Before death confirmation
Indicate you would check the resuscitation status of the patient before doing anything else:
- If the patient is not for resuscitation, continue to confirm the death
- If there is uncertainty as to the resuscitation status, CPR should be commenced whilst this is clarified
Ask the ward staff about the circumstances surrounding the death, as you should ideally document this.
Ask for the patients notes:
- Double check for a resuscitation status form
- Read the last few entries for some background
If family or friends are present:
- Introduce yourself
- Offer your condolences
- Explain the need to confirm the death
- Offer the family the opportunity to wait outside - respect their preference
Death confirmation
1. Wash hands
2. Confirm the identity of the patient - check the wrist band
3. General inspection - skin colour / any obvious signs of life
4. Look for signs of respiratory effort
5. Does the patient respond to verbal stimuli? – “Hello Mr Smith, can you hear me?”
6. Does the patient respond to pain? - press on fingernail / trapezius squeeze
7. Assess pupils using pen torch - After death they become fixed & dilated
8. Feel for a central pulse - carotid artery
9. Auscultation:
- Listen for heart sounds for at least 1 minute
- Listen for respiratory sounds for at least 3 minutes
10. Assess for a pacemaker - not essential, but good practice, as will need to be checked prior to cremation
11. Wash hands and exit the room – ensuring the door is closed / curtains are drawn
Documentation
Once you have completed the above, document your assessment clearly
Ensure you adhere to hospital documentation guidelines - date / time / your name & grade
Document each of the examination steps you performed & the result of each step
Finally document that you are confirming the death & the time at which you did so
Sign & print your full name, grade, GMC number and Bleep/DECT number
To complete death confirmation
Inform nursing staff that you have confirmed the death:
- They will then inform next of kin, if not already present
- They will also contact the porters to arrange transfer of the body to the morgue
Offer to speak with the family - to discuss any questions or concerns