Practice No.
137 B
Reference: 10/06
Version 1
Page 1 of 5
New
January 2010
NMC Code of Professional conduct
for nurses
GSCC Code of Practice for Social
Care Workers
Confirmation of the ‘Fact of’ an Expected Death
This procedure provides the framework for the confirmation, by a registered nurse, of the fact of an
expected death. The publication by the Department of Health of the ‘Death Certification and
Investigation in England, Wales and Northern Ireland; the Report of a Fundamental review (2003)’,
highlighted the need for an evidence based, confirmation of expected death procedure, to be in
place.
It also aims to clarify the distinction between confirmation and certification of death, in relation to the
professional practice of a Registered Nurse.
1.
INTRODUCTION
Dealing with any death in a caring, compassionate and professional manner is the last service
that can be provided for an individual. Where death is managed sensitively there is the
potential to ease the suffering of those who are bereaved.
The ability of a nurse to confirm the fact of the expected death of an individual, and provide
appropriate aftercare to relatives and carers, will provide continuity at a time of stress and
anxiety.
For the purposes of these guidelines, 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.’ The individual’s GP will have been attending
regularly to provide medical support and will have confirmed, and documented, the
expectation of death, compliant with this definition, in the individual’s end of life care plan.
Discussion should have taken place between the medical practitioner and nursing staff, and it
should be agreed that further intervention would be inappropriate, and death is expected to
be imminent. Relatives should be aware of the individual’s deteriorating condition and where
possible, will have been involved, with the individual if appropriate, in the development of the
End of Life care plan.
2.
LEGISLATION
Certification of death is the process of completing the “Medical Certificate of Cause of
Death”, this must be completed by a medical practitioner.
Confirmation of the fact of death is defined as deciding whether a person is actually
deceased, and does not require a medically registered practitioner to undertake confirmation.
The Law of England and Wales
Does not: require a doctor to confirm that death has occurred or that ‘life is extinct’
 require a doctor to view the body of a deceased person
 require a doctor to report the fact that death has occurred
 oblige a doctor to view the body of the deceased, but good practice requires that if
the doctor has any doubt about the fact of death, the body should be viewed

permit a nurse legally to certify death
Does: require the doctor who attended the deceased during the last illness to issue a
certificate detailing the cause of death, ‘to the best of his knowledge and belief’,
and to deliver that certificate forthwith to the Registrar. (Certification should occur
within 24 hours or the next working day).
 permit a nurse to confirm that death has occurred, providing there are explicit local
guidelines to allow such an action.
3.
GOOD PRACTICE
Expected Death
When the death occurs in a residential or nursing home and the GP who attended the patient
during the last illness is available, it is sensible for him/her to attend when practicable and
issue a death certificate. Where death is expected, the End of Life care plan should indicate if
the GP wishes to be notified when death is imminent. It should however be appreciated that
the needs of the living may require the GP to give priority to other patients.
If an ‘on-call’ doctor is on duty, whether in or out of hours, it is unlikely that any useful purpose
will be served by that doctor attending. In such cases it is recommended that a practice
procedure is agreed with all relevant parties, that the fact of death may be confirmed and the
home may contact an undertaker if necessary, to remove the body. Any such practice must be
confirmed in writing and the GP must be notified as soon as practicable after the death has
occurred. This must be documented in the End of Life care plan and counter signed by the
GP, where there is not an overarching unit agreement in place.
Where the GP attending the individual during the last illness may not be available, the correct
course of action is for the GP practice to inform the Coroner of the circumstances. The
coroner will then make the decision regarding disposal of the body. In such cases, nursing
and care staff will have a vital role in the sensitive care of the family and friends of the
deceased. At such times it may be particularly appropriate for managers to remind staff of the
Employee Support Line service.
Unexpected death
Where an unexpected death occurs in a Hampshire County Council residential or nursing unit,
the registered GP must be requested to attend, and where relevant, it may also be necessary
to inform the police and/or coroner.
In these circumstances, practice guideline 133 MUST be followed.
4.
COMPETENCIES
Nurses must at all times work within their professional knowledge and competence and only
undertake practices for which they have received appropriate training.
Only Registered nursing staff, who have received the relevant training in the confirmation of
the fact of death, and are accredited to do so, may confirm the fact of death of an HCC unit
resident. Accredited nurses must also be aware of the legal issues and accountabilities that
relate to this area of professional practice. (RCN 2004)
The Registered Unit manager must ensure that this competency is recorded on the nurse’s
personal and training files.
Registered nurses, with the necessary competencies, and accredited by HCC to work within
these guidelines, will have the authority to confirm the fact of death, notify relatives and
arrange for the removal of a body. They will also have the authority to confirm expected
death, to notify relatives, to support relatives in making arrangements for last offices and for
removal of the body to the care of the family’s chosen provider of funeral services, according
to relevant culture and faith.
Nurses must not confirm any deaths which were not expected, or where a post mortem or
routine referral to the coroner’s office is indicated, or where the death occurs –
 within 24 hours of onset of illness
 where no firm clinical diagnosis has been made
 deaths following an untoward incident, fall or drug error
 patients known to have a Mesothelioma diagnosis or industrial
disease i.e. asbestosis
 deaths which occur as a result of negligence or malpractice
 any unclear or remotely suspicious death
In these cases the GP or on-call doctor has a responsibility to refer the death to the Coroner.
5.
CRITERIA FOR THE FACT OF DEATH (this will need to be confirmed with the trainer.)
In HCC residential and nursing establishments, these criteria may only be applied by
Registered nurses who are trained and accredited to confirm the fact of death.
Nurses must:Check for clinical signs of death, using a stethoscope and penlight or ophthalmoscope.
Confirm and document cessation of circulatory and respiratory systems and cerebral
function, using a copy of Appendix A, which must be placed in the deceased’s End of Life
care plan.
The following are the recognised clinical signs used when confirming death.
Cessation of circulatory system
 No carotid pulse
 No heart sounds – verified by listening with a stethoscope for a minimum of 1 minute recommended 3 minutes
Cessation of respiratory system
 No respiratory effort
 No chest sounds – verified by listening for a minimum of 1 minute - recommended 3
minutes
Cessation of cerebral function
 Pupils fixed and dilated not reacting to light, verified by use of a pen light or
ophthalmoscope
 No eye movements
 No response to external stimuli, using sternal pressure.
Following confirmation of death
The nurse must record in the individual’s End of Life Care plan, using Appendix A
 The date of death
 The time of death
 Identify any persons present at the death or, if the deceased was alone, who found the
body
 Time of confirmation
 Place of death
 Clinical signs of death
 Name of doctor informed and the time and date that this took place
 Parenteral drug administration equipment or any life supporting equipment should not
be removed prior to confirmation of the fact of death, but may be removed after
confirmation of fact and prior to certification of death
 The nurse must also ensure that the deceased’s relatives are informed if they were
not present, or that appropriate arrangements have been made for them to be
informed by the Registered or Duty manager
 The nurse must also ensure that the deceased’s Care Manager or the home Link Care
Manager is informed of the death in accordance with service procedure.
3.
MONITORING
It is the responsibility of the Registered Manager
 to monitor compliance with these guidelines
 to ensure actions are taken to address non-compliance
 to document evidence that the nurse has received training in the individual training
record.
REFERENCES
BMA Confirmation and Certification of Death April 1999
NMC 2006, NMC Advice, Confirmation of death. http://www.nmcuk.org/nmc/main/advice/confirmation of death.html
RCN 2004, Confirmation (verification) of Expected Deaths by Registered Nurses, Royal College of
Nursing.
Southampton City Primary Care Trust. 2006 Verification of Expected Death by Registered Nurses
District Nursing Services Procedure .
Appendix A
Nurse Confirmation of an Expected Death
Resident Name: ………………………………
Date of Birth: …………………..…………….
SWIFT reference no: …………………………
Time and Date of Death: …………..……….
GP Name: ………………………………………
Place of Death: ………………………………
Persons present at death:……………………….
Person finding deceased:……..…………..
Response
Time Confirmed
No response to painful stimuli, determined by sternal rub for
10 seconds.
Absence of carotid pulse after palpation for 3 minutes.
Absence of heart sounds, determined by auscultation with stethoscope,
after 3 minutes.
Absence of respiratory activity, determined by observation and auscultation
with stethoscope, after 3 minutes
Fixed dilated pupils, which do not react to light. This is determined by shining a
torchlight into the patient’s eye and observing for any change in shape or size. This
should be checked in both eyes.
Name of Nurse confirming death:Date:
Signature: ………………………….. Printed: …………………….
Qualification:
Removal of parenteral or life supporting equipment :Type of equipment ……………………………………………….
Site :………………….………………..
Name of drugs or infusion
fluid
Amount remaining
Infusing at a rate of
Set up at (date and time)
I confirm that the infusion was calculated and confirmed as delivering the correct amount and
contaminated equipment disposed of in accordance with procedure..
Confirmed by:
Witnessed by:
Name: …………………………………….
Signature: …………………………..……
Date: …………………………………….
Time: ……….…………………………….
Name: …………………………………….
Signature: .……………………………….
Date: …………………………………….
Time: …………………………………….
Relatives informed – name………………
Time and date:……………………………
Copy placed in the deceased’s End of Life Care Plan
Copy faxed to General Practitioner (original in care plan)
Copy faxed to Care Manager or Link Care Manager (original in care plan)