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SH CP 146

Care of a Patient after their Death


Procedure
Version: 2

Summary: Trust procedure on the care of a patient after their


death.

This document supports staff in providing timely, safe,


effective and sensitive care to a deceased patient and
their families.

Keywords (minimum of 5): Death of a patient, Last offices, Unexpected Death,


(To assist policy search engine) Deceased person, Verification of expected death,
Referral to coroner, Tissue donation.

Target Audience: This document applies to all Trust staff who may be
involved in the care of a patient after their death.

Next Review Date: January 2018

Approved and ratified by: End of Life Steering Date of meeting:


Group 18 November 2014

Date issued: December 2014

Author: Gina Winter-Bates, Head of Specialist Patient


Pathways
Dr Rachel Wilkins, Consultant Geriatrician
Sponsor: Director of Nursing, Allied Health Professionals and
Quality

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Care of a Patient after their Death Procedure
Version: 2
January 2017
Version Control

Change Record
Date Author Version Page Reason for Change
14.8.14 Steve Coopey 1 6,7 Re-wording and removal of references to Liverpool Care
Pathway
10/9/14 Gina Winter- 2 Full Rewording of care of body after death and verification of
Bates review death, Removal of all out date references. Addition of
Coroner details for Oxford and Bucks
Oct Julia Lake 2 6,7,8 Added link to Trust procedure for reporting death and
2016 managing incidents
Oct Julia Lake 2 19 Added contact details for Trust Chaplin
2016 Policy review no further amendments required

Reviewers/contributors
Name Position Version Reviewed &
Date

Toni Scammell Modern Matron Lymington Hospital Version 1 September


2013
Kevin Page Lead Nurse OPMH Version 1 September
2013
Mary Pilgrim Infection Control Adviser Version 1 September
2013
Steve Coopey Practice Development Specialist Nurse Version 1 September
2013
Sue Gasparro Clinical Trainer Version 1 September
2013
Jan Holden Area Matron Version 1 September
2013
Charlotte Turner Risk & Business Continuity Officer Version 1 September
2013
Ricky Somal Equality & Diversity Lead Version 1 September
2013
Sue Hobbs Community Matron Version 1 September
2013
Simon Johnson Resuscitation Officer Version 1 September
2013
Louise Felice Head of Legal & Insurance Services Version 1 September
2013
Paula Hull Associate Director of Professions & Quality Version 1 September
2013
Gina Winter-Bates Head of Specialist Patient Pathways Version 2 16/1/01/14
Rachel Wilkins Consultant Geriatrician and End of Life Version 2 16/1/0/14
Chair
Debbie McGregor Safeguarding Lead Nurse Version 2 10/10/14
Nick Fennemore Trust Chaplain Version 2 16/10/14
Ricky Somal Equality and Diversity Lead Version 2 16/10/14
End of Life Steering Group Version 2 November
2014
Nick Fennemore Head of Chaplaincy, Spiritual & Pastoral Version 2 October 2016
Care

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Care of a Patient after their Death Procedure
Version: 2
January 2017
Contents

Page

1. Unexpected Death of an Inpatient 4


2. Unexpected Death of a patient in the Community 5
3. Referral to the Coroner 5
4. Other special considerations e.g. suspicious deaths, death of a 6
detained patient
5. Expected Death of an Inpatient 7
6. Expected Death of a patient in the Community 8
7. Procedure for the Verification of Expected Death 8
8. Personal care of the patient after their death in a hospital setting 9
(formerly known as last offices)
9. Personal care of the patient after death for care of patient in a 14
community setting (formerly known as last offices)
10. Requirements for People of Different Religious Faiths 17

A1. Record of Verification of expected death by Registered nurses 23


A2. Unexpected Death Checklist 24

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Care of a Patient after their Death Procedure
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Care of a Patient after their Death Procedure

1. Unexpected Death of an Inpatient

1.1 If resuscitation is unsuccessful or was not commenced and it is believed that the
inpatient has died unexpectedly the person in charge of the ward must contact the
duty Doctor or on call GP service immediately to advise them of the situation and
request their attendance to confirm death.

1.2 At this point the body or the immediate area in which the patient was found should
not be moved other than for the purposes of resuscitation.

1.3 The Doctor attending the ward who confirms that death has occurred should record
the following in the deceased patients healthcare record: -

The date and time that they as the attending Doctor arrived on the ward
Their clinical observations to confirm death

- No carotid pulse over 1 minute


- No heart sounds over 1 minute
- No respiratory movement and breath sound over 1 minute
- Pupils not reacting to light
- No response to painful stimuli

The date and time that they confirmed death had occurred

1.4 The Doctor should also ensure that the date of death is recorded on the front of the
patients secondary care record file.

1.5 If death is confirmed by the attending Doctor and they are unable to immediately
ascertain that death is due to a known and natural cause or they are in any way
concerned about the circumstances or means of the death then the police (who act
as representatives of the coroner) and the senior manager for the unit or on call
manager (if out of hours) should be informed immediately. In this circumstance the
body of the deceased should remain in place on the ward and be untouched until the
police have given permission for the body to be removed. A checklist for staff in the
event of an unexpected death is attached in Appendix 2.

1.6 In the event of a suspected suicide/homicide or otherwise suspicious death


staff should refer to the Trust Policy for Managing Incidents for required
notification actions.

1.7 It is very important that support is given to the family of the deceased person and that
they are informed of the death and the next steps in the care of the patient following
their death. Where possible family members should be informed face to face and
details of the Trust Patient Advice and Liaison Service (PALS) provided.

1.8 If the family wish to view the body of the deceased person, staff should discuss this
with them taking account of their spiritual or religious beliefs (see Section 10) on
honouring the spiritual or cultural wishes of the deceased person and their
families/carers.

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1.9 It should be noted that police permission is required before viewing of the deceased
is allowed in the event that the death is a suspected suicide, homicide or is otherwise
suspicious.

1.10 Where a referral to the coroner is required (see Section 3) it is the responsibility of
the doctor who confirmed death to contact the coroners office immediately.

1.11 The indications for when the death should be referred to the coroner are detailed in
Section 3.

1.12 All inpatient deaths are required to be reported on Ulysses at the time that the death
occurs, in line with the Managing Procedure for Reporting and Investigation Deaths
policy

2. Unexpected Death of a patient in the Community

2.1 The actions of staff in the event that they are faced with an unexpected death in the
community are essentially the same as for an unexpected death in an inpatient
setting.

2.2 In a community setting the patients own GP (or another GP from their practice)
should be contacted to make them aware of the death and request their attendance
to confirm death.

2.3 In these circumstances the police can be of assistance in locating relatives and
breaking significant news.

3. Referral to the Coroner

3.1 If the cause of death is known, is a natural cause, and a doctor has attended the
deceased within 14 days prior to death, then a death certificate may be issued
without referral of death to the coroner.

3.2 The death should be referred to the coroner if:

The cause of death is unknown


The deceased was not seen by their attending doctor either after their death or
within the 14 days prior to their death
The death may have been caused by violence, trauma or physical injury whether
intentional or otherwise
The death may have been caused by poisoning
The death may have been the result of intentional self-harm
The death may be the result of neglect or failure of care
The death may be related to a medical procedure or treatment
The death may be due to an injury or disease received in the course of
employment or industrial poisoning.
The death occurred whilst the deceased was in custody or state detention,
whatever the cause of death:
o The patient was detained under the Mental Health Act 1983
o The patient was subject to a Deprivation of Liberty Safeguards Urgent or
Standard Authorisation
o The patient was deprived of their liberty by an order of the Court of Protection

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If there is any doubt or concern about the cause of death the coroner should be
contacted. The coroners contact details change from time to time and up to date
contact details can be obtained via:
Hampshire http://www.3.hants.gov.uk/coroners.htm .
Oxfordshire https://www.oxfordshire.gov.uk/cms/content/contact-coroner
Buckinghamshire http://www.buckscc.gov.uk/bcc/community/coroner.page
Wiltshire
http://www.wiltshire.gov.uk/communityandliving/birthsdeathsmarriages/deathregisteri
ng/wiltsswindoncoronersservice.htm
Out of Hours the police will act as representatives of the coroner and should be
contacted.

3.3 The coroner has a judicial duty to enquire into those deaths reported to him. The
coroner is concerned with:

The identity of the deceased


When the deceased died
Where the death occurred
How the deceased came about their death

3.4 Following referral to the coroner:

A death certificate may be issued after consultation


The coroner may order a post mortem examination. If this confirms that death was
due to natural causes, the coroner will issue a death certificate.
If the post mortem examination reveal an unnatural cause. An inquest may be
held.

3.5 If a death is reported to the coroner and a post mortem examination is required:

All endo-tracheal tubes and catheters should remain in situ. Catheter bags may be
removed and catheter spigoted. Endo-tracheal tube ties should be cut and the
tube may be cut short to rest within the mouth, but the cuff should remain inflated
Chest drains, surgical drains, epidural lines should also remain in situ. They can
be disconnected, capped and then folded back and covered with an occlusive
dressing.
Intravenous and subcutaneous cannulae should be left in situ and infusion lines
clamped but left intact.

3.6 All community deaths that are unexpected are required to be reported on Ulysses at
the time that the death occurs, in line with the Managing Procedure for Reporting and
Investigation Deaths policy

4. Other special considerations e.g. suspicious deaths, death of a detained


patient, death of a patient otherwise deprived of their liberty

4.1 If a person has died in suspicious circumstances and a police investigation is likely
then the following procedures should be observed to preserve forensic evidence and
minimize cross contamination:

The body should not be washed or cleaned, unless express permission has been
given by senior police officer in charge of the investigation or by the coroner.

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The body should not be touched by the family and friends, unless express
permission is given as above. The police will normally allow supervised touching
by the family
There may be specific religious and sacramental rites required to be given to a
dying person or recently deceased. It would be rare for the police to refuse
permission for this.
Clothing and property (including cash and valuables) of the deceased should be
listed as per Trust Policy, bagged and handed to the police if requested. A
signature of receipt should be obtained from the police.

5. Expected Death of an Inpatient

5.1 When an expected death of an inpatient is anticipated the following actions must be
taken

5.2 The medical team responsible for the care of the patient must ensure that an entry is
made in the healthcare record that clearly states that the death of the patient is
expected and that if death occurs this can be verified by a registered nurse who has
been assessed as competent to do so (see Section 7 on verification of expected
death).

5.3 The medical and nursing teams must ensure that the patients family/next of kin have
been made aware of the patients condition and that death is expected. This
communication must be clearly documented within the healthcare record.

5.4 This information must be clearly communicated between healthcare staff at each shift
handover

5.5 The multidisciplinary team responsible for the care of the patient must review the
patients condition regularly and as a minimum on a weekly basis and clearly
document the outcome of this review within the healthcare record. This
reassessment must take into account the patients wishes (where known) and the
familys views, especially their knowledge of the patients wishes.

5.6 The spiritual, cultural or practical wishes of the dying person must be identified and
documented in the healthcare record (this may already have been completed as part
of the advance care planning).

5.7 For patients who are likely to die within the next few days, doctors and nurses should
assess the patient regularly so that an individual end of life care plan can be made or
adjusted, taking into account the patients wishes (where known) and families views.

5.8 Staff should communicate with the patient (wherever possible) and family/carers
regularly to address questions or concerns they may have about any aspect of care.
In particular families should be warned if a patient is likely to die in the next few days
so that they have time to begin to prepare themselves.

5.9 Staff should continue to pay attention to symptom and comfort measures (including
offering oral fluids and mouth care) and the provision of psychological, social and
spiritual care and ensure that these are addressed within the individuals care plan.

5.10 All inpatient deaths are required to be reported on Ulysses at the time that the death
occurs, in line with the Managing Procedure for Reporting and Investigation Deaths
policy
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6. Expected Death of a patient in the Community

6.1 In circumstances where an expected death of a patient in a community setting is


anticipated the following actions must be taken.

6.2 The GP and nursing team must ensure that the patients family/next of kin are aware
of the patients condition and that death is expected. This communication must be
clearly documented within the healthcare record.

6.3 This information should also be clearly communicated between community nurses at
the point of handover to another member of the community nursing team.

6.4 The GP and members of the nursing team who have been attending the patient
should consider whether in the event of death it is appropriate for a member of the
nursing team looking after the patient to verify that death. This may be preferable at
what is a distressing time for the family in the event that the GP is not able to be
present.

6.5 If the GP has agreed that verification by a nurse is appropriate then an entry must be
made in the healthcare record that clearly states that the death of the patient is
expected and that if death occurs this can be verified by a registered nurse who has
been assessed as competent to do so. (see section 7 on verification of expected
death).

6.6 The multidisciplinary team responsible for the care of the patient must review the
patients condition regularly (minimum frequency weekly) and clearly document the
outcome of this review within the healthcare record. It is good practice for an
individual care plan to be in place covering all aspects of palliative care.

6.7 The spiritual, cultural or practical wishes of the dying person should be identified and
documented (this may already have been completed as part of the advance care
planning).

7. Procedure for the Verification of Expected Death

7.1 It is essential that the nurse takes time to observe the patient for any spontaneous
movement or any reaction to the environment e.g. chest movement, swallowing,
coughing, nasal flaring and eye movement, whilst in the process of verifying death.

7.2 The nurse should be accustomed to using a stethoscope and be experienced in


listening to healthy heart sounds before assessing the absence of heart sounds.

7.3 Death will be verified using the criteria below. These observations should be
repeated after 5 minutes.

Absence of carotid pulses over 1 minute


Absence of heart sounds over 1 minute
Absence of respiratory movements and breath sounds over 1 minute
Pupils not reacting to light
No response to painful stimuli e.g. trapezium squeeze

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Clinical Feature Examination / Assessment Positive criteria of death
Cardiac function Palpation of carotid pulses over Absent pulsation
1 full minute timed by clock /
watch

Listen for heart sounds over the Absent heart sounds


cardiac apex in the healthy
adult, the apex beat lies in the
5th intercostal space, within the
mid-clavicular line. Various
conditions may result in an
abnormal position of the apex.
Listen over 1 full minute timed
by clock / watch.

Respiratory function Look for respiratory movement. Absent respiratory


Listen for breath sounds mid- movement.
axillary line 3rd intercostal space Absent breath sounds.
bilaterally. Listen over 1 full
minute timed by clock / watch.

Pupillary reflex A very bright light is required In death both pupils


and it may be necessary to should be fixed and
darken the room. The nurse unresponsive to bright
should direct the light from the light.
side of the patient to avoid an
accommodation response. The
reaction or absence of reaction
of the pupils to the light should
be assessed in each eye
separately shielding the other
eye from the light whilst doing
so.

Central Nervous Assess using Alert (A) The patient should be


Response to verbal stimuli (V) unresponsive to both
System
Response to physical stimuli (P) verbal and physical stimuli
Or unresponsive (U)

8. Personal care of the patient after their death in a hospital setting (formerly
known as last offices)

Action Rationale
Inform the nurse in charge and inform the A registered medical practitioner who
medical staff of the patients death has attended the deceased person
during the last illness is required to give
a medical certificate of the cause of
death. The certificate requires the
doctor to state the last date on which he
or she saw the deceased alive and
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whether or not he/she has seen the
body after death

In the case of an expected adult death, a Only a registered medical practitioner


registered nurse deemed competent by can certify death. Nurses who have
the Trust may confirm death adjusted their scope of practice and
been assessed as competent to do so
may confirm/verify death in accordance
with agreed trust procedure.
.
Confirmation of death must be recorded in
the patients healthcare record

An unexpected death must be confirmed To ensure senior management aware


by the attending medical officer and if of unexpected death
confirmed the service manager should be
contacted or duty manager out of hours.
Incident form to be completed
Inform the patients relatives/next of kin of Prepare them sensitively for changes to
the patients death. Ensure that this is the body
handled in a sensitive and appropriate
manner with as much privacy as possible.

Ask if the relatives wish to see the Chaplains contact details on ward
chaplain or an appropriate religious leader
or other appropriate person to the persons
faith or ethnic origins that need to be
attended to immediately

If relatives are in the hospital ask if they


wish to assist with the last offices and/or if
they have any particular wishes regarding
the procedure

If the relatives are not in the hospital ask if In the event that a viewing at a later
they wish to view the body on the ward or date or out of hours is requested the
at a later date nurse in charge will contact either the
porters service or funeral directors as
appropriate

Assemble required equipment To prevent interruptions of the


procedure once commenced

Wash hands and put on disposable gloves Hand washing reduces the
and apron transmission of micro-organisms.
Wearing protective clothing reduces the
risk of contamination with body fluids

Any injuries sustained whilst carrying out


the procedures on the deceased must be
reported through the Trust risk system and
follow the Trust Sharps and Inoculation
Management Procedure

Lay the patient on their back with one To maintain the patients dignity and for
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pillow in place (adhere to the Moving and future management of the body as rigor
Handling Policy) mortis occurs 2-6 hours after death.

Straighten the patients limbs (if possible)


and place their arms by their sides

Gently close the patients eyes if open by To maintain patients dignity and for
applying light pressure for 30 seconds. If aesthetic purposes. Closure of eyes will
corneal or eye donation to take place, provide tissue protection in case of
close the eye with gauze moistened with corneal donation (Green & Green 1992)
normal saline Moistened gauze prevents the eyes
from drying out

Do not apply tape Tape may mark the skin

If syringe driver in situ, disconnect and


remove battery

In cases where there is no referral to the


coroner required infusions can be
discontinued and infusion lines, cannulae,
drainage and other tubes can be removed

If referred to the coroner endo-tracheal


tubes, catheters and infusion lines should Deaths in certain circumstances must
remain in situ. (see section 3) be referred to the coroner and may
require a post mortem
Discard all sharps into a sharps bin as per
Trust Sharps and Inoculation Management
Procedure

Place a receiver between the patients The body can continue to excrete fluids
legs and drain the bladder by pressing on after death
the lower abdomen. Pads and pants can
be used to absorb any leakage

Exuding wounds should be covered with The dressing will absorb any leakage
absorbent gauze and secured with an from the wounds and provide protection
occlusive dressing from any staff coming into contact with
the body. If post mortem is required
existing dressings should be left in situ
and covered.

Wash the patient if necessary, unless For hygienic and aesthetic reasons.
requested not to do so for religious/cultural Washing of a patient if a death is
reasons or patient has died in suspicious suspicious could destroy evidence
circumstances

It may be important to the family and It is an expression of respect and


carers to assist with washing, thereby affection, part of the process of
continuing the care given to the patient in adjusting to loss and expressing grief
the period before death.
Clean the patients teeth and gums using a
moistened, soft small headed nylon
toothbrush and or suction to remove any
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debris and secretions

Clean any dentures and replace them in For hygienic and aesthetic reasons.
the mouth a small pillow or rolled up If dentures cannot be replaced send
towel placed under the patients chin may them with the body in a clearly
help to keep the jaw closed and teeth in identified receptacle
situ

Tidy the hair as soon as possible after This guides funeral directors for final
death and arrange into the preferred style presentation
(if known)
Patients should not be shaved; usually a Shaving a deceased person when they
funeral director will do this. are still warm can cause bruising and
Some faiths prohibit shaving marking, which only appear days later

Remove all jewellery, in the presence of To meet with legal requirements and
another nurse, unless requested by the relatives wishes this must be discussed
family to do otherwise. Any jewellery with family prior to action
removed must be documented on a
property form and placed in the hospital
safe until collected by the family. Wedding
rings may be left in situ and taped in place.
Any jewellery remaining on the body
should be documented on the
identification card accompanying the
patient to the mortuary or undertakers

Record all property in the patient property


book and pack in a labelled property bag,
keeping secure until collected by the
family. Pack personal property showing
consideration for the feelings of those
receiving it. Discuss the issues of soiled
clothes sensitively with the family and ask
whether they wish them to be disposed of
or returned

Unless a specific request has been made


by the family for alternative clothes the
patient should be dressed in a hospital
gown

If relatives are present at the time of


death, or attend the hospital shortly after,
staff should ensure that they are given the
Trust Bereavement information copies of
which are available on the ward.

Relatives should be told to contact the This information should be held locally
relevant Trust officer who supports and be readily available
bereavement or the patients GP to collect
the death certificate

Label one wrist and one ankle with an To ensure correct and easy
identification band containing the following identification of the body in the
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information: mortuary and undertakers

Full name
NHS Number
Date of Birth

Complete patient identification cards and


notification of death book clearly in
capitals

If the patient has an implant device such Implanted devices may present a
as a pacemaker or an infectious disease hazard at cremation
is known or suspected record this fact on
both patient identification cards

Tape one identification card to clothing or


hospital gown

Wrap the body in a sheet, ensuring that To avoid damage to the body during
face to feet are covered and that all limbs transfer
are held securely in position

Tape the second notification of death card For ease of identification in the
to the outside of the sheet mortuary or undertakers

If the body may be infectious or there is a Actual or potential leakage of fluids


risk of leakage of body fluids place the whether infectious or not poses a health
body in a body bag and put the second and safety hazard to those handling the
identification card into the pocket of the body
body bag Most deceased patients with a known
or suspected infection would be classed
as category 1 or 2 (see infection control
policy SHCP 10 and SH CP 23) and
therefore DO NOT require a body bag.
MRSA is an example of this.
Conditions which require a body bag
include:

Known intravenous drug users


Severe secondary infection
Gangrenous limbs and infected
amputation sites
Large pressure sores
Death in a dialysis unit
Incipient decomposition

If the deceased person has a known See Infection Control Policy SHCP 10,
infectious disease Category 3 & 4 they Appendix 19 (SH CP 23).
must be placed in a heavy duty body bag
and you must inform anyone else who
comes in contact with this patient e.g.
funeral directors, porters.

Remove gloves and aprons. Dispose of


equipment according to local policy and
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wash hands

If mortuary on site request porters to If the person has died in an


remove body from the ward to the environment where other people maybe
mortuary distressed by the death, then
sensitively inform them that the person
has died
If no on site mortuary, contact local funeral
directors or the funeral directors according
to the relatives wishes

Screen off the area where removal of the To avoid causing unnecessary distress
body will occur to other patients, relatives and staff

Record all the details and actions in the


nursing records

Any property retained on the ward out of


hours must be stored in a secure area and
any valuables stored in the ward or
hospital safe

9. Personal care of the patient after death for care of patient in a community
setting (formerly known as last offices)

Action Rationale
Inform the nurse team leader and inform A registered medical practitioner who
the General Practitioner of the patients has attended the deceased person
death during the last illness is required to give
a medical certificate of the cause of
death. The certificate requires the
doctor to state the last date on which he
or she saw the deceased alive and
whether or not he/she has seen the
body after death

In the case of expected adult death, a Only a registered medical practitioner


registered nurse deemed competent by can certify death. Nurses who have
the Trust may confirm death adjusted their scope of practice and
been assessed as competent to do so
may confirm/verify death in accordance
with agreed Trust procedure.

Confirmation of death must be recorded in


the patients medical and nursing notes

An unexpected death must be confirmed To ensure senior management aware


by the attending medical officer and, if of unexpected death
confirmed, locality manager should be
contacted or duty manager out of hours.
Incident report form to be completed

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Inform the patients relatives/next of kin of Prepare them sensitively for changes to
the patients death if not present. Ensure the body
that this is handled in a sensitive and
appropriate manner with as much privacy
as possible.

Ask if the relatives wish to contact an


appropriate religious leader or other
appropriate person to the persons faith or
ethnic origins that need to be attended to
immediately

Assemble required equipment To prevent interruptions of the


procedure once commenced

Wash hands and put on disposable Hand washing reduces the


gloves and apron transmission of micro-organisms.
Wearing protective clothing reduces the
risk of contamination with body fluids

Any injuries sustained whilst carrying out


the procedures on the deceased must be
reported through the Trust risk system and
follow the Trust Sharps and Inoculation
Management Procedure

Lay the patient on their back with one To maintain the patients dignity and for
pillow in place (adhere to the Moving and future management of the body as rigor
Handling Policy) mortis occurs 2-6 hours after death.

Straighten the patients limbs (if possible)


and place their arms by their sides

Gently close the patients eyes if open by To maintain patients dignity and for
applying light pressure for 30 seconds. If aesthetic purposes. Closure of eyes will
corneal or eye donation to take place, provide tissues protection in case of
close the eye with gauze moistened with corneal donation (Green & Green 1992)
normal saline Moistened gauze prevents the eyes
from drying out

Do not apply tape Tape may mark the skin

If syringe driver in situ, disconnect from


line and remove battery

In cases where there is no referral to the


coroner required infusions can be
discontinued and infusion lines, cannulae,
drainage and other tubes can be removed

If referred to the coroner endo-tracheal


tubes, catheters and infusion lines should Deaths in certain circumstances must
remain in situ. (see section 3) be referred to the coroner and may
require a post mortem - see appendix 4
Discard all sharps into a sharps bin as per
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Trust Sharps Safety and Management
Procedure

Place a receiver between the patients The body can continue to excrete fluids
legs and drain the bladder by pressing on after death
the lower abdomen. Pads and pants can
be used to absorb any leakage

Exuding wounds should be covered with The dressing will absorb any leakage
absorbent gauze and secured with an from the wounds and provide protection
occlusive dressing from any staff coming into contact with
the body. If post mortem is required
existing dressings should be left in situ
and covered.
Wash the patient if necessary, unless For hygienic and aesthetic reasons.
requested not to do so for religious/cultural Washing of a patient if a death is
reasons or patient has died in suspicious suspicious could destroy evidence
circumstances

It may be important to the family and It is an expression of respect and


carers to assist with washing, thereby affection, part of the process of
continuing the care given to the patient in adjusting to loss and expressing grief
the period before death.

Clean the patients teeth and gums using


the moistened , soft small headed nylon
toothbrush and or suction to remove any
debris and secretions

Clean any dentures and replace them in For hygienic and aesthetic reasons.
the mouth a small pillow or rolled up If dentures cannot be replaced send
towel placed under the patients chin may them with the body in a clearly
help to keep the jaw closed and teeth in identified receptacle
situ

Tidy the hair as soon as possible after This guides funeral directors for final
death and arrange into the preferred style presentation
(if known)
Patients should not be shaved; usually a Shaving a deceased person when they
funeral director will do this. are still warm can cause bruising and
Some faiths prohibit shaving marking, which only appear days later

If the deceased person has a known See Infection Control Policy, Appendix
infectious disease Category 3 you must 19 (SH CP 23).
inform anyone else who comes in contact
with this patient e.g. funeral directors,
porters.

Remove gloves and aprons. Dispose of


equipment according to local policy and
wash hands

Record all the details and actions in the


nursing records

16
Care of a Patient after their Death Procedure
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10. Requirements for People of Different Religious Faiths
This section has been extracted from The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 8th edition (2011)

The following are only guidelines; individual requirements may vary even among members of the same faith. Varying degrees of adherence
and orthodoxy exist within all the worlds major faiths. The given religion of a patient may occasionally be offered to indicate an association
with particular cultural and national roots, rather than to indicate a significant degree of adherence to the tenets of a particular faith, if in doubt,
consult the family members concerned or contact Head of Chaplaincy 07788335022

For further
Cultural or religious Post-mortem / Specific burial
Beliefs about death Preparing the body information
routines transplantation requirements
contact
Buddhism Death is viewed as There is no one specific At all times the body No objections Prefer cremation The Buddhist
very important as it ritual but a state of should be treated with as a symbol of Hospice Trust
is a time of transition calm is necessary. An greatest care and impermanence of
before rebirth as example may be: respect. the body 01983 526945
they move toward
Nirvana the A monk called to When washing has www.buddhisthos
freedom from recite prayers / lead taken place, the body pice.
suffering death and meditation should be wrapped in Org.uk
rebirth The family wanting a plain white sheet
the body to remain
in one place for up
to 7 days for the
rebirth to take place.
However, it is
recognised this is
not possible in a
healthcare setting

Christianity Gods forgiveness is Priest or minister may No specific No objections No preference Hospital
Anglican / available to all who attend to say prayers. requirements Chaplaincies
Church of ask because of the Primarily to support Council or contact
England selfless/sinless relatives and friends Head of
death of Jesus Chaplaincy
Christ on the cross. 07788335022
17
Care of a Patient after their Death Procedure
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January 2017
Non- As Christ was Prayers may be offered No specific No objections No preference
conformist/ resurrected, death but these will be requirements 020 7898 1894
Free Church has been overcome informal in most
and eternal life is a situations. www.nhs-
gift from God, chaplaincy-
available to all who spiritualcare.org.u
believe and seek Priest requested to No objections Burial has in the k
Roman forgiveness recite prayers for the A religious icon such past been
Catholicism dying and then prayers as a crucifix or rosary preferred
for the dead may accompany the
patients body
Church of Earthly life is viewed The body should be No religious Burial preferred The Church of
Jesus Christ as a test to see if washed and dressed objection Jesus Christ of
of Latter Day individuals are fit to in a shroud. Some Latter Day Saints
Saints return to God on may wear a religious
Mormon death. Death is undergarment which 0121 712 1200
Church viewed as a must remain in place
temporary after the patient has www.idschurch.or
separation from died g
loved ones
Christian There are no specific Females only to touch This is generally Prefer cremation For details of
Scientist rituals associated with female body not supported local Christian
death unless there is a Science Church
legal
requirement for www.christianscie
it nce.
Org.uk
Hinduism Hindus believe that Last rites include: tying Close family members Only if Cremation within National Council
all human beings a thread around the usually wash the body absolutely 24 hours of death of Hindu Temples
have a soul that neck or wrist to bless led by the eldest son. necessary. If a arranged by the (UK)
passes through the dying person, They may be post-mortem eldest son
successive cycles of sprinkling holy water distressed if a non does take place www.hinducouncil
birth and rebirth. It from the River Ganges Hindu touches the the organs must uk.org
is believed that on them, placing a body so gloves should be returned to
eventually the soul sacred Tulsi leaf in their be worn. A female the body.
will be purified and mouth if possible, must only be touched

18
Care of a Patient after their Death Procedure
Version: 2
January 2017
join the cosmic placing the person on a by a female and a
consciousness sheet or mat on the male by a male
floor to symbolize
closeness to Mother The body should be
Earth, freedom from covered by a plain
physical constraints white sheet
and the easing of the
souls departure All religious objects
should remain in
place
Islam Death is a mark of The time before death The body should be Post mortems Burial will take Muslim Council of
transition from one is important for turned to the right are considered place as quickly Great Britain
state of being to extending forgiveness (Quibla (Mecca)) if acceptable only as possible
another. Muslims to family and friends. this hasnt happened if required by http://www.mcb.or
are encouraged to before the patient law. This is g.uk/
accept death as part The Koran is recited dies. because it is downloads/Death
of the will of Allah until the point of death believed that -
The relatives will post mortem will Bereavement.pdf
close the eyes and delay burial and
bandage the lower that the person
jaw so the mouth may still be able
doesnt gape to perceive pain
after biological
Flex the joints of the death*
arms and legs to stop
them becoming rigid. *Note: -The
section in italics
A complete cleansing above is an
(Ghusal) will then take amended form
place performed by of words from
the relatives (this may that detailed
take place after the within version 8
body has been of the online
removed from the Marsden
ward) manual because
it is believed this

19
Care of a Patient after their Death Procedure
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January 2017
The body will be more accurately
wrapped in a Caffan. reflects the
If there isnt one actual position
available, a sheet will that applies
do.

A female must be
handled by female
nursing staff and a
male by male staff.

Maintaining modesty
and dignity is
essential.
Jehovahs When a person dies There are no special No special Funeral must be his@wbtbs.org.uk
Witness their existence stops rituals or practices to requirements are to modest and
forever perform be observed dignified www.watchtower.
org

Judaism Death is the end of Orthodox Jews dont The body will receive This is not Cremation is The Burial
life but eternal life is permit the touching or the ritual washing permitted by permitted for non- Society of the
offered if they have moving of a dying (Taharah) performed Orthodox Jews Orthodox Jews United
the right relationship person. Following by either trained except where Synagogue
with God death, the rabbi will be members of the the law requires
requested to perform synagogue or the it. 020 8343 3456
Last Rites Jewish Burial Society.
Reform Jews The Office of the
It is important that If the rabbi cannot be permit it on the Chief Rabbi
somebody stays with contacted, essential grounds of the (Orthodox)
the body until a procedures can be furthering of 735 High Road
member of Jewish performed by medical North Finchley
Burial Society or family healthcare staff: knowledge London
member arrives WC1N 9HN
Close eyes and
The family may want to mouth 020 8343 6301
keep watch with the All catheters and
20
Care of a Patient after their Death Procedure
Version: 2
January 2017
body to pray even if it is drains and the fluid
in the mortuary in them must be Union of Liberal
left as they are and Progressive
considered part of Synagogues
the body Montagu Centre
Open wounds 21 Maple Street
must be covered London
The body must be W1T 4BD
laid flat with hands
open and arms
parallel to the body
DONT wash the
body
Traditionally the
body is covered by
a plain white sheet
with the feet facing
the door
Sikhism Life after death is a Prior to the death, The relatives may No objections Cremation Sikh Educational
continuous cycle of comfort may be derived wish to prepare the and Cultural
rebirth; the persons from reciting verses body but this shouldnt Association (UK)
soul is their essence from the holy book be assumed. The five
(Guru Granth Sahib) Ks should be left on 01474 332356
the body.

1. Kesh uncut hair


symbolic of
sanctity and a love
of nature
2. Kangha a
wooden comb
symbolizing
cleanliness
3. Kara a steel
band worn on the
right wrist symbolic
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Care of a Patient after their Death Procedure
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of strength and
restraint
4. Kirpan a sword
or dagger
symbolizing the
readiness to fight
against injustice
5. Kaccha unisex
undershorts
symbolizing
mortality

The body must be


touched only by staff
of the same sex

The eyes and mouth


closed

The face straight and


clean

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Care of a Patient after their Death Procedure
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Appendix 1

Record of Verification of expected death by Registered nurses

Identification of Patient

Name:..

D.O.B.:

Hospital Number/NHS Number:..

The patient died at: Time Date


Persons present at death

Patient has died in the absence of a doctor Yes No


GP and relatives aware of expected death Yes No
Patient is 18 years of age or older Yes No
Patient is known to the Primary Care Team Yes No
Clinical Signs
Initial 5 mins
Lack of spontaneous activity
Absence of respiration
Absence of carotid and brachial sounds
No response to painful stimuli
Pupils not responding to light

Relatives informed

Yes No Time
Consultant/GP/out of hrs
informed

Signature of nurse verifying


death

Print name of nurse verifying


death

PLEASE RETAIN IN PATIENTS HEALTHCARE RECORDS

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Care of a Patient after their Death Procedure
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Appendix 2

Unexpected Death Checklist for suspected suicides please refer to the Trusts Policy for
Managing Incidents for full guidance.

Patients Name: Ward: Date:

Actions Carried Out Please circle Signature


1 Staff informed not to administer Last Offices Yes No
2 Area / Locality Manager or Duty Manager (Out Yes No
of Hours) informed
3 Police informed Yes No
4 Next-of-Kin informed Yes No
5 Coroner informed
6 Relevant Consultant informed Yes No
7 Finance Department informed Yes No
8 GP of deceased informed (within working Yes No
hours)
9 Minister of Religion informed, where possible Yes No
11 Funeral Director telephoned to remove body, Yes No
once police permission has been given
12 Counselling services (CISM) contacted and Yes No
arrangements made for Counsellor to attend
the unit, if appropriate/requested.
13 Arrangements made for relatives to see Yes No
deceased if appropriate/if requested
14 Member of staff assigned to meet Funeral Yes No
Director
15 Member of staff assigned to ensure all clients Yes No
are engaged in other activities or kept away
from the area (whilst body is removed)
16 Arrangements made for relatives/friends to Yes No
speak to a member of staff and PALS.
17 Members of staff available to reassure patients Yes No
18 Compelte Ulysses death report Yes No

Where actions on the checklist are not carried out detail reason below

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