Document Ratification Group Approved on 25 th June 2009 Trust Executive Board Date July 2009 Next Review Date June 2011

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1 Verification of Adult Death by Registered Nurses Document Type: Policy Register Number: Status Public Developed in response to: Contributes to CQC Core Standard Hospital at night and Reduction in Junior doctor hours C7a Consulted With Individual/Body Date Dr Blainey Medical Director April 2009 Professionally Approved By Gwyneth Wilson Director of Nursing April 2009 Version Number 2.0 Issuing Directorate Nursing & Quality Approved by Document Ratification Group Approved on 25 th June 2009 Trust Executive Board Date July 2009 Next Review Date June 2011 Author/Contact for Information Vicki Leah, Consultant Nurse Policy to be followed by (target staff) All Registered Nurses Distribution Method Intranet, Trust Website Related Trust Policies (to be read in conjunction Trust Resuscitation Guidelines with) Document Review History Review No Reviewed by Review Date 1.0 Catherine Morgan April 2009 It is the responsibility of staff to ensure they are accessing the most up to date version of this document which will always be the version on the intranet. 1

2 Index 1 Introduction 2 Scope of Policy 3 Equality & Diversity 4 Death Certification 5 Definitions 6 Legal position 7 Competencies 8 Patients to whom policy refers 9 Medical responsibilities 10 Procedure for verifying inevitable expected death 11 Exceptions to policy 12 Monitoring & Audit 13 References 2

3 1 Introduction 1.1 First level Registered Nurses within Mid Essex Hospital Services Trust are permitted to perform the role of verifying the death of adult patients (aged 18 or over) in cases when the patient s death is expected. 1.2 This policy sets out best practice for Registered Nurses in verifying expected deaths within Mid Essex Hospital Services NHS Trust. It has been developed in recognition of changing service needs, the need to comply with junior doctor working time directives and the professional development of nurses in providing timely, appropriative aftercare for patients, relatives and carers in a sensitive and caring manner. 2 Scope of Policy 2.1 This policy applies to all those registered nursing staff with the necessary competencies, working within Mid Essex Hospitals Services NHS trust. 2.2 Experienced registered nurses (Band 6, 7 and 8), with the necessary competencies working within this policy have the authority to verify the fact of death, notify relatives and arrange for removal of the body. 3. Equality & Diversity The Trust is committed to the provision of a service that is fair, accessible and meets the needs of all individuals. 4. Death Certification 4.1 This policy does not allow a nurse at any time to certify a death 5. Definitions 5.1 Certification of death is the process of completing the Medical Certificate of Cause of Death this must be completed by a medical practitioner. 5.2 Verification of the fact of death is defined as deciding whether a patient is actually deceased and does not require a medical practitioner to undertake verification. Traditionally, a medical practitioner has always been called upon to pronounce life extinct although a certifying doctor is required only to certify the cause of death and not the fact of death and does not need to have examined the body in order to sign the death certificate. 6 Legal position 6.1 The legal position regarding certification of death is determined by the Births and Deaths Registration Act A registered medical practitioner who has attended a deceased 3

4 person during his last illness is required to give a medical certificate of the cause of death to the best of his knowledge and belief. 6.2 Verification of expected death is a procedure that can be undertaken by Registered Nurses to establish the irreversible cessation of all vital functions in a patient who has been designated Not for Resuscitation by their responsible medical practitioner, and whose death is expected. 6.3 In summary English Law: Does not require a doctor to confirm that death has occurred. Does not require a doctor to view the body of a deceased person. Does not require a doctor to report the fact that death has occurred. Does require the doctor who attended the deceased during the last illness to issue a certificate detailing cause of death. 7 Competencies 7.1 The NMC Code of Conduct (2002) places specific responsibilities on nurse practitioners to maintain professional knowledge and competence. To practice competently within these procedures, nurses must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. Nurses will acknowledge the limits of their competence and only undertake practice and accept responsibility for those activities in which they are competent. 7.2 All registered nurses verifying death must have the competences, skills and knowledge to enable them to determine the physiological aspects of death. If the nurse requires training to achieve these competencies it will be provided by the Consultant Nurse for Older People s Services. 7.3 Registered Nurses must be aware of the legal issues and related accountability that relates to this extended scope of professional practice (RCN 2004). 7.4 Registered nurses are required to record their competency and the details of training or updating received in their Personal Development Folders. They must record: the date of training the name and grade of the trainer skills learned 8 Patients to whom policy refers 8.1 For the purpose of this policy, inevitable expected death can be defined as death following on from a period of illness that has been identified as terminal, and where no active intervention to prolong life is ongoing. 4

5 8.2 Discussion should have taken place between the medical practitioner and nursing staff, it should be clearly agreed that further intervention would be inappropriate, and death is expected to be imminent. Wherever possible the relative should be made aware of the patients deteriorating condition and of the patient s care plan. 8.3 Where the death is unexpected and where no explicit advance decision has been made about the appropriates or otherwise of attempting resuscitation prior to a patient suffering cardiac or respiratory arrest, there should be a presumption that a health professional will make all reasonable effort to attempt to resuscitate the patient in accordance with Trust resuscitation guidelines. 9 Medical responsibilities 9.1 The patient s medical practitioner will formally identify patients whose death is expected and communicate this to the nursing staff. The discussions will include the views, if appropriate, of the patient, relatives and nursing staff. 9.2 The decision that death is expected will be documented in the medical and nursing notes. This decision must be recorded separately from any Not for Resuscitation order. 10 Procedure for verifying inevitable expected death 10.1 The nurse should ensure the patient s medical records reflect that the death is expected Time of death should be noted Assessment of the patient must be carried out in the following way to verify death using a stethoscope and a penlight All the signs should be apparent before death is verified.the requirements for this are: no response to painful stimuli (sternal rub) absence of a carotid pulse over one minute absence of heart sounds over one minute absence of respiratory movement and breath sound for one minute presence of fixed, dilated pupils If all the above are absent the nurse may verify that the patient has died 10.5 When verifying death the nurse must record in the medical notes The date and time of death Time of verification of death Clinical signs of death (absence of papillary reaction, heart and respiratory sounds) Sign and print her/his name and position. 5

6 10.6 Following verification of death the nurse must inform the medical practitioner at the earliest convenient time (not between 12 mid-night and 7am) 10.7 The relatives should be informed in accordance with their expressed wishes if not present at the time of death. 11 Exceptions to the policy 11.1 Nursing staff are not covered by this policy to verify death in unexpected circumstances. These include: Where the patient has no recent Do Not Resuscitate agreement Deaths of unidentified persons Where there is cause to believe that here is a suspicion of unnatural death Where there has been a serious untoward incident e.g. death following a fall, drug error Neonatal and paediatric deaths Stillbirths Any death that is likely to be referred to the coroner e.g. within 24 hours of admission, overdose, under general anaesthetic, asbestosis, tuberculosis, road traffic accident within 24 hours of surgery, head injury. In such circumstances a doctor must be called. 12. Monitoring and Audit 12.1 Audit of compliance with this Policy should be considered on an annual basis in accordance with the Clinical Audit Strategy. As part of the directorate audit workplan planning process, the directorate audit lead will liaise with appropriate staff to prioritise audit activity icluding audit of compliance with Clincial Guidelines. Where patient safety incidents or complaints highlight non compliance with this document, the directorate audit lead should be informed, and where appropriate, an audit undertaken. 13. References Brent PCT 2004, Policy regarding Verification of Death for Patients in Trust Community Hospitals. Assessed in January 2007 Home Office 2001, Report of the Home Office review of death certification, Executive Summary and Recommendations, http // NMC 2002, The Code of Professional Conduct, Nursing and Midwifery Council NMC 2000, NMC advice, verification of Death http;// RCN 2004, Confirmation Verification) of expected deaths by registered nurses. (updated January 15 th 2004) Royal College of Nursing West Lincolnshire PCT, 2004, Verification of Death by Registered Nurses. Assessed in January