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POLICY NO: P-42
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VERIFICATION OF DEATH
BY NURSING HOME STAFF POLICY
Legal Position
“ A registered Medical Practitioner who has attended a deceased 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, and to deliver the certificate forthwith to the Registrar. The certificate
requires the doctor to state the last date on which he saw the deceased person alive and
whether or not he saw the body after death. He is not obliged to see the body after death.
He is not obliged to view the body but good practices is that if he has any doubts about the
fact of death, he should satisfy himself in this way.”
(Paragraph 5.01 Report of the Committee on the Death Certification, and Coroners-Home
Office. Cmnd. 4810 November 1971)
More Simply
English Law
 DOES NOT require a doctor to confirm death has occurred or that “life is extinct”.
 DOES NOT require a doctor to view the body of a deceased person.
 DOES NOT require a doctor to report the fact that a death has occurred.
 DOES require the doctor who attended the deceased during the last illness to issue
a certificate detailing the cause of death.
Expected Outcomes.


That the death of the patient is dealt with in a sensitive and caring manner,
respecting the dignity of the patient, relatives and carers.
More appropriate use of General Practitioner (GP) time.
1.0 Definition of Expected Death
1.1 An expected death is:
“A acute/chronic deterioration in a clients present health status, or
confirmation of an infection likely to exacerbate a clients existing medical
condition, which has been documented by the Visiting Medical Officer
(VMO), or General Practitioner (GP), within the last two weeks”.
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2.0 Principles for Practice.
2.1 Every case will be discussed by the VMO/GP and Nursing Team caring for the
Resident. This discussion should wherever possible include the resident and/or
Relative/next of kin.
Any improvement in the resident’s condition must be discussed, reviewed and
documented in their care plan.
2.2 The decision on every case will be reviewed daily by the Nursing Team who
will inform the VMO/GP and the relative/next of kin of any changes.
2.3 All religious and cultural needs of the resident must be clearly identified and
recorded in the nursing documentation prior to death.
2.4 If a case of “expected death” occurs during surgery hours, the Registered Nurse
on duty will inform the VMO/GP who has been treating the resident.
2.5 If the “expected death” occurs out of surgery hours, it is the responsibility of the
on call doctor or deputising co-operative to ensure the deceased residents’
VMO/GP is notified at the first opportunity in the next period of normal working
hours.
2.6 With local agreement with the undertaker, the discretion of the VMO/GP, and
with the knowledge of the deceased residents’ family, the deceased resident will
be removed before certification of death by the VMO/GP.
2.7 The date and time of such agreements will be written into the nursing
documentation and signed by the Registered Nurse on duty at that time.
2.8 The VMO/GP and designated Registered Nurse able to verify death will
complete the form “Verification of Expected Resident Death” before and on the
death of the resident. This form will be kept with the nursing documentation.
3.0 Criteria for Excluding Residents Under This Protocol..
3.1 If the nurse verifying death feels there is a suspicious circumstance.
3.2 Deaths of residents within 24 hours of admission to the Nursing Home.
3.3 All sudden and unexpected deaths.
3.4 Death as a result of untoward accident.
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3.5 Death as a result of negligence or mal practice.
3.6 Death following post-operative or invasive procedure. In these cases the
VMO/GP must be informed of the death, and it is his/her responsibility to
refer the case to the Coroner.
All patients’ deaths which will become Coroner’s cases are not suitable
cases for nurses to verify. (RCN 1996).
The United Kingdom Central Council (UKCC), Code of Professional Conduct
(1992), (3rd Edition) and the UKCC Scope of Professional Practice (1992) stated
clearly that:
“The Registered Nurse practitioner is personally accountable for his/her
practice and in the exercise of his/her professional accountability, must
acknowledge any limitation in his/her knowledge and competence and
decline any duties or responsibilities unless able to perform them in a safe
and skilled manner.”
4.0 Verification of Death By a Nurse.
4.1 Death must always be verified in the prescribed manner.

Palpate Carotid pulse for 1 full minute.

Listen to heart sounds with a stethoscope for 1 full minute.

Listen for breath sounds for 1 full minute.

Check both pupils with a pen torch or ophthalmoscope. Both pupils must be
fixed, dilated and not reacting to light.
5.0 Recording of Verification of Death.

No pulses palpable

No heart sounds.

No respirations heard

Both pupils fixed and dilated and not reacting to light.
6.0 The entry must be followed by.
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
The time and date that the residents’ death was verified by the nurse.

The date and time the VMO/GP was informed.

The signature of the nurse verifying death, which must also be printed clearly
underneath her signature
7.0 Criteria for Staff Verifying Death.
7.1 Any Registered Nurse who has undertaken the approved training of Verification
of Death by Nursing Home Nurses can be nominated by their employer to verify
death.
7.2 Those staff eligible must ensure they have the necessary confidence and
competence (RCN1996) to undertake the role.
7.3 Staff able to verify death within the nursing home will inform the VMO/GP, who
will complete the “Verification of Expected resident Death” form.
7.4 Education and Training will be based on the principles of practice as identified in
the:

UKCC Code For Professional Conduct (1992) paragraph 1-16.

UKCC Guidelines for Professional Practice (1996)
This will include aspects of:

Accountability

Necessary skill and knowledge to determine the physiological signs
of death.
REFERENCES.
a) British Medical Association (1999)
Confirmation and certification of Death. Guidelines for GPs in England and Wales.
General Practitioners Committee.
b) Kent Local Medical Committee (1999)
“ Confirmation and Certification of Death, Guidance for GPs”
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c) Royal College of Nursing (1996)
“Verification of Death for Registered Nurses” Issues in Health and Nursing No 38.
d) United Kingdom Central Council for Nursing Midwifery and Health Visiting (1992)
Code of Professional Conduct paragraphs 1-9 (3rd Edition)
e) United Kingdom Central Council for Nursing Midwifery and Health Visiting (1996)
Guidelines for Professional Practice.
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VERIFICATION OF EXPECTED RESIDENT DEATH
A form will be used as designed below:I, Dr-------------------------------------------------being the General Practitioner/Visiting
Medical Officer in charge of this resident----------------------------------------------am
aware that this residents’ death is imminent and expected. I therefore give my
permission for the designated nurse on duty at the time who is able to verify death,
to do so in my absence.
Signature------------------------------------------------------------------------------------------Print Name----------------------------------------------------------------------------------------Fax Number--------------------------------------------------------------------------------------VERIFICATION OF RESIDENTS’ DEATH
Resident’s Name---------------------------------------------------------------Circulatory
No Radial Pulse
No Carotid Pulse
Using StethoscopeNo
Heart
Sounds(One Minute)
( RGN to initial in boxes)
Respiratory
No respiratory effort
Using StethoscopeNo Chest Sounds
(One Minute)
Cerebral
No Eye Movements
Both Pupils Fixed
and Dilated (use
pen torch)
Both Pupils Not
Reacting to Light
(use pen torch)
I have verified the death of-------------------------------------------------------following the
Protocol for the Verification of Death by Nursing Home Staff on:Date--------------------------------------------------Time-------------------------------------------------Signature of Verifying Nurse-----------------------------------------------------------Print Name-----------------------------------------------------------------------------