POLICY FOR WHEN AN ADULT PATIENT DIES
Version
6
Name of responsible (ratifying) committee
Nursing and Midwifery
Date ratified
8th May 2014
Document Manager (job title)
Matron, MOPRS CSC End of Life team
Date issued
19th May 2014
Review date
May 2016
Electronic location
Clinical Policies
Related Procedural Documents
Royal Marsden Manual of Clinical Nursing Procedures,
Verification of Death Competency, Communication
Competency, Care Plan Prompts, Certification and
Registration of death with Bereavement Services
Key Words (to aid with searching)
Nurses, Doctors, Chaplaincy, Individualised End of Life
Care Plan, Bereavement
Version Tracking
Version
6
Date Ratified
Brief Summary of Changes
Author
Removal references to LCP and addition of care plan
prompts as an appendix; Amendment of guidance for
use of body bags, addition of doctors to print name and
put their bleep number when verifying death on the
ward, and names of those present at a death to be
stated.
Policy for when an adult patient dies
2016
Dawn Traer,
Senior
Bereavement
Officer
Vivien Alexander,
Matron
Anne Lindsay,
Chaplain
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CONTENTS
1. QUICK RFERENCE GUIDE…………………………………………………………................3
2. INTRODUCTION................................................................................................................4
3. PURPOSE………………………………………………………………………………………..4
4. SCOPE……………………………………………………………………………………………4
5. DEFINITIONS…………………………………………………………………………………….4
6. DUTIES AND RESPONSIBILITIES…………………………………………………................5
7. PROCESS………………………………………………………………………………………..6
8. TRAINING REQUIREMENTS………………………………………………………………….8
9. REFERENCES AND ASSOCIATED DOCUMENTATION ………………………………...9
10. EQUALITY IMPACT STATEMENT……………………………………………………………9
11. MONITORING ………………………………………………………………………………….10
APPENDICES
A.
B.
C.
D.
E.
F.
G.
H.
I.
Procedure for when a patient dies ………………………………………………………11
Preparation of the deceased ……………………………………………………………..13
Religious cultural and issues for patients dying in hospital ………………………….14
Verification of expected death by registered nurses …………………………………..15
Transport of deceased by portering staff to mortuary ………………………………….16
Checklists: when a patient dies & last offices box ……………………………………..17
Certification and registration of death including bereavement services …………….19
Competency: verification of expected death …………………………………………….21
Care Plan Prompts ………………………………………………………………………...23
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Policy for when an adult patient dies
2016
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QUICK REFERENCE
For quick reference the guide below is a summary of actions required. This does not negate the need
for those involved in the process to be aware of and follow the detail of this policy.
1. Where possible patient and family should be given the opportunity to express their wishes,
which should be documented. A patient receiving End of Life Care must have a DNACPR
decision recorded as per Trust DNACPR Policy.
2. Inform member of medical staff to confirm death. Ensure confirmation of death is
documented in deceased notes. For verification of expected death by registered nurse refer
to Appendix D.
3. Ensure next-of-kin as agreed prior to patient’s death, are informed of patient’s death and
communication documented in deceased notes. If there are personal effects next-of-kin
should be given the opportunity to take them away. Ensure the name of the next-of-kin is
documented in the notes. If next-of-kin require the personal belongings but do not wish to
take them at the time of death, ensure these are taken to the bereavement office as early as
possible the next working day. GPs must be informed by next working day. Messages must
be given to a named person and the name recorded; answer phone messages are not
acceptable.
4. If next-of-kin not present at time of death, establish if they wish to visit ward. Attendance time
should normally be limited to 2 hours. Beyond this time offer relatives the alternative to visit
at the Funeral Directors premises or in exceptional circumstances the hospital viewing room
within the mortuary. If next-of-kin decide not to visit on the ward please ensure they are
aware to contact the Bereavement Office Monday-Friday. Attendance at the department is
strictly by appointment only, 023 92 286175.
5. Check with family and deceased notes for any specific personal, religious or cultural requests.
6. If next-of-kin visit deceased on ward after death provide them with the Coping with your
Bereavement booklet. Ensure they are aware that an appointment must be made with the
Bereavement Officer to collect Medical Certificate of Cause of Death. A booklet is not
required for next-of-kin of deceased with cultural & ethical requirements for burial within a
short time period. Staff should contact the Bereavement Office in office hours or Duty
Manager out of hours.
7. Under NO circumstances should valuables be left anywhere on the ward even if there is a
Controlled Drugs cupboard or a ward safe. If there are valuables and next-of-kin are not
present contact security department and follow the valuables procedure – i.e. complete a
Patient Property Form. If next-of-kin are prepared to take the valuables away ensure their
name is documented in the notes along with which valuables have been handed over.
8. Commence Procedure for preparation of the deceased (App B). A patient must never be left
naked. Dress deceased in own night clothes if possible, alternately use a hospital
gown or shroud. Last Offices boxes will be provided in each ward (see App F) It is the
responsibility of the Ward Sister/Charge Nurse to keep the box stocked and in good order.
9. If patient’s death is expected, all tubes and lines should be left in situ.
10. If the patient’s death is unexpected, a post mortem may be required. In these circumstances
all lines, tubes and equipment associated with care and treatment must remain spigotted or
secured in situ
11. When MRSA or C.Diff are written as part of the cause of death or a contributory factor
Bereavement Services will inform control of infection.
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1. INTRODUCTION
The care and services provided to a dying or deceased patient and their next-of-kin are of
utmost importance. The support provided to the patient at the end of their life should reflect the
patient’s individual preferences, values, culture, spiritual needs and beliefs.
The patient and their next-of-kin should be afforded the greatest respect, maintaining privacy,
dignity and confidentiality at all times.
All staff providing care and services should feel confident that the care they are providing is
appropriate, soundly based and respectful.
2. PURPOSE
This policy and associated protocols describe the standard of care and service that the
deceased and their next-of-kin can expect, from before death to when the deceased is released
from Portsmouth Hospitals NHS Trust (the Trust), facilitating the Trust’s compliance with
legislative requirements.
3. SCOPE
This policy applies to all staff involved in the care and delivery of service to the deceased and
next-of-kin at the time leading to and after death. The following principles should underpin the
professional services offered around the time of the death and afterwards. They apply equally
to the care and support of the patients and that of their next-of-kin.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
4. DEFINITIONS
Certification – a legal process involving the completion of paperwork that can only be
undertaken by a doctor who attended the deceased during their last illness.
The practices associated with the person’s understanding of her/his identity which
usually follow the traditions linked to the racial, national or social group with which s/he
identifies or claims allegiance. (Examples: may be expressed through dress, diet or attitude to
others.)
Cultural
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
A DNACPR order indicates that in the event of a cardiac arrest, CPR will not be initiated.
DNACPR decisions are the overall responsibility of the Consultant/General Practitioner in
charge of the patient’s care. Attempts at CPR will not be commenced when it is felt that a
patient would not survive or when it is not the patient’s wishes. It is emphasised that a
DNACPR decision does not prevent other forms of treatment being provided. See current Trust
DNACPR Policy for further detail.
Expected Death – it has been predicted that the patient will die and the patient has a fully
completed valid Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Decision recorded
on a PHT DNACPR Record Form as per PHT policy.
Next-of-kin: This term is used to cover relatives, friends and carers of the deceased
Verification of Expected Death – the formal confirmation, by a competent medical or nonmedical practitioner, that a patient has died.
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Religious
The faith framework which the person chooses to adopt and the practices which
are associated with the expression of that religious framework in his/her life style and
behaviour. (examples: may be expressed through dress, diet, or participation in religious rites
and ceremonies.)
Unexpected Death – death has not been predicted and a post mortem may be required (see
Certification and Registration of Death. App. G)
5. DUTIES AND RESPONSIBILITIES
All Staff
All members of staff of the Trust who are involved in the care of the deceased:




Will treat them with respect and dignity at all times.
Should have knowledge of end of life care plan
Should have participated in End of Life training
Have a duty of care to the deceased, until they are discharged from the mortuary to the
care of the Funeral Director.
Nursing Staff
All nursing staff will ensure that the support provided to the patient at the end of their life should
reflect the patient’s individual preferences, values, culture, spiritual needs and beliefs. The
nurse responsible for preparing the deceased will escort / accompany the deceased to the ward
doors. Nursing staff should accompany next-of-kin viewing the deceased on the wards taking
into account any particular sensitivities/ circumstances relevant to that patient death.
Nursing staff need to ensure after verification of death who was present at the time of death,
and if any family their names should be written down as this information is being requested by
the coroner.
Doctors
Doctors are expected to communicate effectively with the multi-professional team and the
deceased’s next-of-kin.
Doctors need to ensure their name and bleep number is written clearly in the medical notes, to
prevent delay and added distress for bereaved relatives.
Matrons and Ward Sisters/ Charge Nurses
To be fully aware of the policy principles and to disseminate policy to appropriate members of
staff.
To be fully aware of the legislative requirements outlined in the policy, and to monitor
adherence by staff members.
Bereavement Services
Bereavement Services will seek to provide the documentation and advice required by the nextof-kin of the deceased in a timely, empathic and professional manner. Personal effects
belonging to the deceased will be handed to the next-of-kin at their appointment with a
bereavement officer. They will work closely with the Chaplains to deliver support to bereaved
persons.
Chaplaincy
Chaplains will be familiar with the general responsibilities of other Trust staff and will be
available 24/7 to offer support to patients, relatives and staff if required. They will act as a
resource in matters pertaining to the expressed spiritual and religious needs of people of all
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faiths / beliefs and none, referring on to the appropriate Faith leaders where possible as
required.
6. PROCESS
The following principles should underpin the development of services and professional practice
around the time of the patient’s death and afterwards. They apply equally to the care and
support of the patient and that of their next-of-kin.
6.1
Respect for the Individual
When a patient dies, confidentiality must be maintained and individual preferences
values, cultures and beliefs honoured to the best of care givers ability. This includes
transportation by non-clinical and mortuary staff.
6.2
Choice
Professionals involved in caring for and supporting people who are dying or bereaved
should offer choice, provide information, time and support to people to enable that choice
to be informed. If the patient is entering the dying phase, discussions should be initiated
with the patient and/or their next of kin to assess their preferences and wishes. If the
preferred place of care is outside of the hospital, nursing staff should endeavour to meet
the request. Individual’s preferences and specific requests should be documented. For
dying patients, adoption of an individualised end-of-life-care plan (EoL) as a tool to
support the provision of quality care in the last days of life should be considered standard.
6.3
Communication
Communication with people around the time of death and afterwards should be clear,
sensitive and honest. Families and loved ones should be involved in discussions about
the use of individualised EoL plan to support care
6.4
Information
People, who are dying and those who are bereaved, need accurate written information,
appropriate to their needs, communicated clearly, sensitively and at the appropriate time.
6.5
Involvement
Services when a patient dies should be responsive to the experiences of the patients and
people who are bereaved. Information from patients and next-of-kin should inform both
service development and care provision. Professionals must be prepared, and sufficiently
skilled to involve patients and their families, enabling them to express their needs and
preferences.
6.6
Recognising and Acknowledging Loss
People who are bereaved need others to recognise and acknowledge their loss. Staff
caring for the bereaved need to recognize their needs and have these needs
acknowledged.
6.7
Time and Timing
Professionals should be aware of the importance of time and should try to work at a pace
dictated by peoples need.
6.8
Environment and Facilities
Staff should ensure privacy and comfort at the time leading to and at death.
6.9
Equality of Provision
All patients and bereaved people are entitled to a service that responds to and respects
their basic needs.
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6.10 Informed Staff
All those involved in the care of bereaved people should be well informed and confident
about the care and support they give.
6.11 Staff training and Development
Staff caring for people who are dying and for bereaved people will have opportunities to
develop their knowledge, understanding, self-awareness and skills by nurses accessing a
variety of End of Life (EOL) care training including e learning, and both formal and
informal learning opportunities to achieve EOL competencies.
6.12 Staff Support
Staff caring for dying patients and for the recently bereaved, particularly managing
unexpected deaths will have access to support either through their Line Manager, the
chaplaincy department or Aquillis counselling services. For further details please see the
Trust Human Resources Policy on ‘Supporting Staff’
6.13 Unexpected death of a patient, member of staff or a visitor
If a patient, member of staff or visitor suffers a cardiac arrest whilst on Portsmouth
Hospitals NHS Trust (PHT) premises then cardiopulmonary resuscitation (CPR) will be
commenced as per PHT CPR policy. The Cardiac Arrest Team Leader and/or Duty
Hospital Manager will arrange the post resuscitation care.
6.13 Visitors
If a visitor suffers a cardiac arrest whilst on Portsmouth Hospitals NHS Trust (PHT)
premises then cardiopulmonary resuscitation (CPR) will be commenced as per PHT CPR
policy. The Cardiac Arrest Team Leader and/or Duty Hospital Manager will arrange the
post resuscitation care.
6.14 Peri Operative Department (Theatres)
6.14.1 In order to comply with legal requirements if a death occurs within the peri
operative environment the person in charge must ensure that the following
individuals are informed immediately:

Operating Department Manager
Ward and/or Intensive Care Staff
6.14.2 It is the responsibility of the medical staff to inform their senior colleagues.
6.14.3 Trained staff from the patients’ base ward area (ITU, etc.) may be involved in
certain situations, for example unexpected death.
6.14.4 There is a small waiting room between recovery and the management offices
where next-of-kin may sit. However, there is an agreement between Critical Care
and Theatres to enable families to wait and use the full facilities within Critical
Care (quiet rooms, beds, drinks) which may be preferable.
6.14.5 If the Critical Care provision is used the theatre staff must ensure that
communications remain robust as the next-of-kin will not be within the theatre
complex and communications will not be made by Critical Care staff.
6.14.6 Next-of-Kin should be given the opportunity to pay their last respects within the
theatre environment, if this is their preference. However, they may find it less
intimidating to wait to view the deceased within the mortuary, where there are
rooms furnished for this to be undertaken sensitively. There is an internal
document to consider other areas within theatre if patients to be viewed or cared
for during unexpected end of life events. There is an internal Theatre Standard
Operating Procedure for the Care of the Deceased (SOP 52) which gives more
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information on the processes within the theatre environment, this can be found on
the Theatres Intranet site.
6.14.7 As death within the peri-operative environment in an infrequent occurrence, it is
essential that the operating theatre staff are given appropriate support (see
section “Staff Support” above). In some instances for traumatic events a team
debrief may be required.
6.15 Brought in Dead (BID)
South Central Ambulance Service (SCAS) Technicians, Paramedics and Emergency
Care Practitioners are able to recognise life extinct.
On the rare occasions that ambulance crews convey a patient who is deceased, (such as
a patient who is in public view) he or she will be taken direct to the mortuary. During office
hours, SCAS contact the mortuary staff directly to advise they are on route. Out of hours
SCAS to contact the Helpdesk and request Porters who open up the Mortuary.
6.16 If relatives do not wish the deceased to be taken into the Hospital Mortuary
If the doctor is able to issue a Medical Cause of Death Certificate (MCCD) and is certain
a post mortem or referral to the Coroner is not required:
6.16.1 Porters are asked to take the deceased to the mortuary viewing room where the
mortuary technician can complete the documentation for the reception of the
deceased.
6.16.2 Under no circumstances must funeral directors come on to the ward to collect a
deceased. The deceased must be removed from the ward by the porters,
according to their protocols and practice.
6.16.3 If a doctor is unable to issue a Medical Cause of Death Certificate or is unsure
whether the Coroner will need to be informed or a post mortem required the
deceased must remain on Trust premises and will not be released to a funeral
director under any circumstances until the Coroner has made a decision.
6.16.4 During normal duty hours the Bereavement Officer should be consulted for
procedural advice. Out of normal hours the Duty Manager will be consulted who,
in turn, should follow the guidelines set out in the duty manager handbook. In
cases where the Coroner requires a post mortem it will not be possible to release
the deceased to the relatives and the deceased will be removed to the mortuary
and kept under appropriate conditions
7. TRAINING REQUIREMENTS
7.1 Chaplains and Bereavement Staff: provide training on request. As many staff as possible
involved in caring for dying patients and the delivery of services to the deceased and their
next-of-kin will undertake this training.
7.2 Clinical Staff will undertake pre-registration education related to care of the dying patients.
An option for clinical staff is they can attend the “My patient has Died” course, provided by
the Trust Chaplaincy Department, during the first year of their employment. It provides a
basic introduction to issues surrounding bereavement and death while in medical care.
7.3 Nursing staff will have access to the online EOL e learning package for EOLC and will be
expected to undertake core modules in agreement with their manager and to record ad hoc
training or attendance at study sessions
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Nursing staff required to verify expected death will complete the competency assessment
and may only undertake this task once this has been successfully completed and signed
off as competent.
7.4 All new staff including Carillion staff can access training as part of their induction. This will
include “My Patient has Died” course. All Nursing staff attend Setting Direction (Nursing
Induction) that includes a session by the palliative care team
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Internal
 Notification and recording of adult deaths in Portsmouth Hospitals NHS Trust Version 3
14 April 2010
 Current Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy on the
intranet in Clinical Policies
 Current Cardiopulmonary Resuscitation Policy on the intranet in Clinical Policies

External
 HSG (92) Patient who die in hospital, Department of Health 1992
 When a patient dies: Advice on Developing Bereavement Services. Department of
Health. 30 October 2005.
 Essence of Care Clinical practice Benchmark – Privacy and Dignity 2001
 Families and post mortems: a code of practice Department of Health. 25 April 2003
 The Royal Marsden Manual of Clinical Nursing Procedures Chapter 22, 8th Edition 2011.
 Guidance for Staff Responsible for Care After Death (Last offices), National End of Life
Care Programme, April 2011
 The route to success in End of life care – achieving quality in acute hospitals. National
end of Life Care programme 2010
 http://www.endoflifecareforadults.nhs.uk/publications/guidance-for-staff-responsible-forcare-after-death
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff reflects
their individual needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly
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10. MONITORING COMPLIANCE
Element to be
Monitored
Last Offices box content
checklist
100% of patients
received appropriate
standard of care relating
to EOL care
Lead
Tool
Ward Sisters
Audit of
Checklist
Appendix F
part 2
Monitoring of
complaints.
EOL Care Lead
Consultant, Heads of
Nursing
Policy for when an adult patient dies
Frequency of Reporting of
Compliance
Baseline then annually
As occur
Reporting
Matrons within CSC
Through CSC monitoring their
complaints
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Lead(s) for Acting on
Recommendations
Ward Sisters/ Matrons
Ward Sisters/ Matrons
APPENDIX A: PROCEDURE FOR WHEN A PATIENT DIES
Procedure For When A Patient Dies
Action
Where possible patient and family should be given the
opportunity to express their wishes in relation to this
process which should be documented. A patient receiving
End of Life Care must have a DNACPR decision
recorded as per Trust DNACPR Policy.
Inform member of medical staff to confirm death. Ensure
confirmation of death is documented in deceased notes.
Please ensure the doctor prints their name and
documents their bleep number.
Names of nursing staff present at the time and any family
members.
For verification of expected death by registered nurse
refer to Appendix D. Note: if the patient is known to have
an implantable cardioverter-defibrillator (ICD) fitted
please inform the doctor and request that he asks the
pacing clinic to turn the device off as soon as possible.
Ensure next-of-kin as agreed prior to patient’s death, are
informed of patient’s death and communication
documented in deceased notes. If there are personal
effects next-of-kin should be given the opportunity to take
them away. Ensure the name of the next-of-kin is
documented in the notes. If next-of-kin require the
personal belongings but do not wish to take them at the
time of death, ensure these are taken to the bereavement
office as early as possible the next working day.
GPs must be informed by next working day. Messages
must be given to a named person and the name
recorded; answer phone messages are not acceptable.
If next-of-kin not present at time of death, establish if they
wish to visit ward. Attendance time should normally be
limited to 2 hours. Beyond this time offer relatives the
alternative to visit at the Funeral Directors premises or in
the hospital viewing room within the mortuary– this is by
appointment only within working hours (08:00 16:30).
If next-of-kin decide not to visit on the ward please ensure
they are aware to contact the Bereavement Office
Monday-Friday. Attendance at the department is strictly
by appointment only – 023 92 286175
Check with family and deceased notes for specific
requests, religious or cultural requests.
If next-of-kin visit deceased on ward after death provide
them with the Coping with your Bereavement booklet.
Ensure they are aware that an appointment must be
made with the Bereavement Officer to collect Medical
Certificate of Cause of Death. A booklet is not required
for next-of-kin of deceased with cultural & ethical
requirements for burial within a short time period. Staff
should contact the Bereavement Office in office hours or
Duty Manager after hours.
Under NO circumstances should valuables be left
Policy for when an adult patient dies
2016
Rationale
Principles of ‘Respect for the Individual’,
‘Choice’ and ‘Communication’
Reduce delay and added distress from
family
Legal requirements.
To ensure all are aware of patient’s
death and record of communication
provided.
Principles of ‘Choice’, ‘Communication’,
‘Information’,
‘Involvement’
and
‘Recognising and Acknowledging Loss’
To ensure specified and specific needs
are met.
To provide practical advice to bereaved
and ensure they understand appointment
system in place.
To ensure no needless distress is
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anywhere on the ward even if there is a Controlled Drugs
cupboard or a ward safe. If there are valuables and
next-of-kin are not present contact security department
and follow the valuables procedure – i.e. complete a
Patient Property Form.
If next-of-kin are prepared to take the valuables away
ensure their name is documented in the notes along with
which valuables have been handed over.
Commence Procedure for preparation of the deceased
(App B). Last Offices boxes will be provided in each ward
(see App F) It is the responsibility of the Ward
Sister/Charge Nurse to keep the box stocked and in good
order.
If patient’s death is expected, all tubes and lines
excluding subcutaneous butterflies should be left in situ,
.
If the patient’s death is unexpected, a post mortem may
be required. In these circumstances all lines, tubes and
equipment associated with care and treatment must
remain spigotted or secured in situ
When MRSA or C.Diff are written as part of the cause of
death or a contributory factor Bereavement Services will
inform control of infection.
caused.
To avoid confusion at times of distress
To ensure standardised approach and
evidence of procedure followed.
To prevent leakage of bodily fluids
and maintain dignity of the deceased.
The deceased is under the jurisdiction of
the Coroner and not the hospital.
Legal requirement
To ensure Control of Infection meet their
deadlines.
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APPENDIX B: PREPARATION OF THE DECEASED PATIENT
Purpose
The aims of this procedure to ensure deceased patients are treated with respect and dignity even
after death. It also describes a process by which deceased patients are made to appear as natural
as possible to reduce the risk of unnecessary distress to relatives and carers. Two members of
nursing staff should undertake this procedure.
Equipment required:
Deceased’s own nightwear if possible: if not a hospital gown.
Toiletries
Last Offices Box
PROCEDURE FOR THE PREPARATION OF THE DECEASED PATIENT
Action
Curtains will be drawn fully around the bed space once death is
suspected.
Deceased will be laid flat, with one pillow, eyes closed, arms by their
sides and dentures in place (if appropriate). The jaw should be
supported by a rolled towel or pillow.
Deceased and family requests for a favourite toy / treasured possession
to accompany deceased honoured and yellow sticker completed to
indicate this.
All jewellery should be removed with the exception of the wedding ring,
in the presence of another member of staff unless relatives or patient
has specified otherwise. The removal and retention of any jewellery
should be clearly documented. Follow the procedure for removal and
storage of valuables.
Leave all lines in situ (excluding subcutaneous butterflies)
Rationale
To promote privacy
and dignity.
To ensure
appropriate
positioning prior to
onset of rigor mortis
Principle of ‘Respect
for the Individual’
To ensure safety of
deceased valuables.
ITU – where all tubes except the ET tube are left in situ and the ET tube
is taped to the outer cover wrap.
Peri-Operative (Theatre) – where all wound drains must be left in
position, catheters and/or cannulae should be closed with a spigot,
endotracheal or tracheostomy tubes should remain in situ*, wounds
should be covered with a dressing. A cadaver bag should be used for a
peri operative patient.
Relieves distress to
relatives or fulfills
legal requirement
It is appropriate for a theatre practitioner to escort the deceased to the
theatre suite exit.
* The Coroner may agree to the removal of either an endotracheal tube
or tracheostomy tube if the family wish to view the body. In this case the
ET/tracheostomy tube should be taped to the outer cover wrap.
Wearing gloves and an apron, wash the deceased as required (NB.
Some relatives may have made specific requests to be involved in this
aspect of care and religious issues must be considered)
Packing of orifices is not usually undertaken. Due consideration must be
given to ensuring deceased retain their dignity and alternate methods
such as using pads or dressings should be used as the first line of
action. Leaking wounds should be covered with a dressing and
Principle of ‘Respect
for the Individual’
To ensure risk of
contamination from
body fluids is
reduced and dignity
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waterproof covering. If in doubt, contact the mortuary staff for advice.
Use of body bags are encouraged for those patients with loose stools,
leaking oedema and leaking wounds. .
Dress deceased in own night clothes if possible, alternately use a
hospital gown or shroud. Under no circumstances should the patient be
left naked. Record on checklist.
Ensure ID bracelet in place and information correct.
Use a sheet, ensuring that the face and feet are covered and all limbs
are held securely in position. Complete yellow patient data label to affix
to the sheet or body bag.
Use a body bag for ‘leaking infections’ only, For example, if someone
has MRSA nose and groin they can be wrapped in a sheet but marked
on the large yellow label ‘MRSA’.
Position slide sheets under the deceased so that the lateral transfer into
the concealment trolley can be undertaken as per ‘Technique Dii, People
Moving and Handling Policy’.
Request for portering staff to attend the ward to transport the deceased.
Inform porter of the weight of the patient.
Screen off the area to the deceased patient’s bed space.
Complete appropriate documentation, including check list, ensuring
completed deceased notes are available to be transferred to the
mortuary with the deceased. Ensure note tracking has been completed.
X-rays are returned to the Radiography Department.
Record deaths on the PAS system to ensure all outstanding
appointments are cancelled.
Complete App D and App E of the Notification of a Death Policy and fax
to Health Records 023 92 681193. This gives information regarding the
mandatory notification of the GP which must be done by phone on the
next working day, it is not acceptable to leave an answering machine
message when calling the GP surgery.
Completed checklist is retained on ward in identifiable folder and kept for
6 months prior to being disposed of as confidential waste.
of deceased is
maintained.
Principle of ‘Respect
for the Individual’
To ensure ease of
identification
To avoid potential
damage to deceased
during transfer and
To ensure ease of
identification
To minimise risk of
contamination
To avoid potential
damage to deceased
during transfer and to
protect the
musculoskeletal
health of staff
Principle of ‘Informed
Staff’
Reduction of ward
distress
Principle of ‘Informed
Staff’
Ensure all
appointments,
transport requests
etc are cancelled.
To prevent
‘misplacement’ of
PID
APPENDIX C: RELIGIOUS AND CULTURAL ISSUES FOR PATIENTS DYING IN HOSPITAL
If in doubt chaplains are available 24/7 for advice and support through Queen Alexandra Hospital
switchboard. It is also very important to speak with relatives, if in any doubt about a patient’s wishes
before commencing last offices, as they will be able to guide and support to ensure a patients wishes
are met.
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APPENDIX D: VERIFICATION OF EXPECTED DEATH BY REGISTERED NURSES
Purpose
For some patients, death in the near future is inevitable and can be predicted. It is recognised that a
competent Registered Nurse may verify an expected death, affording an increase in the quality of
care for patient’s families and carers by enabling a staff member known to the family to inform them
of the death of their relative. This guideline and associated competency will describe the process to
be undertaken in Portsmouth Hospitals NHS Trust.
Action
A Registered Nurse who has undertaken a competence
assessment and who is able to demonstrate evidence of
competence is able to undertake this procedure.
Death must have been expected and a written record
exists in the medical notes that:
a) Do Not Attempt Cardiopulmonary Resuscitation
decision has been fully documented on a
DNACPR Record Form as per PHT policy.
b) Death can be verified by a suitably trained nurse if it
is written in the notes as being appropriate.
The patients should be carefully examined, and the
following signs checked for over a period of not less than
three minutes,

Absence of cardiac output

Absence of respiration’s

Pupils do not react to light
 Use the label provided and place in medical notes
to ensure consistent documentation.
The time and date of death should be clearly recorded
immediately after the last entry in the medical notes. The
nurse should sign and print their name and R.N. Status.
The verifying nurse for an expected death should inform
the doctor as soon as is practicable.
NB. It should be made clear to the next-of-kin that
verification and certification may be different times as
although the nurses have verified death, the doctor may
not certify death until practicable i.e. the next working
day (Mon-Fri).
If relatives wish to see a doctor at the time of death this
should be facilitated.
Rationale
Ensures staff adequately trained
experienced
To provide documentary evidence
of agreement
To comply with Duty of Care
To comply with Trust policy on
documentation
To ensure medical team are aware
of the death.
To provide opportunity for relatives
to discuss issues with medical
staff.
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APPENDIX E: TRANSPORT OF DECEASED PATIENTS BY PORTERING STAFF TO
MORTUARY
PHT PATIENTS
Action
The deceased is treated with the same respect
afforded in life
Patients are transferred to the mortuary using a
specifically constructed framework with a cover, which
ensures dignity. Notes should be concealed under the
framework and cover for confidentiality.
Ward staff are advised of the trolley arrival onto the
ward. Curtains are drawn to ensure dignity and
sensitivity.
The deceased is handled using a patslide with care
onto the trolley. All staff apply manual handling
precautions. Any adverse incidents are reported to the
Risk Management Department using the Trust Adverse
Incident reporting form.
The deceased’ name, ward, mortuary tray letter and
Porter’s signature are entered into the mortuary
logbook. Great care is taken to ensure correct
identification.
PATIENTS BROUGHT IN DEAD (BID)
Action
All BID patients are delivered to QA.
Funeral Directors or Ambulance Crew call the
Helpdesk on x6321 and request Portering to open the
Mortuary. Funeral Director or Ambulance Crew is
responsible for recording required data in the logbook.
Valuables present with the BID are the responsibility of
the Funeral Director or Ambulance Crew. Valuables are
logged on a Patient Property Form, located on the table
next to the porters log sheet. This form, together with
the valuables are placed inside a Patient Property
Envelope, witnessed and sealed. They are then placed
in the safe which is built into the side of the small store.
Any valuables left on the deceased are recorded in the
mortuary log book.
Should a request for viewing be received, the mortuary
should be contacted or switchboard should be
requested to call the duty mortuary technician via on
call phone.
Principle of
Individual’
Principle of
Individual’
Rationale
‘Respect
for
the
‘Respect
for
the
Principle of ‘Respect for the
Individual’ and ‘Environment and
Facilities’
Concealment of trolley with respect
See Portering Supervisor
Accurate identification of deceased
is imperative when transferring to
the mortuary or handing over to the
funeral directors.
Rationale
To ensure
valuables
safety
of
deceased
Principle of ‘Informed Staff’ and
‘Choice’
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Policy for when an adult patient dies
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APPENDIX F: CHECKLISTS: WHEN A PATIENT DIES
DATE & TIME OF DEATH …………………………………………
Ward/Area: ………………………………
Procedure performed by:
Name (printed)
……………………………………………….
Name (printed)
………………………………………………..
STANDARD
Communication
Patient Identification
completed
Deceased property
secured
Deceased prepared
for transport to
mortuary
(Religious/cultural
requirements met)
Safe Medication
Management
Implantable Cardioverter Defibrillator
Documentation /
communication
completed
Affix Patient data label
RN / HCSW
RN / HCSW
PROCEDURE
YES
COMMENT
Next of Kin have been informed
Ensure wrist identification bracelet in place and
information correct.
Complete yellow patient data label for placement on outer
body cover.
Complete documentation deceased file note & yellow
sticker for any jewellery left on the deceased. See page
8.
Valuables envelope prepared for any remaining valuables
with deceased.
Once a Patient Property Form (PPF) is witnessed and
completed security, or as per site processes should be
contacted through Carillion helpdesk (x6321) to collect
these valuables, who, in turn will follow their strict
procedure for safeguarding them.
All other personal effects should be listed, checked and
placed in a secured labelled bag signed by two staff
members and delivered to Bereavement Office same or
next working day.
If unable to replace dentures: these must be placed in a
labelled denture pot and transported to the mortuary with
the deceased and noted on yellow sticker.
Deceased placed in own nightwear or hospital gown.
Do NOT leave deceased naked.
All tubes left in situ
Pillow in position under deceased head. Mortuary pillow
used for transfer to mortuary
Porters requested to collect deceased for transfer to
mortuary. Special needs regarding size/weight etc.
communicated. All deceased notes to be transferred
inside trolley.
Ensure POD locker emptied.
If fitted inform the doctor and request that he asks the
pacing clinic to turn the device off as soon as possible.
Nursing documentation completed
Coping with your Bereavement Booklet with bookmark
attached to be handed to next of kin if present at death.
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GP Notification
Deceased GP Informed by telephone (voice mail not
acceptable) or Ward Clerk notification to do so
completed. Check with GP that deceased is his/her
patient. Notification must take place next working day.
Record deaths on the PAS system to ensure all
outstanding appointments are cancelled.
Complete App D. Notification of death (See Notification of
a Death Policy) and fax to Health Records 023 92 681193
Checklist signed by qualified nurse and witnessed and
filed securely on ward for 6 months.
Dr ………………………………. Notified of time and date of death ……………
By Ward Clerk / Nurse / HCSW …………………………………………………….
On Tel / Fax No. …………………….
At the following address ……………………………………………………………
LAST OFFICES BOX - CONTENT CHECKLIST
ITEMS


















Bereavement Booklets
Marsden Procedure (laminated)
Check List
Gloves
Valuables envelope
Name bands
Yellow Labels
Spigots
Scissors (single use)
Tape (Spenfex 25mm x 50m)
White zip-up bag (extra strength)
Trolley Canvas
Denture pot
Shrouds
Manilla River (Valuables) envelopes
Property bags
QUANTITY
ORIGIN / ORDER NUMBER
10
Bereavement Office
1
Marsden Manual (Chapter 22)
1
Medical photography
10 of each
Materials Management FTE 153/152/154
S/M/L
10
UK Procure WH10017
5 of each
Materials Management
Red
FSL141
White FSL142
Child FSL139
20
5
5
5
Medical Photography
Materials Management
FVJ005
Materials Management
FGP171
Materials Management
VWR380
2
UK Procure VMS002
2
Linen Room
5
Materials Management
Denture pot – MRA079
Denture lid - MRA105
5
VMS 148 – Materials management
5
02940
5
Materials Management
MVM 021
Linen Room
sheets
Appendix E Notification of death
10
Health Records
* quantities of items may be reduced in clinical areas with less numbers of deaths such as peri operative
(theatres) care
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Policy for when an adult patient dies
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APPENDIX G: CERTIFICATION
BEREAVEMENT SERVICES
AND
REGISTRATION
OF
DEATH
INCLUDING
Note: ED deaths (formally known as A&E) are usually referred either to the Coroner or to
the GP of the deceased. In some cases (although still rare) the Hospital will issue a death
certificate: ED has its own protocol in place for this procedure. If in doubt please ring
bereavement services (x6175 or x6406) for advice and guidance or bleep 1170: nurse-incharge on ED.
G1 BURIAL CERTIFICATION PROCEDURES
Doctor attends Bereavement Office and completes Medical Certificate of Cause of
Death (MCCD): completion will be checked by the Bereavement Officer, who, in turn, will
hand MCCD to the next-of-kin.
The Bereavement Officer will instruct the next-of-kin of their responsibilities now and what
will happen at the Register Office.
G2 CREMATION CERTIFICATION PROCEDURES
G2a Doctor attends Bereavement Office and completes Medical Certificate of Cause of
Death (MCCD) in conjunction with Form 4 of the Cremation certificate – see below J2b).
Form 4 of the cremation paperwork will be retained in the Bereavement Office where the
follow-on procedures for completion of cremation paperwork will be carried out by a
Bereavement Officer.
The completed MCCD paperwork will be checked by the Bereavement Officer and
retained until the form 5 of the cremation paper has been completed.
The Bereavement Officer will then instruct the next-of-kin of their immediate
responsibilities and what will happen at the Register Office.
Note: Should the Coroner request a Post-Mortem there will be no MCCD or Cremation
Certificate issued from the Hospital. The Bereavement Officer will explain the procedure to
the next-of-kin
Practical arrangements for disposal, whether by burial or cremation, are handled by the
Funeral Director.
G2b Duties and Responsibilities regarding Cremation Certification
The process which follows will be carefully adhered to. It is designed to be:
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


Safe: The doctor signing the Form 5 Cremation Certificate fulfils a vital public safety
role in ensuring to the satisfaction of the Crematorium Referee, the Coroner and
Registrar General that the cause of death is as stated by the doctor who has had
charge of the patient and has signed the Form 4 Cremation Certificate
Equitable: A fee is payable by the relatives, through the Funeral Director, to the
doctors signing forms 4 and 5 of the cremation certificate. It will be equitable that all
doctors wishing to partake of this work have an equal chance to do so.
Efficient: The prompt signing of the Form 5 is essential to the swift processing of
documentation to enable the body to be released to the Funeral Directors for
cremation. Delays in the process can cause distress to relatives and complaints to the
Trust.
Bereavement Services
The Senior Bereavement Officer shall be responsible for the arrangement of a rota of
suitably qualified doctors and the day-to-day facilitation of this service only.
The Senior Bereavement Officer shall initiate and circulate, as and when required, a letter
to Trust Consultants asking them to draw the attention to those of their staff who are
suitably qualified to the opportunity to be placed on the ‘Form 5 List’.
The ‘Form 5 List’ shall be held by the Bereavement Officers at QAH. The work will be
allocated in rotation, subject to the doctor being contactable and available.
The Doctors
All doctors completing Form 4 and Form 5 of the Cremation Certificates are fully
responsible and accountable for accuracy, content and fulfilling the requirements as set
out in the Cremation Certificate and in accordance with Home Office Guidelines.
Doctors will, by way of their Application and Agreement to be on ‘the Form 5 List’ agree to
fulfill these duties in accordance with the above guidance and in a timely manner.
Complaints
In case of complaint arising from the Crematorium Referee or any other source, the
Chaplaincy Team Leader, the Head of Bereavement Services, and the Senior
Bereavement Officer shall be notified regarding any course of action that needs to be
taken
G3 The Coroner
In some cases the death has to be referred to the Coroner for discussion. This is a
legal requirement. Listed below are examples (this is not an exhaustive list)
 died within 24 hours of admission
 had an operation within the last 12 months
 died during or shortly after surgery
 had a fall resulting in a fracture
 alcohol-related illness
 any asbestos exposure
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Policy for when an adult patient dies
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After this discussion if the Coroner decides a Post Mortem need not be performed
then the MCCD and cremation certificate can be issued – this process is called a
Coroner’s Clearance (Refer back to J1 and J2).
If the Coroner decides a post mortem has to be performed, neither the MCCD or
cremation certificate can be completed. The relevant paperwork is issued from the
Coroner’s Office after the post mortem. A bereavement officer will explain the
process to the relative.
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APPENDIX H – COMPETENCY PROFROMA (AC2)
Competency Statement: Verification of Expected Death by a Registered Professional
Competency
Indicators 1st Level
Demonstrate
knowledge and
understanding of
patient specific plan of
care including:
 patient history
 religious beliefs
 cultural
expectations
 family
requirements and
support
Demonstrate
competence in
managing last offices
according to Trust
policy
Discuss Trust policy
for verification of
expected death and
relevant professional
and legal
responsibilities.
Achieved
Assessor
Signature
Competency Indicators
2nd Level
A Registered Nurse - under the supervision
of medical staff / registered nurse with
proven expertise in verification of expected
death:
Demonstrate correct confirmation of
instructions for nurse verification of
expected death.
Discuss process for obtaining advice if
circumstances are altered.
Ability to examine patient to determine
physical signs of cessation of life for not
less than three minutes:
Absence of cardiac output (inaudible apex
beat, no palpable femoral /carotid pulse)






Absence of respirations confirmed by
auscultation
Lack of pupil reaction to direct light
(fixed and dilated)
Accurate recording of date and time of
death in the medical notes (sign and
print name and status)
Provide effective support to relatives
present
Notify absent relatives and religious
representative as per stated wishes in
plan of care
Inform medical officer responsible
within one hour (defer to 09.00 hrs
between 22.00-08.00hrs)
Achieved
Assessor
Signature
Competency
Indicators
3rd level
Able to undertake
verification of
expected death
without
supervision
Achieved
Assessor
Signature
Competency Indicators
4th level
Act as mentor and
assessor for staff
undertaking this
competency
Able to offer advice and
assistance to staff
regarding the completion
of this activity.
Undertake audit and
contribute to policy review
Achieved
Assessor
signature
Portsmouth Hospital Trust
Policy Death Procedures
Protocol
The Royal Marsden Hospital
Manual of Clinical Nursing
Procedures 8th Ed (Last
Offices Chapter 21)
Essence of Care 2003 –
Privacy and Dignity and
Record Keeping
Guidance for Staff Responsible
for Care After Death (Last
offices), National End of Life
Care Programme, April 2011
Education resources to support your development
Code of Professional Conduct. 2004/ 2008. Nursing
& Midwifery Council
Guidelines For Records and Record Keeping 2009.
Nursing & Midwifery Council
Author:
Review Date:
Department:
Record of Achievement.
To verify competence please ensure that you have the appropriate level signed as a record of your
achievement in the boxes below either by the educator/ trainer if attendance on study session and or
the workplace assessor when performed in practice.
Level 1
Level 2
Level 3
Level 4
Date:
Signature of
Educator/ Trainer
Date:
Signature
of
Educator/ Trainer
Date:
Signature
of
Educator/ Trainer
Date:
Signature
of
Educator/ Trainer
Date
Date
Date
Date
Signature of
Workplace
Assessor
Signature of
Workplace
Assessor
Signature of
Workplace
Assessor
Signature of
Workplace
Assessor
References to Support Competency
Essence of Care. 2003 Department of Health
Nursing & Midwifery Council 2008 Code of Professional Conduct.
Nursing & Midwifery Council 2009 Guidelines For Records and Record Keeping .
Mallett J. and Dougherty L. Eds. 2011 The Royal Marsden Hospital Manual of Clinical Nursing Procedures
8thth Edition
Portsmouth Hospital Trust Policy Death Procedures Protocol 2005
Guidance for Staff Responsible for Care After Death (Last offices), National End of Life Care Programme,
April 2011
APPENDIX I – CARE PLAN PROMPTS CARE PLANNING PROMPTS and GUIDANCE NOTES
FOR
END OF LIFE CARE
CARE PLAN: F
Patient Safety
Continue to use Braden score; Falls risk assessment, Bed rail assessment, MRSA risk assessment,
SKIN care bundle and manual handling profile to assess patient needs.

Consider appropriateness of VTE and MUST assessment – clarify with medical team and document
plan in medical notes.

If using a T34 syringe driver for subcutaneous continuous infusion use as per hospital policy and
guidelines. Monitor use of pump by syringe driver check sheet.
CARE PLAN: G
Communication and Preferences

Is the patient able to participate in discussions and express their preferences and concerns?

Does the patient have mental capacity to make their own decisions around treatment?

Ensure clear documentation in the medical and nursing notes of this decision making rationale and
document conversations with the patient and their family / carers.

Where possible and practicable, ensure that the patient and their family/carers are aware that the
patient’s condition is deteriorating and that we feel that they may be entering the dying phase of
their life.

Offer the patient’s family/carers the ‘Coping with Dying’ leaflet, to support their understanding of the
dying process and the changes which may occur.

If the patient’s preferred place of death is other than Queen Alexandra Hospital, consider whether a
supported discharge could be arranged quickly and set up an MDT, family and patient discussion to
facilitate this.

If the patient wishes for tissue or organ donation, ensure that this is arranged and provide details
and transplant co-ordinator contact details.

Ensure the patient has a Do Not Attempt Cardio-Pulmonary Resuscitation decision documented in
the medical notes.

Ensure up to date contact details and wishes are documented and the patient’s family/carers are
made aware of the hospital facilities, relative’s room, telephone number and visiting times.

Has the patients GP been informed via fax that their patient’s condition has deteriorated and they
are now receiving End of life care in hospital?

Has the patient’s CNS/ Community Nursing team/OT/ Social Worker/ Physio been informed that
their patient’s condition has deteriorated and are now receiving End of life care?
CARE PLAN: H
Breathing

Is the patient experiencing difficulty breathing?

Likely cause? (e.g. tumour pressure, respiratory failure, cardiac failure, respiratory centre
depression, stridor).

Consider positional change, postural drainage and use of pillows to aid the patients comfort.

Consider the use of respiratory suctioning /airway adjuncts only if clinically appropriate, where the
benefit outweighs the risk and potential distress for the patient.

Is PRN anti-cholinergenic and anxiolytic medication prescribed to ease symptoms?

Is the patient receiving continuous anti-cholinergenic or other medication via a syringe driver
infusion to aid their breathing? Use of respiratory tract secretions algorithm.

Use of prescribed oxygen for comfort?

Receiving physiotherapy?

Use of breathlessness and respiratory tract secretions algorithms.
CARE PLAN: I
Nutrition, hydration and fluid balance

Where the patient is able, offer them assistance with eating and drinking.

Provide details of individual dietary preferences where applicable.

Ensure frequent reassessment of their ability to swallow safely.

Document the decision making rationale regarding continuation, reduction or discontinuation of
clinically assisted nutrition and hydration.

For patients who continue to receive clinically assisted nutrition and/or hydration, continue the
applicable care plan specific to their needs.

Ensure frequent review of continued clinically assisted hydration and/or nutrition with regards to
tolerance and appropriateness as the patient’s condition deteriorates.

Offer the family/carers evidence based education around the dying process, the reduced desire for
intake of food and fluids at this time, and supportive information about dehydration as the person is
dying.

Provide the family/carers with instruction of good mouth care techniques and equipment for them to
administer mouth care.
Nausea and vomiting?

Likely cause? (e.g. bowel obstruction, gastric stasis, raised intracranial pressure, organ failure,
uraemia, GI bleed).

Are there any non-pharmacological interventions which help relieve the nausea or vomiting? (e.g.
Naso-gastric tube drainage, acupressure bands, position, aromatherapy.

Is PRN anti-emetic medication prescribed? Yes. If ‘No’, contact the medical team for immediate
review.

Is the patient receiving continuous anti-emetic medication via a syringe driver infusion?

Use of nausea and vomiting algorithm.
CARE PLAN: J
Elimination, Personal Cleansing and Dressing
Care as per generalised prompts

Monitor for signs of dysuria and urinary retention. Consider this as a potential cause of any
agitation.

Offer assistance as appropriate to help the patient to open their bowels and pass water.
Mouthcare

Provide pink sponges, fresh water and either Aquagel or artificial saliva spray by the bedside.

Administer prescribed antifungal medication (e.g. Nystatin) on pink sponges in the case of
continued oral thrush.

Offer the family/carers guidance on how to administer mouth care for their loved one to support their
participation in care.
CARE PLAN: K
Vital signs
Discontinuation of vital signs?
Pain ?
.

Pain assessment tools.( Abbey )

Usual sites of pain?

Likely cause (e.g. tumour pressure, neuropathic pain, flatus, bladder spasms).

Are there any non-pharmacological interventions which help to relieve the pain?
(e.g. heat pad, massage, positional changes)

Is PRN analgesic medication prescribed?

Pain algorithm.

Administer prescribed analgesics for relief of pain and document their effectiveness.

Reassess the effectiveness of analgesic medications regularly and report concerns to the medical
team for review, at least daily.

Diabetic algorithm.
CARE PLAN: L
Mobilising and Falls Prevention.
Care as per generalised prompts.

Does the patient prefer to be nursed in the bed / chair?

Does the patient prefer to lay on a particular side/flat/upright?

Offer assistance with positional changes and provide comfort aids as necessary
(e.g. heat pads, pillows etc.)

Does the patient have a specific night time settling routine?

Ensure the nurse call bell is available at all
times.

Refer to terminal restlessness and agitation algorithm if required.
CARE PLAN: M
Psychological Well-being and Relationships
Care as per generalised prompts.

Does the patient or their family/carers have particular religious, cultural or spiritual faith needs which
are important to them?

Do they receive support from a chaplain, faith leader or other person?

Is the patient exhibiting signs of terminal restlessness, agitation or hallucinations?

Likely cause? (e.g. the dying process, raised intracranial pressure, hypoxia, dementia, pain, the
need to micturate

Does the patient have dementia, cognitive impairment or a learning disability?

Consider the use of assessment tools (e.g. Doloplus 2. Disdat tool) and the flow chart algorithm for
management of agitation and terminal restlessness.

Are there any specific techniques which are helpful in calming the patient? (e.g.distraction, music,
quiet, company, reminiscence, photographs.

Does anything exacerbate the patient’s agitation? (e.g. noise, loneliness, the dark, pain, needing to
micturate.

Offer a calm environment. Consider limiting noise and interruptions/stimulation which may
exacerbate the patient’s agitation.

Offer comfort, touch and reassurance where appropriate.

Is PRN anxiolytic/sedative and/or antipsychotic medication prescribed?

Is the patient receiving continuous anxiolytic/sedative/antipsychotic medication via a syringe driver
infusion?

Is patient still able to have medications orally or via feeding tube.

Use of Terminal restlessness and agitation algorithm.
CARE PLAN: N
Sleeping and rest
Care as per generalised prompts.
CARE PLAN: O
Discharge from our care




Ascertain preferred place of care/preferred place of death.
Fast track discharge? Involve IDB.
Discuss with patient /family re EOL care planning, potential support in the community.
Suggest use of GSF/EPaccS register as part of discharge summary.
CARE AFTER DEATH


Relative or carer present at time of death? If not, notify as soon as possible.
Are there any traditions or practices to be aware of after death which the patient would like us to
respect and uphold?
Patient Dignity Care Plan
The patient is treated with respect and dignity while last offices are undertaken
Universal precautions and local policy and procedures including infection risk adhered to
Spiritual, religious, cultural rituals / needs met
Organisational policy followed for the managements of ICD’s where appropriate
Organisational policy followed for the management and storage of the patients belongings and valuables
Care Plan achieved
Yes / No
Variances recorded
Yes / No
Healthcare professionals initials_________________________________ Date_______________ Time _________
Relative or Carer information Care Plan
Conversation with the relative or carer explaining the next steps
Bereavement information given
Yes / No
What to do after a death (England and Wales) or equivalent is given
Yes / No
Information given regarding how and when to contact the bereavement office / funeral director to make an
appointment - regarding the death certificate and patients valuables and belongings where appropriate
Discuss as appropriate: Viewing the body / The need for post mortem / The need for removal of cardiac devices /
The need for discussion with the coroner
Information given to families on child bereavement services where appropriate - national and local agencies
Care Plan achieved
Yes / No
Variances recorded
Yes / No
Healthcare professionals initials_________________________________ Date_______________ Time _________
Organisation information Care Plan
The primary health care team / GP is notified of the patients death?
Yes / No
The primary health care team / GP may have known the patient very well and other relatives or carers may be
registered with the same GP. Telephone or fax the GP practice
Care Plan achieved
Yes / No
Variances recorded
Yes / No
Healthcare professionals initials_________________________________ Date_______________ Time _________
The following organisations are informed of the patients death, where appropriate:
Bereavement office / Patients and relatives support office / District nursing team / Social services / CQC
Community Matron / Specialist palliative care team
Has the patient’s death been entered on the organisations IT system? Yes / No
Care Plan achieved
Yes / No
Variances recorded
Yes / No
Healthcare professionals initials_________________________________ Date_______________ Time _________
Completion of Verification of death Sticker/proforma for medical notes.
GUIDELINES FOR THE MANAGEMENT OF DIABETES
INSULIN
TREATED TYPE
1 OR 2
Prescribe 25% of total daily
insulin requirement in 2 equal
divided doses or 8 units of
Insulatard BD whichever is
the lowest
IF DISTRESSED MONITOR
ORAL
HYPOGLYCAEMIC
AGENTS
DIET
STOP ORAL
MEDICATION
WHEN PATIENT
UNABLE TO
SWALLOW
NO BLOOD
GLUCOSE
MONITORING
REQUIRED
REFER TO DIABETES
SPECIALISTS NURSES
FOR INDIVIDUALISED
CARE
NO BLOOD
GLUCOSE
MONITORING
REQUIRED
FOR FURTHER ADVICE PLEASA CONTACT DIABETES SPECIALIST TEAMS AS FOLLOWS;
Diabetes Centre Diabetes nurse referral via OCM
Diabetes Centre Ext: 6260, available 0800-1630hrs on weekdays, can leave message at other times to seek working hours review
Policy for when an adult patient dies
Issue 6. 19/05/2014 Review date: 18th May 2016
Page 37 of 37