Policy 6.6.1 DEATH OF A - CARE FOLLOWING DEATH DEATH OF A PATIENT Protocol 7 PROTOCOL

STANDARDS TO BE MET 1. The healthcare team must ensure that the deceased / tūpāpaku is cared for with privacy and dignity and relevant family / whānau needs are assessed and addressed. 2. Clinical staff will liaise with the family / whānau to ensure the deceased / tūpāpaku is prepared in accordance with their cultural and religious beliefs. 3. Ensure all staff on the ward are aware of the death. 4. Notify House Officer of death. House Officer is responsible for notifying the Consultant. 5. Ensure notification of death and referral to Coroner, if required, is completed as per protocol 1. 6. Notify Maori Health if the deceased / tūpāpaku identifies as Maori. 7. Preparation of Body and Laying out Procedure 7.1 Use standard precautions. 7.2 Lay body flat and straighten limbs. 7.3 Remove all tubes, drains etc and dress to prevent leakage (if this is a Coroner’s case refer to Protocol 2 before removing any tubes or drains). 7.4 Ensure deceased / tūpāpaku is appropriately prepared prior to family / whānau contact and / or transfer from the ward. . 7.5 Sponge deceased/ tūpāpaku if soiled. 7.6 Leave ID Band in place. 7.7 Arrange for cleaning and blessing of the room 8. Family / Whānau 8.1 If not present family / whanau to be notified of death as soon as possible. 8.2 Ascertain if family / whānau will visit the deceased / tūpāpaku prior to leaving the ward. 8.3 Offer the services of the Chaplain / Māori Health / Social Work. 8.4 Ascertain the wishes of family / whānau for funeral arrangements and any special requirements due to cultural practices. Advise family / whānau cardiac devices (ICDs / pacemakers) will be removed prior to cremation. 8.5 Ensure cultural requirements are maintained 8.6 Family to make arrangements for removal of deceased / tūpāpaku from the facilities. 9. Hospital Requested Post Mortem 9.1 For Perinatal / paediatric post mortem refer to protocol 11. 9.2 Only requested if deceased / tūpāpaku does not come within the jurisdiction of the Coroner 9.3 Family / whanau must consent to hospital requested post mortem 9.4 If the clinician wishes to do an autopsy and there are no next of kin authorisation may be obtained from the Coroner. 10. Body Storage 10.1 If deceased / tūpāpaku is not being released directly to the Funeral Director a staff member should accompany deceased / tūpāpaku to the Body Storage Facility with the : a) The Orderly will obtain a concealment trolley from the Body Storage Facility and take to service area at the back of lifts nearest to the Ward

Issue Date: Nov 2019 Page 1 of 5 NOTE: The electronic version of Review Date: Nov 2022 Version No: 9 this document is the most current. Protocol Steward: Senior Advisor, Authorised by: Medical Director Any printed copy cannot be Governance and Quality assumed to be the current version.

Policy 6.6.1 DEATH OF A PATIENT - CARE FOLLOWING DEATH DEATH OF A PATIENT Protocol 7 PROTOCOL

b) The Orderly will enter the ward and liaise with the nurse to ascertain infectious status. They will also ensure that all curtains are closed on path leading to / from deceased c) The Orderly will collect the concealment trolley and take to location of deceased d) The deceased is placed on the concealment trolley and a Nurse, with 3x patient labels, will accompany the deceased and Orderly to the Body Storage Facility via the lift e) The Orderly will place 1x patient label on each of the following: i. Incoming Body Acceptance form ii. Body Release form iii. Identification toe tag f) The ward nurse is to sign, date and time the appropriate form(s) g) The ward nurse is to check the deceased for any jewellery / personal items which are to be recorded on the Acceptance Form by the ward nurse and are catalogued to either the Nurse or stay with the deceased. h) Coronial Cases: i. if any tubes / lines remain on the deceased these are not to be removed ii. if there are tubes / lines with the deceased these are to remain with the deceased i) When releasing the deceased a Body Release form is to be completed. The Orderly is to check completion and view identification (ID badge number, driver licence etc) of person removing body which is to be recorded on form j) Police / Coroner – refer to above community process for autopsy transfers k) A Police case may turn into a non-Coronial Case at such time as a doctor completes the Medical Certificate of Cause of Death l) Funeral Directors are to collect the deceased immediately once they have been contacted by the family to avoid transfer of the deceased to the Body Storage Facility as this is always the preference for the family 10.2 Notify Māori Health Services if a tūpāpaku is taken to the Body Storage Facility. 10.3 Arrange for family / whānau to view deceased / tūpāpaku in viewing room if required (note family / whanau should be encouraged to view prior to removal to the Body Storage facility). 10.4 Community Deceased a) BOPDHB no longer holds the contract with the Coroner’s office. Community deaths are now sent direct to a new contract holder who will be a designated local funeral director. The hospital will only be used to bring in community deceased when the designated funeral directors have no capacity available. This may be due to a multiple death scenario or major event where there are more deceased than spaces at designated funeral directors. b) Police controller to contact Duty Nurse Manager to request permission to bring in a community deceased case. Duty Nurse Manager MUST agree before the body arrives. c) Funeral Director / Police / Ambulance arrives with the deceased and meet the Orderly and Duty Nurse Manager at the Body Storage Facility d) The Orderly provides an identification toe tag for the person(s) delivering the body to complete the identification details and the Orderly places on the deceased e) An Incoming Body Acceptance form is completed by both the Orderly and the Funeral Director / Police and the Orderly will check the form with the ID toe tag.

Issue Date: Nov 2019 Page 2 of 5 NOTE: The electronic version of Review Date: Nov 2022 Version No: 9 this document is the most current. Protocol Steward: Senior Advisor, Authorised by: Medical Director Any printed copy cannot be Governance and Quality assumed to be the current version.

Policy 6.6.1 DEATH OF A PATIENT - CARE FOLLOWING DEATH DEATH OF A PATIENT Protocol 7 PROTOCOL

f) The Orderly will commence a Body Release Form with the deceased details in preparation for collection g) The deceased is put into storage following placement on a tray awaiting collection h) The Orderly will enter the job details onto the back of the Orderly roster for each Body Storage Facility job completed 10.5 Suspected Homicide a) Subject to section 11.4 a) and b) above, b) Police ask the for the deceased to be placed in padlocked storage c) The padlock and key is located in the Body Storage Facility and is owned by the Police d) When the deceased is placed in padlocked storage the key will be held by Police e) Police will arrange for the deceased to be transferred for a post mortem / autopsy under Police escort and will provide the key to the Orderlies for returning to the Body Storage Facility f) When the deceased is collected by a Funeral Director the key is provided to the Orderlies for returning to the Body Storage Facility 10.6 Identification of Deceased required by Police a) If requested, the Orderly will assist Police with the removal of clothing and personal items b) The Orderly will prepare the deceased for identification i.e. cleaned to a presentable state c) The Orderly is to place the deceased on a post mortem trolley on sheets d) The identification process will be completed in the Body Storage Facility in the presence of Police e) When identification of the deceased has been completed the Orderly will be notified by Police and the deceased placed back in cold storage with a completed form(s) 10.7 Viewings a) Police Cases i. If a viewing of the deceased is requested the Orderlies will liaise with Police to seek viewing authorisation including maximum viewing time and any other conditions that may apply at that event (i.e. supervision) ii. Normal business hours: Orderly to contact the Chaplain and advise of viewing details iii. After Hours: Orderly to contact the Duty Nurse Manager and advise viewing to take place iv. The Orderly will place the deceased on a post mortem trolley with sheets arranged over and around body, and will conceal all visible metal on the trolley v. The Orderly will prepare the deceased to look as presentable as possible. Any severe physical trauma is to be covered using linen vi. The Orderly will prepare the Body Viewing Room. The Orderly will contact other staff to arrange the temporary closure of access ways (ED / Radiology / APU) during the transportation of the deceased to the Body Viewing Room vii. The Orderly will transport the deceased to the Body Viewing Room through corridors, with Police escort if required viii. The Orderly will liaise with family / whanau / friends to advise the deceased is ready for viewing and the time available

Issue Date: Nov 2019 Page 3 of 5 NOTE: The electronic version of Review Date: Nov 2022 Version No: 9 this document is the most current. Protocol Steward: Senior Advisor, Authorised by: Medical Director Any printed copy cannot be Governance and Quality assumed to be the current version.

Policy 6.6.1 DEATH OF A PATIENT - CARE FOLLOWING DEATH DEATH OF A PATIENT Protocol 7 PROTOCOL

ix. When the approved viewing timeframe expires the Orderly will go to the Body Viewing Room to retrieve the deceased. If the family / whanau / friends are still viewing the deceased the Duty Nurse Manager will liaise with family / whanau representative x. Refer to g) above around notification to Orderly staff around deceased transportation requirements xi. The deceased is returned to the Body Storage Facility, with Police escort if required 11. Release of Body to Funeral Director 11.1 Ensure appropriate documentation is available for release of the body (Body Release Form and Statement of Death, Cremation Form). 11.2 Liaise with the Funeral Director to release the deceased / tūpāpaku directly from the ward. 11.3 The Orderly will accompany the Funeral Director to the Body Storage Area 11.4 The Body Release and Body Acceptance forms are completed and signed by both the Orderly and Funeral Director 11.5 The Funeral Director will identify the deceased using the identification toe tag 11.6 The deceased is transferred to the Funeral Director trolley and removed from the BOPDHB facility 11.7 The Orderly will clean down trays and straps and return to their original location 11.8 Body Release Form: 11.9 For Police cases put these onto the Clipboard located in the Orderlies Lodge 11.10 For hospital cases the form is sent to Health Records through the mail for filing on the deceased patient health record 11.11 The Orderly is to enter the job details onto the back of the roster for each Body Storage Facility job completed 12. Release of Body to Family 12.1 When a body is removed from the hospital by the family Bay of Plenty District Health Board (BOPDHB) must provide them with: a) Transfer of Charge of Body form (BDM39) – available from Orderlies / Duty Nurse Manager b) Medical Certificate of Cause of Death (HP4720) or Medical Certificate of Causes of Foetal and Neonatal Death (HP4721). The family is to keep these as evidence that responsibility for the deceased / tūpāpaku was transferred to them. 12.2 When removed from the hospital the deceased/ tūpāpaku must be placed in a coffin or other appropriate container. An appropriate container would be anything that would prevent the leakage of body fluids. 12.3 The family/whānau should be advised of the following as appropriate: a) If the deceased / tūpāpaku is not embalmed it must be buried or cremated within 3 days. b) The deceased / tūpāpaku can only be buried or cremated in a place permitted by law. They can get this information from the local Council. c) If the deceased / tūpāpaku is to be cremated the family must obtain a Permission to Cremate Certificate from the Department of Internal Affairs. d) A stillbirth (a dead foetus weighing less than 400 gm or less than 20 weeks gestation) is registered as a birth only - there is no need to register a death. e) It is the responsibility of the person responsible for the deceased / tūpāpaku to register the death with Births, Deaths and Marriages. This is done by

Issue Date: Nov 2019 Page 4 of 5 NOTE: The electronic version of Review Date: Nov 2022 Version No: 9 this document is the most current. Protocol Steward: Senior Advisor, Authorised by: Medical Director Any printed copy cannot be Governance and Quality assumed to be the current version.

Policy 6.6.1 DEATH OF A PATIENT - CARE FOLLOWING DEATH DEATH OF A PATIENT Protocol 7 PROTOCOL

completing a Notification of Death for Registration from (BSM28) which can be obtained from:  Birth, Deaths, Marriages and Relationships P O Box 10-526 Wellington 6143; or  Department of Internal Affairs website. f) Notification of death must be done within three (3) days of burial or cremation. 13. Health Record Documentation 13.1 Enter time of death on Last Days Care Plan, if used, or patient’s health record, then assemble notes as for discharge. 13.2 Discharge on computer. 13.3 Pronounce the patient deceased and write this in the Last Days Care Plan, if used, or patient’s health record. 13.4 Request medical staff to complete Medical Certificate of Cause of Death (HP4720). 13.5 Request medical staff to complete Certificate of Medical Practitioner (Form B for cremation only). 13.6 Discharge summary to be completed by medical staff. 13.7 Send patient’s health record for coding following completion of discharge summary by medical staff. 13.8 Ensure Record of Death Form (FM.D1.4) is completed electronically and emailed as either “Coronial” or “Non Coronial”.

ASSOCIATED DOCUMENTS  Bay of Plenty District Health Board 6.6.1 Death of a Patient controlled documents  Bay of Plenty District Health Board policy 6.3.9 Body Parts and Tissues  Bay of Plenty District Health Board policy 1.1.1  Bay of Plenty District Health Board policy 1.4.4 Māori Cultural Safety  Bay of Plenty District Health Board policy 2.1.4 Incident Management  Bay of Plenty District Health Board policy 2.5.1 Health Information Privacy  Bay of Plenty District Health Board Last Days Care Plan (8141) – link viewable only - to be ordered from Design & Print Centre

Issue Date: Nov 2019 Page 5 of 5 NOTE: The electronic version of Review Date: Nov 2022 Version No: 9 this document is the most current. Protocol Steward: Senior Advisor, Authorised by: Medical Director Any printed copy cannot be Governance and Quality assumed to be the current version.