Care of the Deceased SOP
Document Control
Title Care of the Deceased Standard Operating Procedure
Author Author’s job title Lead Nurse Infection Prevention & Control Directorate Department Team/Specialty Nursing Infection Prevention & Control Date Version Status Comment / Changes / Approval Issued 0.1 Mar Draft Developed for consultation 2009 0.2 May Draft Amended following consultation 2009 1.0 Jun Final Approved by Subject Specialist Group consisting of Nurse 2009 Manger, Mortuary Manager, Infection Control Team and Chaplain. 1.1 Jul Revision The following statement added to procedure point 13: ‘or 2010 collected by the named Funeral Director if the patient has died in a community hospital’ 1.2 Aug Revision Amends by Corporate Affairs to document control report, 2010 filename and formatting. 1.3 Sep Revision Further amends made to incorporate all inputs. Contents 2010 list corrected. Appendix A added. Approved at Senior Nurse Forum in November 2010. 1.4 Dec Revision Final Corporate amendments; formatting and added 2010 hyperlinks prior to publication. 1.5 Apr Revision Updated and amended to incorporate ‘Care of the 2013 deceased – Infection Control Policy’, updated Deceased Patient Record & Notice of Death forms, and Community Hospital last offices procedure & checklist. Update to title. Amendments following consultation. Minor amendments by Corporate Governance to formatting for document map navigation and semi- automatic table of contents, document control report updated, hyperlinks added. Prompts and comments to author in red text. 1.6 June Revision Amendment to section 10 to ensure it is not ambiguous 2013 that lines etc. must not be removed from the deceased 1.7 June Revision Approved by Patient Safety Group on the 6th of June 2013 2013 subject to amendments to items 10.5 & 10.8. 2.0 Dec 13 Final Published on Bob. 3.0 Dec 19 Revision Updated in to latest SOP template
Infection Prevention & Control Page 1 of 30 Care of the Deceased SOP
3.1 April Revision Re-write of SOP, updates on IPC precautions including 2021 Covid-19, Medical Examiner system and viewing the deceased. Updates appendices, references & associated documentation. 3.2 May Revision IPC content approved at Infection Prevention & Control 2021 Group. 3.3 June Revision Updates from Pathology Manager re: Medical Examiner 2021 reviewing inpatient deaths from SMCH, the mortuary fridge at SMCH and contacting funeral directors. Minor amendments to contacting the Bereavement Support Office and deletion of appendix F. 4.0 June Final Approved with minor changes at Patient Safety 2021 Operational Group 15.06.2021 Main Contact Lead Nurse Tel: Direct Dial – Infection Prevention & Control Tel: Internal – North Devon District Hospital Email: Raleigh Park Barnstaple, EX31 4JB Lead Director Director of Nursing Document Class Target Audience Standard Operating Procedure All staff who may perform last offices specifically: Clinical Site Managers Registered Nurses Senior Health Care Assistants Health Care Assistants Student Nurses Distribution List Distribution Method Senior Management Trust’s internal website All clinical leaders Superseded Documents Infection Control – Care of the Deceased Policy Issue Date Review Date Review Cycle Three years Consulted with the following Contact responsible for implementation stakeholders: and monitoring compliance: Infection Prevention & Control Mortuary Manager & Workforce Team Development facilitator Director of Nursing Associate Directors of Nursing
Infection Prevention & Control Page 2 of 30 Care of the Deceased SOP
Clinical Matrons Education/ training will be provided by: Community Matrons Workforce Development & Mortuary Team Pathology Service Manager Specialist Nurse Organ Chaplaincy Lead Bereavement Support Officer Mortuary Technicians Workforce Training Managers Ward/Department Managers
Approval and Review Process Patient Safety Operational Group Infection Prevention & Control Decontamination Group Local Archive Reference G:\Infection Control Local Path G:\INFECTION CONTROL\IC Manual - Policies\SOPs\Care of the Deceased SOP\Working Drafts\Final version 4.0 Care of Deceased SOP.docx Filename Care of the Deceased Standard Operating Procedure
Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Standard Operating Procedures Death, Dying, Last Offices, Bereavement, Tissue Donation
Infection Prevention & Control Page 3 of 30 Care of the Deceased SOP
CONTENTS Document Control ...... 1 1. Background ...... 5 2. Purpose ...... 5 3. Scope ...... 6 4. Location ...... 6 5. Responsibilities ...... 6 6. Procedure ...... 6 7. Last Offices - Standard Operating Procedures ...... 9 8. What to tell bereaved relatives following a death at North Devon District Hospital …………………………………………………………………………………………………..14 9. What to tell bereaved relatives / next of kin following a death of an inpatient at a community hospital ...... 14 10. Viewings ...... 15 11. Information ...... 16 12. References ...... 16 13. Associated Documentation ...... 17 Appendix A – Deceased Patient Record Notice of Death ...... 19 Appendix B – Tissue Donation Flow Chart ...... 20 Appendix C - Tissue Donation Guide ...... 21 Appendix D – Community Hospital Checklist ...... 23 Appendix E – Religious & Cultural Requirements ...... 25 Appendix F – Notification of Infection Risk to Funeral Directors ...... 27 Appendix G –Transmission-based precautions to key infection in the deceased ...... 28
Infection Prevention & Control Page 4 of 30 Care of the Deceased SOP
1. Background
Caring for the deceased and providing support to families and friends is of profound importance, NDHT is committed to ensuring the compassionate handling of the deceased during this time.
Last Offices are performed after confirmation of death and should be carried out within four hours of death. Last offices are defined as the nursing care given to a deceased patient that will continue to demonstrate dignity and respect for the individual. It involves the preparation of the deceased for transportation and presentation to the mortuary and should focus on the patient’s religious and cultural beliefs, respecting the patients, families and significant others traditions. It must also follow health, safety and legal guidelines ensuring the deceased is presented to the Mortuary or Funeral Director in a manner which ensures infection risks are minimised. In most circumstances the same infection control standard precautions to prevent the spread of infection that were used in life apply to deceased patients. However deceased patients with infections may pose a risk to healthcare workers and relatives thus it will be necessary to adopt additional transmission based precautions.
If asked, staff should give the family, partners or friends the opportunity to view the deceased either in the ward or mortuary viewing suite If they wish to speak to a member of the hospital chaplaincy team please ring the NDDH switchboard (01271 322577) who will contact the NDDH duty or North community chaplain respectively, but please note an instant response is not always possible. The contact numbers of local clergy can be found in the telephone book under the church name, or the funeral director will make this contact on behalf of the deceased's family.
At community hospital sites follow your local procedure for contacting a community chaplain. There are a number of other considerations to be taken into account when caring for the deceased such as their wishes with regard to Organ / Tissue donation, the completion of the Death Certificate and communication with the Medical Examiner, consideration of the need for informing the Coroner, and the correct documentation and communication for releasing the deceased to an undertaker.
2. Purpose
2.1. The Standard Operating Procedure (SOP) has been written to:
Identify procedures for the care of the deceased. Ensure that the correct procedure re: certification, reporting to the Medical Examiner / Coroner and associated paperwork is completed correctly for all deceased patients.
Provide information and guidance to the bereaved by a simple explanation of ‘next steps’ and delivery of the current bereavement booklet.
Detail procedures for undertaking Last Offices
Infection Prevention & Control Page 5 of 30 Care of the Deceased SOP
Ensure the appropriate infection control procedures are adhered to preventing the spread of potential infections.
3. Scope
3.1. This Standard Operating Procedure (SOP) relates to the following staff groups who may be involved in the administration of last offices and the care of the deceased:
Clinical Site Managers
Registered Nurses
Nursing Associates / Trainee Nursing Associates
Trainee Assistant Practitioners / Assistant Practitioners
Senior Health care Assistants
Health care Assistants
Student Nurses
Porters
Mortuary staff Staff undertaking this task must be able to demonstrate continued competence as per the organisations policy on assessing and maintaining competence.
4. Location
4.1. This Standard Operating Procedure can be undertaken in all clinical settings and in the patient’s home where competent staff are available to undertake this role.
4.2. Staff undertaking this procedure must be able to demonstrate continued competence as per the organisations policy on assessing and maintaining competence.
5. Responsibilities
5.1. All staff completing last offices and involved in the care of the deceased and their relatives are required to adhere to the information, guidelines and procedures contained within this document.
6. Procedure
6.1. Religious, Cultural & Individual Requirements
Infection Prevention & Control Page 6 of 30 Care of the Deceased SOP
Last offices may vary according to the religious, cultural and individual needs. Brief information is included in this document, Appendix E. However further information is available from the chaplaincy team. It is appropriate to be guided by the family of the deceased as individuals may have different preferences regardless of their religion or culture. It is good practice to sensitively discuss and document the patient’s wishes prior to death if the opportunity presents.
On occasion family members may request that a body is released from the hospital more quickly than usual, perhaps in accordance with their faith. Different faith groups have specific rituals when a loved one is dying and after death. Jewish and Muslim faiths require burial to occur within 24 hours of death. At NDDH the Bereavement Support Office and Mortuary will support this; however the speed will depend on if the medical team are able to issue a medical certificate of cause of death after discussion with the Medical Examiner and the involvement of the Coroner, If possible, where death is anticipated, the Medical Examiners (ME) office should be informed of these cases before death to enable scrutiny and timely issue of the MCCD (Medical Certificate of Cause of Death). Please contact the office as soon as possible if you have a patient with specific requirements. The Medical Examiner’s Office is currently situated with the Bereavement Support Office on Level 0. They can be contacted on extension 2404, or via email [email protected] It is acceptable to allow the family chosen funeral director to collect the deceased directly from the community hospital where the Medical Examiner is satisfied the body can be released. The ME service and Bereavement Support office can provide advice during office hours. Do not give an assurance to families that this will be the case other than to say every effort will be made to allow release as soon as possible in accordance with the circumstance, legal requirement and Coroner.
6.2. The Coroner, Unexpected, Sudden & Suspicious Deaths
Informing the Coroner is now decided by the Medical Examiner at NDDH and will apply to cover inpatients deaths in community hospitals shortly. The Coroner is to be informed of a death for a variety of reasons; unexpected death and death following an invasive procedure (e.g. surgery, endoscopies).This can include expected deaths. Informing the Coroner of a death does not necessarily mean a post mortem is required. When discussing next steps with family, medical and nursing staff need to be aware of this requirement.
The last offices procedure considers that a post mortem examination may be required and ensures the body is prepared for the Mortuary with this in mind. Please note an unexpected death is not necessarily a suspicious death. New legislation laid out the Coroners and Justice Act 2009 is now implemented across England and Wales with the Medical Examiner System being developed in all acute hospitals. The aim is to improve accuracy and safety in the death certification and cremation documentation process and to provide more support to the bereaved. All deaths in North Devon District Hospital must be referred to the Medical Examiner’s Office, who will assist the teams in ensuring accuracy of Medical
Infection Prevention & Control Page 7 of 30 Care of the Deceased SOP
Certificate of cause of death (MCCD) completion, and also advise whether the death needs referring to the Coroner or not. The Medical Examiner will independently review the medical notes and after discussion with the QAP (Qualified Attending Practitioner - the doctor who will write the MCCD) will together conclude the cause of death. The Medical Examiner Office will speak directly to the nominated family member to discuss the cause of death and whether they have any concerns. Following this the nominated doctor will either refer the death to the coroner, or complete the MCCD. The MCCD will then be issued to the family for registration. Once the Medical Examiner is satisfied that a Medical Certificate of cause of death can be issued, the family may register the death. https://ndht.ndevon.swest.nhs.uk/bereavement/medical-examiner/medical-examiner- system-for-death-certification-information-for-consultants-and-junior-doctors/ https://ndht.ndevon.swest.nhs.uk/bereavement/medical-examiner/reporting-to- coroner/ https://ndht.ndevon.swest.nhs.uk/bereavement/medical-examiner/medical-examiner- system-information-for-wards/ The destruction and disposal of Controlled Drugs (CDs) must not be undertaken following the unexpected/sudden or suspicious death of a patient; please refer to the Trust Controlled Drugs Standard Operating Procedure for further information on the procedure to follow. The Controlled Drugs Policy and SOP are available on Bob https://ndht.ndevon.swest.nhs.uk/controlled-drugs-policy/
6.3. Deaths which occur in ED or on route to ED
All deaths must be reported to the coroner’s office or police, during office hours report to the coroner’s office and outside of these hours or if the death is suspicious contact the police. Once cleared to do so arrangements can be made to transfer the body to the Mortuary.
6.4. Unexpected Deaths
All deaths must be reported to the coroner’s office or police, during office hours report to the coroner’s office and outside of these hours or if the death is suspicious contact the police. The Coroner office or police will advise on next steps and arrange for removal of body where necessary.
6.5. Suspicious Deaths
Death in suspicious circumstances or a death thought to be suicide must be referred to the police immediately. Once any resuscitation attempts have stopped and death is confirmed every attempt must be made not to disturb the area around the deceased to preserve any evidence. The scene must be secured and the body must not be touched or moved unless authorised to do so. This includes the removal of any equipment or lines. The police will act on behalf of the Coroner and will arrange the removal of the body.
The duty manager for your area must be informed.
Infection Prevention & Control Page 8 of 30 Care of the Deceased SOP
Health care records following a death must be completed as soon as possible in accordance with NDHT and departmental procedures. An Incident form must be completed for all non-expected, sudden or suspicious deaths.
6.6. Verification of Death
The Standard Operating Procedure for The Verification of an Expected Death by a Registered Nurse must be followed. The death must be confirmed and documented by an appropriate person in accordance with the circumstances of the death as set out in the SOP.
7. Last Offices - Standard Operating Procedures
7.1. The death must be verified and documented in the patient’s notes as required, see the Standard Operating Procedure for The Confirmation of an Expected Death by a Registered Nurse.
7.2. Two competent persons, one of whom must be a Registered Nurse must carry out verification of the deceased patient’s identity and document on the Deceased Patient Record. Verification of identity must involve cross-referencing both name bands with the Deceased Patient Record - Notice of Death (NDDH only) and the patient’s Healthcare Record. All three sources of Data must correspond. Any discrepancies must be addressed by verifying identity and replacing the name bands etc.
7.3. Following a death at NDDH the Deceased Patient Record book is to be completed. Guidance on completing this documentation is in Appendix A. In addition follow the tissue donation guidance as set out in the Tissue Donation Flowchart, Appendix B, and Tissue Donation Guide, Appendix C.
7.4. At community hospital sites with inpatient beds complete the Community Hospital Checklist.
7.5. Infection Risks
Consideration of any infection prevention & control risks must be made before arranging viewing and before movement to the mortuary. Standard infection control precautions (SICPs) are used to manage the risks of infection from patients in healthcare settings and are applicable as a means of controlling the risks of infection from the deceased.
The principles of standard infection control precautions (SICPs) and Transmission Based Precautions (TBPs) continue to apply whilst deceased individuals remain in the care environment. This is due to the ongoing risk of infectious transmission via contact although the risk is usually lower than for living patients.
Infection Prevention & Control Page 9 of 30 Care of the Deceased SOP
‘Standard Precautions’ refers to the application of infection control practices to prevent exposure to and the transmission of micro-organisms, which may be pathogenic (cause disease). These routine practices when caring for all patients include:
• Hand decontamination
• Wearing appropriate personal protective clothing
• Safe disposal of clinical waste
• Decontamination of equipment and the environment
• Safe disposal of sharps.
• Safe handling of linen.
When standard infection control measures alone are insufficient to interrupt transmission, additional transmission-based precautions are indicated.
Appendix G shows HSE guideline for ‘Managing infection risks when handling the deceased’.
For High risk patients, or where a risk of fluid leakage is likely, the body must be placed in a zipped body bag. Infections & scenarios that require this include;
Hepatitis B, C & D
HIV
Mycobacterium tuberculosis (TB)
Clostridium difficile if leakage is present
Severe secondary infection
Known intravenous drug user
Large pressure sores
Always consider the safety of people who will be continuing care and handling the body after it leaves the ward. Document any infectious disease on the notification of death to allow the mortuary team to communicate this to the receiving Funeral Directors. See Appendix G or contact the infection control team for guidance. For community deaths complete Appendix F – Notification of Infection Risk to Funeral Directors.
Where a Hazard Group 4 pathogen is suspected, for example, Viral Haemorrhagic fever, follow the Infection Control policies and seek advice from the Infection Control Team. These cases must be double body bagged with absorbent padding placed between the bags.
Infection Prevention & Control Page 10 of 30 Care of the Deceased SOP
Covid-19
Where the deceased was known or possibly infected with COVID-19, viewing, hygienic preparations, post-mortem and embalming are all permitted.
As there will be a risk to mortuary staff from close contact with visitors and a small risk to relatives of the deceased from Covid-19, it is important to ensure compliance with social distancing. Visitors must be made aware of any risk and wear PPE if required. Any decisions made by staff and/or refusals by visitors to comply with requests e.g. PPE, social distancing etc. should be documented in the deceased’s records. Allow family to spend time with the deceased patient as required. At this time it may be appropriate to lay the deceased out in a particular way for example it is often nicer for relatives to see the patient lying on their side with their hand placed under their head opposed to on their back.
7.6. Two members of staff should carry out last offices, involving family as appropriate in accordance with religious, cultural and individual needs.
7.7. The area around the deceased patient must be screened off to promote privacy and to avoid unnecessary distress to other patients and relatives.
7.8. Equipment
Apron and gloves
Bowl of warm water and toiletries
Deceased Patient Record book (see Appendix A for guide)
Shroud or patients own clothing
Body bag or a zipped body bag for high risk patients or where a risk of fluid leakage is likely.
Appropriate PPE
Absorbent pads
Clinical waste bag
Laundry skip
Bed sheet
Deceased Patients Property Book
Deceased Patients Property Bag
7.9. Wash hands and put on disposable gloves and apron.
7.10. Once the family have spent the time they require with the deceased lay the deceased on their back and remove all but one pillow. Straighten limbs and align in a natural position with arms at the side.
Infection Prevention & Control Page 11 of 30 Care of the Deceased SOP
7.11. Close the deceased patient’s eyes by applying light pressure to the eyelids.
7.12. Attachments must not be removed from the body e.g. catheter, cannula, lines and drains must be spigotted and only attached mechanical equipment removed. This considers that a post mortem examination may be required and ensures the body is prepared for the Mortuary with this in mind.
7.13. When performing last offices religious, cultural and individual requirements must be considered. If appropriate (see appendix E) wash the deceased patient and cover any wounds or puncture sites with a clean waterproof, occlusive dressing. A clean stoma bag should be applied to an established stoma.
7.14. Incontinence pads can be used if the deceased patient has faecal or urinary leakage.
7.15. If requested to do so or appropriate shave the deceased patient.
7.16. Clean the deceased patients’ mouth and clean their dentures with dental paste and a tooth brush. Replace the dentures in the patients’ mouth. Where this is not possible place them in a clean container clearly labelled with the patient details and send them to the mortuary with the deceased patient. Close the jaw, to enable the mouth to close.
7.17. In the presence of another nurse all jewellery should be documented and only removed on the request of the relatives. The patient property policy must be followed at all times.
Jewellery left on the body should be documented on the Deceased Patient Record book.
At community hospital sites (with inpatients beds only) document jewellery left on the body on the Community Hospital Checklist – Appendix D. Please note the funeral director is expected to check and verify the presence of jewellery left on a body.
Jewellery that is removed should be recorded in the deceased patient property book and secured as per Trust policy.
Jewellery given to relatives must be recorded in the Deceased Patient Property book and signed for accordingly.
Use general terms when documenting jewellery items, for example; yellow metal rather than gold, white metal rather than silver.
Loose jewellery left on the body should be taped.
7.18. Dress the deceased patient in personal clothing if requested, or a shroud.
7.19. Attach an identification wrist band to the deceased patient’s wrist and another to their ankle. Complete the Deceased Patient Record book for NDDH patients.
7.20. Any potential infection risk must be recorded on the Deceased Patient Record for NDDH patients.
Infection Prevention & Control Page 12 of 30 Care of the Deceased SOP
7.21. For community hospitals complete the checklist, Appendix D.
7.22. Place the deceased patient into a body bag, close the bag and secure with tape if necessary. At NDDH attach the top, white copy of the Deceased Patient Record to the outside of the body bag.
7.23. Place the bottom, yellow copy from the Deceased Patient Record book in the patient record. 7.24. Patient’s property left in the clinical area should be documented in the Deceased Patient Property book, following trust policy and placed in a green patient property bag or the patient’s own case to be taken to the Bereavement Office. Do not overfill the bags, use as many as necessary and pack them sensibly in an organised and tidy manner. Any soiled personal items must be bagged separately and labelled accordingly. All bags must be clearly labelled with the patient’s name. Do not use addressograph labels. 7.25. The property will be collected by the relatives or carers or by their chosen funeral director from the Bereavement Support Office or mortuary respectively. If the patient has died in a community hospital the property must be secured as per local arrangements, in line with trust policy, and made available for collection by relatives. 7.26. Dispose of any materials or equipment that cannot be cleaned and reused according to waste management policy. Remove gloves and apron and wash hands. 7.27. At the NDDH site, contact the porters to remove the patient and transport to the mortuary. Advise the porters of any special requirements, for example bariatric patients where additional staff may be required. Assist the porters with the lateral transfer of the patient to the concealment trolley with a pat slide, 3 people must do this. The porters will take the deceased to the Mortuary. Outside of the hours the mortuary is staffed nursing staff must assist with the transport to the mortuary, specifically the lateral transfer of the deceased from the trolley to the mortuary tray, 3 people must do this. In hours the mortuary team will help with the transfer in the mortuary. At all times follow the NDHT moving and handling policies. 7.28. At community hospital sites with inpatients beds transfer the deceased to your mortuary fridge following your own local procedure. If appropriate contact your contract funeral director to collect the patient and complete the community hospital checklist – Appendix D. 7.29. On this checklist record if the patient is classified as a high infection risk but do not state the actual nature of the risk by completing an Infection Control Notification, (Appendix G) and give it to the Funeral Director. This will be passed on to the family choice Funeral Director, if applicable, to ensure those handling the deceased are aware of any infection risk. 7.30. Upon arrival of the Funeral Director check the identification bands with them. The Funeral Director will then be required to complete and sign the checklist. Depending on the Funeral Director for your location they may have their own ‘tracking’ paperwork which you must complete as required.
Infection Prevention & Control Page 13 of 30 Care of the Deceased SOP
8. What to tell bereaved relatives following a death at North Devon District Hospital
8.1. If they are on the ward:
Give the family the Bereavement Booklet. Offer the family the opportunity to donate tissues and advise if they were interested a specialist nurse in tissue donation will contact them to discuss the options. See Appendix B Ask them to contact the Bereavement Support Office on the number in the booklet the next working day and follow the guidance in the booklet as to next steps.
8.2. If they are not on the ward:
Give them the phone number for the Bereavement Support Office – 01271 322404 and ask them to phone the next working day.
Offer the family the opportunity to donate tissues and advise if they were interested a specialist nurse in tissue donation will contact them to discuss the options. Inform the family the booklet is available on the Hospital website or offer to post a booklet to them.
https://www.rns.uk/north-devon-and-district-hospital
Please do not inform them:
When the Medical Certificate will be ready.
Whether you think there will be a post mortem.
Just to turn up at the Bereavement Support Office.
There can be many complications in the process of issuing the paperwork after someone dies in hospital and it can cause unnecessary distress if relatives are given unrealistic expectations.
Contact the Bereavement Support Office for further advice on ext 2404
9. What to tell bereaved relatives / next of kin following a death of an inpatient at a community hospital
9.1. If they are on the ward:
Give the family the Bereavement Booklet.
Infection Prevention & Control Page 14 of 30 Care of the Deceased SOP
Explain what will happen next and obtain verbal consent to release the deceased to the Funeral Director if appropriate
If transferring to a funeral director Give them the name and contact details of the Trust Funeral Director for your Community Hospital. Highlight it in the Bereavement booklet for them.
Give them appropriate information in regard to the completion of the Medical Certificate of Cause of Death.
Ask them if the funeral is likely to be a burial or cremation.
Ask them to tell their chosen Funeral Director that the deceased can be collected from the community hospital mortuary or the Trust Funeral Director as appropriate.
9.2. If they are not on the ward:
Give them the contact details of the trust Funeral Director for your Community Hospital as appropriate.
Tell them the booklet is available on the Hospital website or offer to post a booklet to them.
https://www.rns.uk/north-devon-and-district-hospital
Please do not inform them:
When the Medical Certificate will be ready.
There can be many complications in the process of issuing the paperwork after someone dies in hospital.
10. Viewings
Viewings and Infection Control - allowing the bereaved to see, touch and spend time with the deceased can be an important part of the bereavement process. However it is necessary to consider their wellbeing, thus answer their questions and give advice in regard to infection risk openly and honestly.
There may be some circumstances where viewing is not permitted e.g. viral haemorrhagic fevers, refer to Appendix G for guidance for viewing the deceased with Infections.
For the deceased where an infection risk is present but viewing is possible the mortuary, bereavement and nursing staff must advise family, partners and friends of the risk and how the risk to them can be reduced. They must be instructed to wash their hands after the viewing before leaving.
North Devon District Hospital Site
Infection Prevention & Control Page 15 of 30 Care of the Deceased SOP
The Mortuary & Bereavement Support Office normal working hours are Monday to Friday, 8.30am to 4pm. To arrange a viewing contact the Bereavement Support Office on ext. 2404, the Mortuary on 4103 or advise the family to contact the Bereavement Support Office. Do not arrange or agree a time for the viewing until it has been agreed by the Mortuary/Bereavement Support Office
Outside of normal working hours contact the Clinical Site Manager (CSM), bleep 500 to contact the on call mortuary technician. The CSM will arrange with the mortuary technician and the family a convenient time. The mortuary technicians are not on site out of hours, so do not make any arrangements for viewing without having contacted them first to arrange a time. Viewings are arranged up to 6pm on week nights and between 9am and 6pm at weekends. Viewings can be arranged outside of these times if special circumstances warrant it. The CSM and mortuary technician will advise on this.
Community Hospital Sites
Where possible a viewing should take place within the two hour period before the patient has been transferred to mortuary fridge or the Trust Funeral Director. It is acceptable to allow time for a family viewing at the hospital before the deceased is transferred.
If family, partners or friends wish to view the deceased once they have been transferred to the Funeral Director contact the Funeral Director to arrange a viewing. Do not make any arrangements with the family until you have spoken to the Trust Funeral Director. Where possible signpost them to the Funeral Director and allow them to make arrangements themselves. It is advisable to delay a viewing until the patient is in the care of the family chosen Funeral Director.
11. Information
Any queries contact: Tissue Donation advice call the tissue co-ordinator on 24 hour pager. 08004320559
Mortuary Staff on 01271 314103 internal extension 4103.
Bereavement Support Office on 01271 322404 internal extension 2404.
Chaplaincy Service on 01271 322362 internal extension 2362 bleep 103.
Histopathology & Mortuary Manager on 01271 311754 internal extension 3754.
Clinical Site Manager (CSM) Bleep 500.
12. References
Dougherty L & Lister S, (2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 9th edition. Wiley-Blackwell. London
Infection Prevention & Control Page 16 of 30 Care of the Deceased SOP
Guidance for staff responsible for care after death (last Offices). National end of life care programme and National nurse consultant group (palliative care).
Verification of an Expected Death – Standard Operating Procedure (by a Registered Nurse) https://www.northdevonhealth.nhs.uk/2021/04/confirmation-of-an-expected- death-standard-operating-procedure-by-a-registered-nurse/
GUIDANCE No. 31 DEATH REFERRALS AND MEDICAL EXAMINERS https://ndht.ndevon.swest.nhs.uk/wp-content/uploads/2019/03/Guidance-No.- 31-Death-Referrals-and-Medical-Examiners.pdf
GOV.UK (2021) Guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19). Available at https://www.gov.uk/government/publications/covid-19-guidance-for-care-of-the- deceased/guidance-for-care-of-the-deceased-with-suspected-or-confirmed- coronavirus-covid-19
The Human Tissue Act (2004). London. Stationary Office. Available at https://www.legislation.gov.uk/ukpga/2004/30/contents
Health and Safety Executive (2018). Managing infection risks when handling the deceased. Available at https://www.hse.gov.uk/pubns/priced/hsg283.pdf
13. Associated Documentation
Assessment and Maintenance of Clinical Competence in Nurses, Midwives and Support Workers Policy
Bereavement Booklets for North Devon District Hospital and the North Devon Community Hospitals available on the Trust website
Deceased Patient Record – Notice of Death forms (NDDH patients only) https://ndht.ndevon.swest.nhs.uk/wp-content/uploads/2012/02/2016-Deceased- patient-record-form-GUIDE-notes-V3-281.02.14.pdf
Decontamination Policy
Standard Infection Control Policy
Moving and Handling Policy
Patient Property Policy
Viral Haemorrhagic Fever Policy
Staff screening and Immunisation Policy
Infection Prevention & Control Page 17 of 30 Care of the Deceased SOP
Verification of an Expected Death – Standard Operating Procedure (by a Registered Nurse)
Organ Donation Policy
Tissue Donation Policy
End of Life Care Policy for Adults and Paediatrics
Death Notification for Healthcare Records Procedure
Controlled Drugs Policy https://ndht.ndevon.swest.nhs.uk/controlled-drugs- policy/
Trust Controlled Drugs Standard Operating Procedure
Infection Prevention & Control Page 18 of 30 Care of the Deceased SOP
Appendix A – Deceased Patient Record Notice of Death
Deceased Patient Record
Notice of Death
Infection Prevention & Control Page 19 of 30 Care of the Deceased SOP
Appendix B – Tissue Donation Flow Chart
Infection Prevention & Control Page 20 of 30 Care of the Deceased SOP
Appendix C - Tissue Donation Guide
Unlike organ donation, all patients that die in hospital can be considered for Tissue Donation. Tissue Donation should be offered to families of all patients. There are exclusion criteria for tissue donation but it is advisable to contact the tissue co-ordinators to discuss each individual case.
Tissues that can be donated in this region are:
Eyes
Heart for heart valves
The general criteria for donation are:
Tissue Age Maximum retrieval time after death
3 years and Eyes 24 hours upwards
Heart Valves 0 – 65 years 48 hours
Absolute Contraindications for Tissue Donation
Positive virology – HIV, Hepatitis B & C, Syphilis
CJD
High Risk activities – IV Drug User
Neurodegenerative Disorders – dementia, Parkinson’s
Leukaemia’s, Lymphomas or myelomas
If the family would like more information explain that you will contact the Tissue Donation Team and that we will get in touch with them. (Please ensure that the family contact details, names and phone numbers are correct)
Page us on 08004320559 (24 hour pager) for information, advice or for donor referrals.
Remember you are offering the family a choice that is theirs to make, not ours to take away by simply not offering the option of Tissue Donation.
The Tissue Donor Co-ordinators have to be contacted in order for the donation to take place. The co-ordinators provide information, answer questions and discuss the wishes of the deceased with the family. The family can then make an informed decision about donation.
Infection Prevention & Control Page 21 of 30 Care of the Deceased SOP
Frequently asked questions
Tissue Donation will not delay the funeral arrangements.
The family will be able to see their relative after the donation.
Coroner’s cases will not prevent donation.
Helpful hints on how to broach the subject of Tissue Donation with families
“I know this is a difficult time but I have some information you may like to consider. It may be possible for…...... to be a tissue donor” then lead in with:
“May I ask if …… carried a donor card?” Or
“Is donation something you had ever discussed?” Or
“Do you know if …… had expressed any wishes in their lifetime regarding donation?”
For information, advice or for donor referrals page us on: 08004320559 (24 hour pager).
Infection Prevention & Control Page 22 of 30 Care of the Deceased SOP
Appendix D – Community Hospital Checklist
Please ensure the results of discussions are documented in notes. Please date and sign each column. Date of death Patients name Patient ID Label Time of death Hospital Number Date of Birth
Completed Date Print name
Verify death of patient as per standard operating procedure
Check coroner not required ( see list over page )
Inform GP (and Devon Docs if out of hours).
Inform staff grade if consultant patient.
Inform relatives of patients death
Discuss care with relatives, identify religious / cultural request
Gain verbal consent from relatives for removal of deceased to Funeral Director
Explain where to collect deceased belongings, death certificate
Ascertain if deceased for burial or cremation (document in notes)
Inform funeral director of deceased patient and arrange removal
Follow standard operating procedure for performing of last offices prior to transfer to the funeral director Advise funeral director of any potential infection risk and issue Infection control notification. Complete Appendix F – Notification of Infection Risk to Funeral Directors
Advise the funeral director that the deceased is for burial or cremation.
Document below any jewellery left on deceased.
Items. Funeral Director Initials.
Pack all patient belongings for collection by next of kin
Discharge patient on PAS and other systems.
Complete record tracking for medical notes
Infection Prevention & Control Page 23 of 30 Care of the Deceased SOP
Funeral Director Details: Name: Funeral Director:
Signature: Date:
Infection Prevention & Control Page 24 of 30 Care of the Deceased SOP
Appendix E – Religious & Cultural Requirements
Please use this section for guidance only; individuals may have different preferences regardless of religion & culture. For further advice, please contact a member of the chaplaincy team.
Baha’i faith: Cremation not permitted, burial should take place as near as possible to place of death. Baha’i relatives will wish to say prayers for dead. Routine last offices are acceptable.
Buddhism: Consider dying is a very important part of life and that it should be approached positively and in as clear and conscious state of mind as possible. Routine last offices are acceptable; however, the body should not be moved for at least one hour if prayers are to be said. Cremation preferred.
Chinese: Customs vary very widely in the Chinese tradition; therefore, it is difficult to speak for all Chinese. Mostly for adults, the body is bathed, and sometimes the body is dressed in white or old- fashioned clothing.
Christianity: Offer support of appropriate chaplain. Roman Catholic patients should be offered visit by priest to give Sacrament of Sick when dying, and may wish to have a rosary or crucifix in their hand. Church of England patients may require prayers to be said at bedside of the dying.
Christian Scientists: Worship is kept free from ritual. Routine last offices are appropriate. Female staff should handle a female body. Cremation preferred, prefer to not have post mortem unless required by law.
Hinduism: Post mortems disliked unless required by law. Consult the family by asking whether they wish to perform last offices, as distress could be caused if non-Hindus touch the body. If family are not available, wear disposable gloves, close the eyes and straighten the limbs. Do not remove jewellery, religious objects or sacred threads. Do not wash the body, as this is part of funeral rites and will usually be carried out by relatives using Ganges water. Wrap the body in a clean sheet. Body is cremated.
Jainism: Prefer no post mortem unless required by law. Prayers are offered for soul of dying patient. Presence of a Jain Spiritual Caregiver is preferred. Family may wish to assist with Last Offices. Body is cremated.
Jehovah’s Witnesses: No objection to post mortem. No special practices for the dying, but will appreciate a pastoral visit from one of their elders. Routine Last Offices are appropriate. May be buried or cremated.
Judaism: Prefer no post mortem unless required by law. Cremation is forbidden. Dying person should not be left alone, may wish to hear special psalms and prayers, can be said by a relative or Rabbi. Patients must not be washed and should remain in the clothes in
Infection Prevention & Control Page 25 of 30 Care of the Deceased SOP
which they died. The body will be washed in a ritual purification. It is important that the body is released to family as soon as possible.
Mormon: Do not object to post mortem. No rituals for dying, however spiritual contact is important. Routine last offices appropriate, if wearing a sacred undergarment must be replaced on body following last offices. Burial is preferred.
Muslim: Prefer no post mortem unless required by law. Patients may wish to face Mecca (South East). Family/friends may sit with patient reading the Holy Quran and making supplication. At death do not wash the body. Where no relatives are available, staff should wear gloves to avoid direct contact with the body. The body should face Mecca and the head should be turned towards the right shoulder before rigor mortis begins. The body can be made respectable by combing hair and straightening limbs, however the family will ritually wash the body before burial. The body of a female should be prepared by a female member of staff and vice versa for a male body. It is important to bury a body as quickly as possible.
Plymouth Brethren: As death approaches family may wish to keep a 24 hour vigil. After death the family may wish to attend to Last Offices themselves. Prefer no post mortem unless required by law.
Quakers: Do not object to post mortem. No special rules or practices for the dying, will appreciate a visit from an Elder or other Quakers who may sit in silent worship.
Rastafarianism: Post mortem is extremely distasteful to most Rastafarians, unless required by law. Routine last offices appropriate. Burial preferred.
Romany origin: Many people of Romany origin are Christians. If a traveller is dying, family/friends from around the country will wish to visit before death, meaning that there will often be many visitors. After death, the family will request that the person be laid out in clothing of their choice.
Sikhism: No objection to post mortem, however prefer not to if possible. Sikh men wear the five K’s: kesh (long hair kept under a turban), kangha (a small comb worn in the hair), kara (steel bracelet or ring worn on right wrist), kachha (special type of underwear) and kirpaan (sword worn symbolically by baptised Sikhs. After death routine last offices may be performed, but the 5 K’s should not be removed. Body is cremated.
Zoroastrian/Parsis: No religious objection to post mortem. Routine last offices are appropriate. Believe it necessary to commence prayers as soon as possible after death. No preference for burial or cremation.
Infection Prevention & Control Page 26 of 30 Care of the Deceased SOP
Appendix F – Notification of Infection Risk to Funeral Directors
Infection Control Notification Name of Deceased………………………………………………………………………
Date and time of death………………………………………………….………………
Hospital and Ward………………………………………………………………………
The deceased is a potential source of infection and precautions must be taken reduce the risk of the spread of infection.
Yes No Unknown Tick as appropriate
In this case the risk is considered;
Low Medium High
The remains present an infectious hazard of transmission by: Tick as appropriate
Inoculation (blood borne virus) Aerosol Ingestion
Body bagging is necessary
Viewing is not recommended No
Hygienic preparation is not recommended
Embalming presents high risk E.g. blood-borne virus
Universal precautions for handling the deceased, regardless of infection risk, must be observed at all times.
Signed ………………………………………………on behalf of Northern Devon Healthcare NHS Trust
Print Name ………………………………………….Designation …………………………………………
You must pass a copy of this Notification on to any funeral director who subsequently takes the deceased into their care.
Notes Not all infected patients display typical symptoms; therefore some infections (including blood borne viral infections) may not have been identified at the time of death.
In community hospital cases, the doctor or nurse certifying death, in consultation with ward nursing staff, is asked to sign this notification sheet; where a post mortem examination has been undertaken and at the acute hospital site, the pathologist (or qualified Anatomical Pathology Technologist) is asked to sign this sheet; in non-hospital situations, the doctor certifying death is asked to sign this sheet.
Infection Prevention & Control Page 27 of 30 Care of the Deceased SOP
Appendix G –Transmission-based precautions to key infection in the deceased HSE guidelines
Infection Prevention & Control Page 28 of 30 Care of the Deceased SOP
Infection Prevention & Control Page 29 of 30 Care of the Deceased SOP
Infection Prevention & Control Page 30 of 30