Health Care Department Operations Manual

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Chapter 3 – Health Care Operations

Article 1 – Complete Care Model

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3.1.18 Registered Nurse Pronouncement of Death

  • Policy

    • California Correctional Health Care Services (CCHCS) shall permit Registered Nurses (RNs) to make the determination and pronouncement of patient death under specified circumstances. This policy applies only to determining the irreversible cessation of circulatory and respiratory function.

  • Purpose

    • To ensure timely pronouncement of death by an RN when death is expected and the attending provider is not available onsite.

  • Responsibility

    • Statewide

      • California Department of Corrections and Rehabilitation (CDCR) and CCHCS departmental leadership at all levels of the organization, within the scope of their authority, shall ensure administrative, custodial, and clinical systems are in place and appropriate tools, training, technical assistance, and levels of resources are available to ensure this policy is successfully implemented and maintained.

    • Regional

      • Regional Health Care Executives are responsible for implementation of this procedure at the subset of institutions within an assigned region.

    • Institutional

      • The Chief Executive Officer, Chief Medical Executive, and Chief Nursing Executive are responsible for the local implementation, monitoring, and evaluation of this policy.

  • Procedure

    • Conditions under which an RN may determine and pronounce death

      • All of the following conditions must be met:

      • A health care provider, (Primary Care Provider [PCP], or an Advanced Practice Provider [APP]) has determined and documented that the patient has a condition or illness whose natural course is expected to end in death and/or the patient’s life expectancy is six months or less.

      • The patient signed a CDCR 7465, Physician’s Orders for Life Sustaining Treatment indicating “Do Not Resuscitate.” The CDCR 7465 must be signed and dated by a physician, or an APP acting under the supervision of the physician, and the patient or legally recognized health care decision maker.

      • The patient’s health care provider has documented in a progress note in the health record that death is expected and has completed an order in the Electronic Health Record System (EHRS) stating that an RN may pronounce death.

    • Assessment and Determination of Death

      • When a patient appears to have died, the RN on duty shall be physically present at the bedside to assess the patient utilizing these steps:

      • Check the patient identification card or the Strategic Offender Management System database to verify the patient photo, CDCR number, and date of birth.

      • Assess response to tactile stimuli by gently tapping the patient in the shoulder and calling their name.

      • Assess pupils for response to light.

      • Assess for spontaneous respirations by observing the chest wall for rise and fall for a full minute to confirm absence of respirations.

      • Assess for carotid and radial or brachial pulse for a full minute and confirm absence of heart beat by auscultating heart sounds using a stethoscope for a full minute to determine cessation of cardiac activity.

      • After performing the above assessment, the RN shall pronounce the time of death.

    • Documentation of Death

      • The RN shall document the assessment in the health record on the Notification of Death/RN Pronouncement of Death PowerForm as follows:

      • No carotid and peripheral pulse.

      • Pupils are fixed and nonreactive to light.

      • No response to tactile stimuli.

      • No respirations for full minute.

      • No heart sound for full minute.

      • Date and time of death.

    • Notifications of Death

      • The RN shall provide the following notifications:

      • Nursing supervisor

      • Watch Commander

      • Physician on-call shall be notified via phone call or EHRS messaging if the PCP is not available in situations such as after business hours, weekends, and holidays.

    • Notification of the next of kin

      • After the RN has notified the watch commander of a patient’s death, the Warden or designee at the level of Correctional Lieutenant or Correctional Counselor II or above is responsible for the notification of the next of kin pursuant to the CDCR Department Operations Manual, Section 51070.10.

    • Training Requirements

      • RNs shall receive an initial training upon implementation of this policy and biennially as part of their competency validation.

  • References

    • California Health and Safety Code, Division 7, Part 1, Chapter 3.7, Article 1, Section 7180, The Uniform Determination of Death Act

    • California Business and Professions Code, Division 2, Chapter 6, Article 2, Section 2725

    • California Emergency Medical Services Authority, Physician Orders for Life-Sustaining Treatment

    • California Correctional Health Care Services, Health Care Department Operations Manual, Chapter 2, Article 4, Section 2.4.2, Physician Orders for Life-Sustaining Treatment (POLST)

    • California Department of Corrections and Rehabilitation, Department Operations Manual, Article 7, Section 51070.10

  • Revision History

    • Effective: 10/2020

    • Revised: 08/20/2025