D&D 5E Crazy idea for Death Saves

[Rune]

[MENTION=67]Rune[/MENTION] - not sure about the one item interaction for free - they are at 0 or fewer HP, after all, so I feel there should...be...a...certain...amount of...effort...required.
Perhaps you could rule one item interaction or one move/help without breaking the interaction up into chunks if you preferred (I chose to 'chunk' to avoid the blasé "oh I just chug a healing potion" shrug off. I'd certainly rule that no spells could be cast - even verbal only ones, as there should still be a certain amount of focus and channeling that goes into your Healing Word, and I'd say being at 0 or below would be enough pain and disorientation to stop you from being able to do that.

Thanks all for feedback so far.

Well, theoretically, that would be covered by the "disadvantage on the next death save" clause, but if you're fine with the more crunchy approach, I see no reason why it wouldn't work. (And I don't think the item interaction will go that far, especially without movement to back it up, but I could see it working either way.)

 

[The Grassy Gnoll]

Re: giving the monsters a death save to reform one last action - remember that if they make the save, they'll be on 1HP and back in the fight. So one death save seems a little too 'stepped on a garden rake' to work.

Although, I think I'll revise my position and say, as per Rune, Disadvantage on your NEXT round death save, and the death save happens prior to any action (original post edited to reflect this).

You could consider a reduced number - first to 2 - to reduce notation for monsters and NPCs. That way, worst case non-survival scenario for an npc would be:
Round 1 - reduced to negative HP
Round 2 - death save - pass - helps (or crawls away)
Round 3 - disadvantage to death save - fails - helps (or rings alarm bell)
Round 4 - disadvantage to death save - fails - dies

At any time, choosing to do nothing will result in a straight death save roll your next turn.

 

[The Grassy Gnoll]

Another alternative - maybe simpler.

Any time you Pass your Death Save, at the cost of Disadvantage on your next death save roll, you get the option to move/help/interact with an object* (drinking a potion requires two interactions - one to find it in your pack, and one to drink it).

Example:
Round 1 - reduced to negative HP
Round 2 - 1st Death Save - pass#1 - decides to crawl towards alarm bell
Round 3 - 2nd Death Save (with Disadvantage) - fail#1 - no action available
Round 4 - 3rd Death Save - fail#2 - no action available
Round 5 - 4th Death Save - pass#2 - weighs up risk of ringing bell v disadvantage next go at 2-2...decisions...

*as per OP, help or 5' crawl with no opportunity attack trigger