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The General Practitioner must be informed by telephone or fax by the next working day. If a fax is sent this must comply with Trust Information governance procedures. Other agencies involved with the patient should be informed as soon as is practical. The responsibility for informing the GP of the death rests with the ward.

Freedom from infection certificates

If a freedom from infection certificate is required, these are available from the Institute of Public Health based at City Campus 0844 225 4524; Mon-Friday 09:0pm -5:0pm

Outside of these hours, contact: 0115 9607599

Certificates are normally arranged by the funeral directors and there is a charge for this service.

Appendix 3

Verification of Death Procedure DEFINITIONS

Verification of death is defined as deciding whether a patient is actually deceased and does not require a medically registered practitioner to undertake this process.

Certification of death is the process of completing the “Medical Certificate of Cause of Death”. This has to be done by the medical practitioner who has attended the deceased in life.

Expected death – this is defined when discussions have taken place between the medical and nursing team and the decision has been made and documented in the medical notes that no further intervention is appropriate. At Nottingham University Hospital Trust, an expected death is defined as one which occurs when the patient has been placed on the Last Days of Life Pathway.

Who can verify a death? 1) A medical practitioner

A registered nurse who has been assessed as competent to carry out the verification procedure, if the death is expected, the patient has been placed on the Last Days of Life Pathway and none of the following apply:

a) The deceased is a child (aged under 18)

b) The death occurred within 24 hours of Hospital admission or there is no firm clinical diagnosis has been made

c) Death is in the immediate (72 hours) post operative or post invasive procedure period.

d) Death followed an untoward incident i.e. fall; fracture; or drug error e) Death of a patient with a notifiable disease.

f) There are any concerns about clinical practice. g) Any unclear or remotely suspicious death.

Procedure EQUIPMENT LIST • Stethoscope • Pen Torch • Cotton Wool • Nursing Notes • Medical Notes

1. Check the identity of the patient.

2. Confirm absence of BOTH respiration and circulation: a. To verify respiration:

Observe for the absence of chest and abdominal movements for five minutes

b. To verify absent circulation

Palpate a major arterial pulse, e.g. femoral or carotid, for a period of at least five minutes.

OR

Using the stethoscope, check for the absence of heart sounds for a period of at least five minutes.

If at any time during the process, cardiac or respiratory activity during this period of observation is noted, a further five minutes observation is required.

3. Once absence of circulation and respiration have been ascertained it is necessary to verify absence of brain activity

a. Check absent corneal reflex by stroking the cornea with a piece of cotton wool

b. Push up both eyelids. Then, using a light source, check that both pupils are fixed, dilated and do not respond to light.

c. Using a knuckle, apply pressure in the supraorbital groove. If a finger is run along the bony ridge at the top of the eye, a groove

4. If death is confirmed, record the date and time that verification is completed, together with the name of the person verifying death, his/her designation and contact number, using the Death

Appendix 4

Deaths requiring a quick turnaround

The Nottingham University Hospital Trust is committed to providing an efficient service for everyone who is affected by a bereavement. It is expected in all cases that the certificate be issued within 24 hours or on the following working day after the death. There are some circumstances, for instance, where a Coroners referral is required, when a certificate cannot normally be issued out of hours. However, the Trust is mindful that there are some religions and cultures that have special requirements with regard to death certification, for instance some cultures require the funeral to take place within 24 hours.

It is expected that staff will do what they can to facilitate in such circumstances, however this must be balanced against legal requirements and must not be to the detriment of the Trust as a whole, and to other service users who are equally entitled to an efficient service.

The Coroners office and Registrar provide a limited service for families who require a quick turnaround for whatever reason. The following is a protocol to follow for deaths that require a certificate and release very quickly.

1. If the family request a quick turnaround time either before or at the time of death, the medical practitioner responsible must look to see if a Coroner’s referral is required.

2. If a certificate can be issued this can be issued and first and last offices can be carried out appropriately – ie removing all lines drips etc. Death certificate books are available on all wards at QMC campus, and from SRU and the Mortuary at City campus.

3. If a referral to the Nottingham Coroner is required, the on-call mobile number is 0783 6229199 and is available 24 hours a day, 7 days a week.

4. If the Coroner cannot authorise the issuing of the certificate the family must be informed and advised that the deceased will be required to remain at the Trust until a decision has been made as to

5. If the Coroner authorises the issue of a certificate then this can be issued and handed to the family. Last offices procedure can be carried out and all drains, lines etc removed.

6. Registration arrangements:

a. Saturday mornings – The Council House is open for registrations between 10am and 12 noon. An appointment is not necessary.

b. Sundays and Bank Holidays – Between the hours of 10am and 12 noon the on-call registrar can be contacted on 078990 60396. Calls will not be accepted at any other time. Arrangements can then be made for the registration to take place during those hours.

7. Once the certificate is issued to the family the deceased can be released to the funeral director, this must be done via the mortuary. Registration does not need to have taken place. Contact the on-call mortuary technician via switchboard, who will arrange to come in, book the deceased into the mortuary database and release the deceased to the funeral director. Under no circumstances is the deceased to be released from any other part of the hospital.

8. On the following working day, inform the bereavement centre of the death and the death certification details so that they can complete GP letter on Notis.

9. If an Out of England order is required this must be dealt with by the Coroner (see on call number above) and will not be attended to until after the death has been registered.

10. If a freedom from infection certificate is required, these can be obtained from the Institute of Population Health 0844 225 4524 based at City Campus for a fee. This service is available Monday to Friday 9 -5. The obtaining of such a certificate is normally dealt with by the funeral directors.

Circumstances in which a death needs to be referred to the Coroner 1. The cause of death is not known

2. Deceased had not been seen by a medical practitioner within 14 days prior to death