it and keep that with the patient.

If it was a trauma their clothes are cut off, put them in a gown make them look presentable. It’s not just a body, it was a human, it was a patient. Make them look as presentable as you possibly can. And then once you have cleaned the body and they’re ready to be transported to the morgue or a funeral home. I’ve been a nurse for 15 years and when I see a death. It scares me a little sometimes when you’re cleaning the body and you move them, like let’s say they go from the bed to the gurney, they will release a little bit of air, that air that was trapped in their lungs and when they get moved, that air will come out.

So it just sounds like they expelled all that air out sometimes because their muscles are relaxed, they may pass gas or a little bit of feces may come out or they may urinate. And this is the worst one. Sometimes their muscles may twitch a little bit and because of the flickering and the twitching, it may cause some body parts to move a muscle to twitch or their eyes may open again, don’t freak out. It happens. And you know what? I’m sorry, its part of nursing, but when you are doing post-mortem care and you are cleaning the body, be prepared for any of these things to happen. I’ve been a nurse for 15 years and I still cannot be in a room by myself. I don’t like it. I don’t have to like it. I’m not gonna like it and I don’t want to do it.

So if I have to do post-mortem care, I’m okay with that. But somebody better be in that room with me and that door will be open. And that’s just me. And if that is you, then that’s okay. Or if you’re the type of person that can be in there with them, cleaning them by yourself, kudos to you because not a lot of people can do that. But just know though that it is our responsibility as nurses to take care of that body and clean them up. So the key points that you need to remember, a little recap on this little short lesson. It is a nurse’s responsibility, that body is our responsibility until they’re transported to the morgue or to the nursing home. If it’s a code or not a code, just whatever the case is, clean the body and make them look presentable.

When the family comes to see them, you don’t want them showing up and its a mess. Sometimes they bring little kids and you don’t want them showing up and just seeing a bloody mess, clean them up, make them look presentable. Depending on the autopsy, you may either remove everything or you may leave everything in. If an autopsy has been ordered by the family. And then lastly, be respectful when you are cleaning the body. This not the time to make jokes. This is a time to be respectful, it’s death, and you wouldn’t want somebody cleaning you up on your last moments here and I’m joking around, be very respectful about that. So I hope that this little short lesson has helped you with some real world experience regarding post-mortem care and when you guys are faced with it, come back and listen to this and it’s okay. You deal with it however you need to now. Make sure that you guys go out and be your best sales today. And as always, happy nursing.

 

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