Standard Operating
Procedure
Access to Funeral &
Mortuary Services for inpatient services during Covid 19
Document Control Title and Version Number Access to Funeral & Mortuary Services for inpatient services during Covid-19 V1 SOP Author: Alex Clennel-White, Policy Officer, Experience, Safety & Risk Department Sue Webber, Deputy Ward Manager, Belvedere Ward Simon Worthy, Contracts and Procurement Manager SOP Sponsor: Clare McAdam, Deputy Director of Nursing Approval Committee: Gold Committee Approval Date: 27 April 2020 Review Date: 26 April 2021 Services Included: Inpatient Units
Contents Introduction ...... 3 Infection Control ...... 3 Funeral Arrangements and Release of the Body ...... 3 Patients Held under a Section on the Mental Health Act ...... 4 Units in Exeter and Surrounding Area ...... 5 Units in Torbay & South Devon Area ...... 6 Units in the North Devon Area ...... 7 Units Out of Area – Cygnet ...... 8 Emergency Storage - Devon Countywide Mortuary Solution: ...... 9 Appendix A - Possible Questions by relatives and Carers ...... 10 Appendix B – T&SD Transfer Document ...... 11 Appendix C – Deceased Patient Record Notice of Death ...... 12 Appendix D – Funeral Care Providers in Devon for Covid-19 patients ...... 13
2 Introduction
Following end of life care within the Trust comes the sad process of dealing with the body of those who have passed away. The guidance in this document will help staff provide the same level of care and compassion to the deceased as they received in life.
Staff will report the death on the RMS using the ‘Covid-19 Related Incident’ entry as Cause Two and the type of death (Expected / Unexpected) as Cause One.
Infection Control
From the Guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19) - Department of Health (Updated 20 April 2020)
Those handling bodies should be aware that there is likely to be a continuing risk of infection from the body fluids and tissues of cases where coronavirus (SARS-CoV2) infection is identified, through either a clinical diagnosis or laboratory confirmation.
The usual principles of Standard Infection Control Precautions (SICPs) and Transmission- Based Precautions (TBPs) apply for bodies that are suspected or confirmed to be infected with coronavirus (SARS-CoV2). No additional precautions are needed unless Aerosol Generating Procedures (AGPs) are being undertaken. Further guidance can be found here:
Health and Safety Executive (HSE) guidance: Managing infection risks when handling the deceased, which details the standard infection control precautions and transmission-based precautions that should be followed in all occupational settings
Association of Anatomical Pathology Technology (AAPT) and Royal College of Pathologists (RCPath) guidance Transmission-based precautions: Guidance for care of the deceased during COVID-19 pandemic, which details the Personal Protective Equipment (PPE) required for Transmission Based Precautions that can be used by any professional involved in the care of the deceased
The risk from people who have died from a SARS-CoV2 infection arises as a result of aerosols generated in the post-mortem handling of the deceased. Management of this hazard will substantially reduce the residual risk as the virus will rapidly degrade when not sustained by living tissue. As a result, there is no requirement for body bags, but there may be other practical reasons for their use.
Funeral Arrangements and Release of the Body
As part of End of Life Care, funeral arrangements should have been discussed and recorded with the relative or carers of the patient. This should take into account the deceased’s wishes for their funeral arrangements according to their religious or spiritual beliefs. If the family has not chosen a Funeral Director then the carer/family should be encouraged to make a choice for a Funeral Director for storage of the body
Following the verification of death and completion of the Medical Certificate of Cause of Death, the agreed care of the body may commence by the appointed funeral care provider.
Where no prior arrangements have been made, staff will need to contact a funeral care provider (Appendix D) or mortuary on co-located site.
3 Patients Held under a Section on the Mental Health Act
This primarily applies to the following units:
Ashcombe Ward - Dewnans Centre Langdon Hospital, Dawlish Avon House Langdon Hospital, Dawlish Chichester House Langdon Hospital, Dawlish Cofton Ward - Dewnans Centre Langdon Hospital, Dawlish Connelly House - Langdon Langdon Hospital, Dawlish Holcombe Ward - Dewnans Centre Langdon Hospital, Dawlish Owen House Langdon Hospital, Dawlish Warren Ward - Dewnans Centre Langdon Hospital, Dawlish
In Secure Service Inpatient wards all deaths should be notified to the police as a ‘death in custody’. The room should be sealed until police have attended or provided instruction.
In other Trust inpatient wards, if person held on section should die unexpectedly then the police should be call and again, room sealed so investigations can take place.
On contacting the police, staff should ensure that the likely cause of death is Covid-19. The police will then advise if they will be sending anyone to inspect the body. If they are not to visit the ward, an email should be requested from the police as evidence that the body can be released.
The decision the that the police do not need to see the body will be communicated to the Nurse in Charge and confirmed by email before the body can be released to the Funeral services
Relevant Contact
H.M. Coroner County Hall Exeter EX2 4QD Tel: (01392) 383636 Fax: (01392) 38363 www.exgdcoroner.org.uk
H.M. Coroner Derriford Business Park Administration office: (01752) 204636 Next of kin enquiries: (01752) 487402 Reporting of deaths in Plymouth: (01752) 487401 / 487403 Reporting of deaths in Torbay and South Devon: (01752) 487404 / 487405
4 Units in Exeter and Surrounding Area
This applies to the following units:
Belvedere Franklyn Hospital, Exeter Rougemont Franklyn Hospital, Exeter Mother And Baby Unit Jasmine Lodge, Exeter LD Inpatient - ASU Team LD Services - Whipton Hospital, Exeter Coombehaven The Cedars, Exeter Delderfield The Cedars, Exeter Psychiatric Intensive Care Unit The Junipers PICU, Exeter Haldon Service Wonford House Hospital, Exeter Russell Clinic Wonford House Hospital, Exeter
During the Covid-19 pandemic, resources from the Royal Devon and Exeter NHS Foundation Trust will not be available. The Trust therefore has made arrangement with Shoobridge Funeral Directors who can provide a full service to the Trust including transportation of deceased. Should it be necessary for Devon County to activate any temporary storage for bodies in the Exeter area, Shoobridge will remain the provider to call for collection of the deceased.
Upon arrival of the Funeral Directors staff will check the identity wristlets that are already in place, confirming the deceased’s identity with the ward staff. The identity wristlets must remain on or with the deceased at all times as they will be used at all stages whilst the deceased remains funeral provider’s care
Shoobridge Funeral Directors has three locations for the deceased with which staff may wish to familiarise themselves should relative or carers ask to where the body is being taken.
The Exeter Office is around 1.5 miles from the Royal Devon and Exeter Hospital and has two chapels of rest.
Exmouth Office: is around 9 miles from “the Royal Devon and Exeter Hospital and has a single chapels of rest.
The Honiton Office is around 15 miles from the Royal Devon and Exeter Hospital and has three chapels of rest.
Relevant Point of Contact:
Paul Shoobridge Director Shoobridge Funeral Services Tel: (01392) 279927 Mobile (07780) 888281 Email: [email protected] Website: www.shoobridgefunerals.co.uk
5 Units in Torbay & South Devon Area
This applies to the following units:
Haytor Torbay Hospital, Torquay Beech Unit Torbay Hospital, Torquay
Both units co-located at Torbay Hospital will be served by the Torbay and South Devon NHS Foundation Trust for the collection, transfer and storage of the deceased prior to funeral arrangements. Staff should familiarise themselves with the transfer paper use by the acute Trust (Appendix B) as this document will be required for use when the portering team collect the body. The Mortuary Managers has arranged for this document to be circulated to the ward clerks / people that would deal with End of Life care but can be contacted for copies in there are none on the ward.
Relevant Point of contact:
Simon Hughes Mortuary Manager Torbay and South Devon NHS Foundation Trust Mortuary Floor 1 Tel: (01803) 655251 Email: [email protected]
6 Units in the North Devon Area
This applies to the following units:
Meadow View North Devon District Hospital, Barnstaple Moorland View North Devon District Hospital, Barnstaple Ocean View North Devon District Hospital, Barnstaple
The units co-located at North Devon District Hospital will be served by the North Devon Healthcare NHS Trust for the collection, transfer and storage of the deceased prior to funeral arrangements. Staff should familiarise themselves with the transfer paper use by the acute Trust (Appendix C) as this document will be required for use when the portering team collect the body. The Mortuary Manager has confirmed there is no change in the normal process.
Relevant Point of Contact:
Lee Luscombe Pathology Service Manager – Head Biomedical Scientist North Devon Healthcare Trust Tel: (01271) 311754 (ext. 3754) Email: [email protected]
7 Units Out of Area – Cygnet
Whilst it is unlikely that anyone whose death is expected would remain as an in-patient in a Cygnet Health Care psychiatric unit, it is possible that anyone could meet an unexpected death due Covid-19.
Cygent Health Care have the following policy that will be followed should a person out of area in one of their beds pass away from Covid-19:
IC 14 Care of the CPF 4.04 Procedure Deceased.pdf in event of an unexpected death.pdf
Relevant Point of Contact
Suzie de Maillard NHS Partnerships Manager
Email: [email protected] Secure Email: [email protected] Telephone: (07526) 175976 Address: Cygnet Hospital Kewstoke, Beach Road, Kewstoke, Weston-Super-Mare, Somerset, BS22 9UZ
8 Emergency Storage - Devon Countywide Mortuary Solution:
Devon County Council has confirmed that “in the first instance certainly across the County of Devon and Torbay areas our main aim is to continue management of deceased patients by business as usual (BAU) for as long as possible”.
Should the mortality rate for Covid-19 rise significantly, there is a risk that the capacity of the Mortuary and Funeral Directors is overwhelmed. To prepare for this possibility, each Local Authority has established a temporary storage unit (TSU) for deceased patients for use if the situation escalates.
Activation of TSUs will be communicated by the Trust updates on Covid-19 or your Relevant Point of Contact will be able to advise who should collect the deceased.
Relevant Point of Contact:
Steven Harvey Emergency Planning Officer Torbay Council, Town Hall, Castle Circus, Torquay, TQ1 3DR Tel: (01803) 208754 Email: [email protected]
9 Appendix A - Possible Questions by relatives and Carers
Can I take their belongings home?
The deceased’s property should be handled with care as per policy by staff using PPE and items that can be safely wiped down such as jewellery should be cleaned with chlorine based cleaning product, for example, Tristel. Possessions should be double bagged and securely tied with families informed of the risks and asked to leave items in the bag for 7 days.
Can I see the body?
Visit to Trust ward are not permitted during this time of the Covid-19 pandemic. Visiting should be possible once the person has arrived with the funeral care provider.
The person was an organ donor, is it still be possible for their organs to be used?
Sadly organ / tissue donation is highly unlikely to be an option as per any other active systemic viral infection
10 Appendix B – T&SD Transfer Document
Transfer Document for Deceased Patient
11 Appendix C – Deceased Patient Record Notice of Death
Deceased Patient Record
Notice of Death White copy: To accompany deceased to the mortuary, attached to the outside of the body bag. Yellow copy: To be filed in the front of the deceased notes. Ward / Unit / Place of Death: Date and time of death: / / at : hrs Dr certifying death: Nurse verifying death: Affix patient identification label Police / Coroner informed: Yes No Police Name / Number: Coroner Name: Informed by: GP informed: Yes No Informed by:
Death verified/certified in notes? Yes No
Nurse verifying deceased identity (Print Name)
Next of kin informed of death? Yes No
Relatives with deceased at time of death? Yes No
Bereavement Booklet given? Yes No
Religious /cultural needs met? Yes No Details:
NOK informed how to contact the Bereavement Office? Yes No
Record any valuables left on body. Dentures Details:
Anyto be lines placed in situ? in mouth (cap ifor unable spigot) to site in mouth send with Yes No deceased in a labelled pot. Any implanted medical devices i.e. Pacemaker Fitted? Yes No Details:
Last offices performed by (Print Names) 1 2
All belongings neatly packed, labelled, Yes No 1 property book completed and checked by 2
Property2 members taken of ward by family? staff (Print Names) Yes No
Is the patient an infection risk? Yes No Details:
Check NHS Organ Donor Register (ODR) on 01179757580 IF THE DECEASED IS NOT ON THE ODR THEN TISSUE DONATION IS STILL TO BE OFFERED
Deceased on the ODR? Yes No
If yes, any restrictions? Yes No Details:
If yes, are there any contra indications? Yes No Details:
Contraindications are listed on back. Tissue Donation discussed with: Name: Relationship: E.G WIFE/ BROTHER/ SON. IF there is no NOK but patient is registered – this should be discussed with the tissue co-ordinator. Outcome of discussion – Agreed to donate Yes No Details:
Who asked? (Print Name) Print your name.
If not asked, why not? Details: Never leave this blank or write N/A. – please document the contraindication or reason for not offering this choice. – You are only asking them to think about the option of donation and to discuss it with a specialist. Sign and Print Name:
Date and Time / / at hrs FOR 24 HOUR REFERRALS /ADVICE CALL THE TISSUE CO-ORDINATOR ON PAGER 07699 704933
12 Appendix D – Funeral Care Providers in Devon for Covid-19 patients
Exeter – During the Covid-19 Pandemic, the Trust has established service provision from Shoobridge Funeral Directors for people who pass away from Covid-19 on Trust wards. See page 5 for further details. Wards without Mortuary support outside of the Exeter area can select from the list below:
Providers below are not endorsed by the Trust for use and provided for information only.
North Devon
Name Area Telephone Number Baddick and Dymond Braunton 01271 812042 Bideford 01237 477222 Braddicks & Sherbome Funeral Directors Ilfracombe 01271 865222 B J Baker Combe Martin 01271 882428 Bideford & District Funeral Service Bideford 01237 420900 Blackmore & Sons South Molton 01769 572338 01288 352282 Arthur W Bryant Buds Holsworthy 01409 253000 Chris Byrom Bamstaple 01271 320490 W D Came Winkleigh 01837 680199 L Clarke & Sons Braunton 01271 813526 Co-operative Funeral Care Bamstaple 01271 314918 Bideford 01237 472008 South Molton 01769 572476 Daffom & Son Torrington 01805 622263 Friendship Barnstaple 01271 267337 J1 Futfords Hartland 01237 441510 W S Gayton & Son Barnstaple 01271 342196 R Gist and Son Torrington 01805 622364 G F Gubbin Launceston 01566 785340 M Grigg Winkleigh 01805 804216 A H Johns Clovelly 077919 77396 Norman Lock & Son Black Torrington 01409 231281 Morris Brothers Tavistock 01822 612023 Padfields Funeral Service Bamstaple 01271 342024 William Pearce & Son Ilfracombe 01271 862242 Vernon Rush Porlock 01643 862615 T Sargent Bude 01288 361468 A G Simmonds & Son Barnstaple 01271 342774 J E Stacey & Co Funeral Directors Holsworthy 01409 253555 Tamlyn Barnstaple 01271 850801 A D Williams Ilfracombe 01271 866332 Northam 01237 472108 Richard Williams Funeral Directors Northam 01237 423690 Denise Wellington Funeral Services Bude 01288 359277
13 Mid and South Devon (For Exeter services, see page 5) Name Area Telephone Number J D Andrews Kingsbridge 01548 852 997 Allwoods Totnes 01803 862 050 Christophers Ashburton 01364 654 965 Christophers Newton Abbot 01626 355 242 Coombes (Dignity) Bovey Tracey 01626 833 409 Co-op Newton Abbot 01626 205 269 Co-op Paignton 01803 407 418 Co-op Dartmouth Road 01803 407 457 Co-op Torquay 01803 311 511 Co-op Workshop 01803 407 471 Co-op Main Office 01803 407 460 J&K Davey (Coop) Kingsteignton 01626 336000 Drakes (T&D) Torquay 01803 329 166 Exeter & District Exeter 01392 433 511 Gill & Eales (Coop) Buckfastleigh 01364 642 $1 0111111MS Green Funeral Company Dartington 11100411 07759 890639 Halletts (Coop) Morleigh 01548 821 258 Heart & Soul Totnes 01803 840 779 Hugh Mills & Gaye Torquay 01803 329 494 Hugh Mills & Gaye Newton Abbot 01626 334 444 ISCA Exeter 01392 427 S55 Kingsbridge Funeral Directors Kingsbridge 01548 856 340 KJ Lack Torquay 01803 313 200 Knapman FD Teignmouth 01626 772080 LeRoy Funerals Exeter 01392 255 535 Maunders (T&D) Paignton 01803 556 581 Parkers Newton Abbot 01626 437 001 Perrings (Coop) Totnes 01803 862 417 Perrotts (Coop) Kingsbridge 01548 852 302 07970 164 345 Pillars Dartmouth 01803 832 121 Savills Kingsbridge 01548 857 701 Sillifants Exeter 01392 272 688 Stockmans Brixham 01803 882 385 Stockmans Churston 01803 843 710 Stockmans Preston 01803 552 112 T Clark (Coop) Teignmouth 01626 775 141 Torbay & District Torquay 01803 315 005 Torre Valley (Dignity) Torquay 01803 221 110 J Way (T&D) Dawlish 01626 862 321 1 B.G. Wills (Coop) Dawlish 01626 862 426 Zealley (Dignity) Newton Abbot 01626 362 355
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