Verification of Expected Death by Registered Nurses APPENDIX 1' HCS c5b,C5c,C11c,C13a

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Verification of Expected Death by Registered
NursesAPPENDIX 1.HCS c5b,C5c,C11c,C13a

• Surrey Community Health Services

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Overview of the session

• Policies, protocols and guidelines
• Identification of death
• Responsibilities of key players
• Accountability and professional issues
• Legal and ethical issues
• Communication and psychological aspects of care
• Cultural and faith based information

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Programme Outcomes

• By the end of the session it is anticipated that
  the participant will
• Be able to define the term expected death
• Understand the differences between verification
  and certification
• Understand the legal issues, documentation and
  record keeping requirements
• Demonstrate the correct procedure for detecting
  the absence of vital signs
• Be able to discuss the needs of patients and
  carers in the management of expected death

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Background

• There is no legal requirement for the medical
  practitioner to attend to verify that death has
  occurred, only to issue a death certificate
  stating the cause of death (BMA 1999)

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Background - continued

• To enhance patient care
• Reduce distress experienced by relatives
• Offset delays both within and outside normal
  working hours
• To improve continuity of care
• Allow earlier disconnection of parenteral
  medication devices and clinical equipment (except
  vascular devices)

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Definitions of expected death

• The natural and inevitable end to an irreversible
  terminal illness. Death is recognised as an
  expected outcome by the health care team, the
  person him/herself if in a condition to express a
  view, and relevant family members, carers and
  next of kin

• a death where a patients demise is anticipated
  in the near future and the Doctor has seen the
  patient within the last 14 days before death The
  Home Office 1972

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Exceptions

• The nurse will not verify death if
• The patient is under 18 years
• It is not expected
• The patient is unidentified
• The patient is not known to a SCHS MDT
• It occurs within 24 hours of admission to a ward
• It follows any post operative / invasive
  procedures
• It follows an untoward incident e.g. a drug error

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Exceptions - continued

• It is within 24 hours of a fall
• There is suspicion /concern of negligence or
  malpractice
• It occurs in a place of custody
• There are suspicious or unclear circumstances
• It is the result of an industrial injury/ disease
  e.g. mesothelioma
• They have not been seen by their GP / community
  hospital doctor in the previous 14 days
• The patient is known to have a cardio
  defibrillator and there is no record that this
  has been deactivated

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Verifying death

• An agreement must take place between appropriate
  medical and nursing staff prior to the patients
  death and a record made that
• Further intervention would not be appropriate
• Death is expected and imminent
• The death is not listed as one of the exceptions
• The medical practitioner is agreeable to the
  registered nurse verifying the death following
  the Surrey PCT/ SCHS Protocol

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Caring for the Carers

• Families and carers should be made aware by the
  medical practitioner or an appropriate member of
  the MDT that the patients condition is
  deteriorating and that death is expected.
• They should also be made aware that as a
  consequence of the irreversible terminal
  condition, cardio-pulmonary resuscitation (CPR)
  would not be appropriate and a record of this
  conversation should be documented in the clinical
  notes.
• Open and sensitive communication with families
  and carers is required to gain an understanding
  of preferences and religious and cultural needs
  and process following death. SCHS (2008)

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The diagnosis of death

• Patients who are expected to die are usually
  observed over a period of time
• The slipping from unconsciousness to death may be
  a slow process
• You need to be very certain that the heart
  really has stopped, that it is not beating very,
  very slowly and very, very slightly, that the
  respiration really has stopped, that you are not
  missing very slow, very shallow respirations
• Dr Grenville Shipman Inquiry

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The diagnosis of death is made by

• Confirming the absence of palpable pulses,
  carotid femoral over one minute
• Confirming the absence of heart sounds and apex
  beat over one minute using a stethoscope.
• Confirming the absence of breath sounds or chest
  movements over one minute using a stethoscope
• Confirming the pupils are fixed and dilated and
  not responding to light over one minute
• If there is any doubt wait 10 minutes and repeat
  the procedure

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After verification the procedure

• Advise the next of kin and offer support and
  information
• Contact patients GP or Community Hospital Doctor
  (in working hours) or advise GP on call service
  that death has occurred if out of hours
• Disconnect all parenteral drug administration,
  clinical equipment, catheters etc. Leave
  vascular access devices in situ.
• Record all actions in patients case notes/care
  plan

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After verification the procedure continued

• Advise the family/next of kin about arrangements
  for collection of certificate
• Arrange to contact funeral director of choice if
  appropriate
• Fax the Verification of expected death proforma
  to patients GP and confirm by telephone
• Advise other agencies and health professionals of
  the death as appropriate

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Accountability issues

• As a registered nurse undertaking this
  responsibility you must remain mindful that under
  The Code (NMC 2008) previously known as the NMC
  Code of professional Conduct you are
• personally accountable for actions and omissions
  in your practice and must always be able to
  justify your decisions

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Equality Diversity

• As a registered nurse
• You are personally accountable for ensuring that
  you promote and protect the interests and dignity
  of patients and clients, irrespective of gender,
  age, race, sexuality, economic status, lifestyle,
  culture and religious or political belief
• (NMC 2008)

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References

• British Medical Association (1999) Confirmation
  and Certification of Death
• Home Office (1971) Report of the Committee on
  Death Certification and Coroners, Nov Cmnd 4810
• Home Office (2004) reforming the Coroner and
  death certification Service a position paper
  Home office Cm 6159
• Nursing and Midwifery Council (2008) The
  Code-Standards of conduct, performance and ethics
  for nurses and midwives.
• Nursing and Midwifery Council (2000)
  Confirmation of Death
• Royal college of Nursing (1996) Verification of
  Expected Death by Registered Nurses . London RCN
• The Royal Marsden Hospital (2005) v.6 Manual of
  Clinical Procedures
• Skills for Health www.skillsforhealth.org
  accessed 2008