After the patient dies, care includes preparing him for family viewing, arranging transportation to the morgue or funeral home, and determining the disposition of the patient's belongings. In addition, postmortem care entails comforting and supporting the patient's family and friends and providing for their privacy.
Postmortem care usually begins after a physician certifies the patient's death. If the death occurs within 24 hours of admission, or if the patient died violently or under suspicious circumstances (for example, an accident, a suicide, or a homicide), postmortem care may be postponed until the medical examiner completes an autopsy. Be aware that if an autopsy is necessary, it will influence the postmortem care.
Equipment
Gauze or soft string ties • gloves • chin straps • ABD pads • cotton balls • plastic shroud or body wrap • three identification tags • adhesive bandages to cover wounds or punctures • plastic bag for patient's belongings • water-filled basin • soap • towels • washcloths • stretcher.
A commercial morgue pack usually contains gauze or string ties, chin straps, a shroud, and identification tags.
Implementation
  • Document any auxiliary equipment, such as a mechanical ventilator, still present. Put on gloves.
  • Place the body in the supine position, arms at sides and head on a pillow. Then elevate the head of the bed 30 degrees to prevent discoloration from blood settling in the face.
  • If the patient wore dentures and your facility's policy permits, gently insert them; then close the mouth. Close the eyes by gently pressing on the lids with your fingertips. If they don't stay closed, place moist cotton balls on the eyelids for a few minutes, and then try again to close them. Place a folded towel under the chin to keep the jaw closed.
  • Remove all indwelling urinary catheters, tubes, and tape, and apply adhesive bandages to puncture sites. Replace soiled dressings.
  • Collect all the patient's valuables to prevent loss. If you're unable to remove a ring, cover it with gauze, tape it in place, and tie the gauze to the wrist to prevent slippage and subsequent loss.
  • Clean the body thoroughly, using soap, a basin, and washcloths. Place one or more ABD pads between the buttocks to absorb rectal discharge or drainage.
  • Cover the body up to the chin with a clean sheet.
  • Offer comfort and emotional support to the family and intimate friends. Ask if they wish to see the patient. If they do, allow them to do so in privacy. Ask if they would prefer to leave the patient's jewelry on the body.
  • After the family leaves, remove the towel from under the chin of the deceased patient. Pad the chin, and wrap chin straps under the chin and tie them loosely on top of the head. Then pad the wrists and ankles to prevent bruises, and tie them together with gauze or soft string ties.
  • Fill out the three identification tags. Each tag should include the deceased patient's name, room and bed numbers, date and time of death, and physician's name. Tie one tag to the deceased patient's hand or foot, but don't remove his identification bracelet to ensure correct identification.
  • Place the shroud or body wrap on the morgue stretcher and, after obtaining assistance, transfer the body to the stretcher. Wrap the body, and tie the shroud or wrap with the string provided. Then attach another identification tag
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    to the front of the shroud or wrap, and cover the shroud or wrap with a clean sheet. If a shroud or wrap isn't available, dress the deceased patient in a clean gown and cover the body with a sheet.
  • Place the deceased patient's personal belongings, including valuables, in a bag and attach the third identification tag to it.
  • If the patient died of an infectious disease, label the body according to your facility's policy.
  • Close the doors of adjoining rooms if possible. Then take the body to the morgue. Use corridors that aren't crowded and, if possible, use a service elevator.

Special considerations
  • If the patient is a trauma victim, the victim of a violent crime (such as a gunshot wound or stabbing), or has been in the hospital less than 24 hours, don't remove tubing or wash the patient until it's confirmed that an autopsy won't be done. If an autopsy is to be performed, keep all I.V. and other patient tubes intact and document as such.
  • Give the deceased patient's personal belongings to his family or bring them to the morgue. If you give the family jewelry or money, make sure a coworker is present as a witness. Obtain the signature of an adult family member to verify receipt of valuables or to state their preference that jewelry remain on the patient.
  • Offer emotional support to the deceased patient's family and friends and to the patient's facility roommate, if appropriate.
Documentation
Although the extent of documentation varies among facilities, always record the disposition of the patient's possessions, especially jewelry and money. Also note the date and time the patient was transported to the morgue.