Last Offices Care of the Deceased UHL Policy
Approved by: Policy & Guideline Committee Date Approved: 13 August 2010 Trust Reference: B28/2010 Version: 4 – PGC 3 June 2016 Supersedes: V3 Author / Jeanette Halborg Head of Nursing Clinical Originator(s): Support and Imaging Mark Burleigh Head Of Chaplaincy and Bereavement Services Name of Responsible Last Offices Care of the Deceased Patient Policy Committee/Individual: Task and Finish Group/End of Life and Palliative Care Committee Latest Review Date 3 June 2016 Next Review Date: May 2022 – Review Date Extension Approved at PGC 21.05.2021 CONTENTS
Section Page 1 Introduction 3 2 Policy Aims 3 3 Policy Scope 3 4 Definitions 3 5 Roles and Responsibilities 4 6 Policy Statements, Standards, Procedures, Processes and Associated 5 Documents 7 Education and Training 5 8 Process for Monitoring Compliance 5 9 Equality Impact Assessment 6 10 Legal Liability 6 11 Supporting References, Evidence Base and Related Policies 6 12 Process for Version Control, Document Archiving and Review 7
Appendices Page One Declaring life extinct 10 Two Actions to be taken for suspicious death 12 Three Review referral to and contact with H.M. Coroner 14 Four Communication with the family 20 Five Post-mortem examination/taking tissue samples after death 25 Six Removal of Endotracheal Tubes (ET) 30 Seven Preparation of the deceased adult (“Last Offices”) 31 Eight Preparation of the deceased child (“Last Offices”) 38 Nine Transfer to the mortuary 46 Ten Risk of infection and use of body bags 54 Eleven Cultural and religious requirements 58
REVIEW DATES AND DETAILS OF CHANGES MADE DURING THE REVIEW V4 - review of V3 in May 2016, reformatted into latest Trust template. Complete Re- write of policy monitoring table, Appendix 2, Appendix 3 section 5.3,5.4,5.5, Appendix 4 update of clinical names in Responsibility Section 1.2, section all reference to Interserve and Directorates removed. V3 – review of Version 2 December 2013, reformatted into latest Trust template, appendix 5 added in and no longer a standalone document (Taking Samples after Death/Removal of ET Tubes Trust reference (B51/2009). V2 – review of V1 in August 2010, complete re-write and reformatted into latest Trust template. Approved by the Policy and Guideline Committee on 13th August 2010 and issued new Trust reference number (B28/2010).
Last Offices Care of the Deceased Patient UHL Policy Page 2 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents V1 approved by the Policy and Guideline Committee on 7th August 2006 as Last Offices Policy – Trust reference B36/2006.
KEY WORDS Last Offices, End of Life, Deceased. 1 INTRODUCTION 1.1 This document sets out the University Hospitals of Leicester (UHL) NHS Trusts Policy and Procedures for care of the patient who has died (deceased patient) from the point of death until arrival in the Mortuary. 1.2 The policy also outlines the procedures that enable respectful and dignified care compliant with regulatory guidance and statutory legislation.
2 POLICY AIMS The aim of this policy is to guide staff through the processes relevant to care of the deceased patient and their relatives to be used in conjunction with the attached appendices.
3 POLICY SCOPE 3.1 The policy covers all three hospital sites within University Hospitals of Leicester NHS Trust (UHL), applies to all staff groups and applies to all deceased patients (adult and children). 3.2 For maternal deaths within UHL, please see “Maternal Death: Guidelines for the Management of Maternal Death, C2/2007”. 3.3 This policy does not apply to St Mary’s Birth Centre. 3.4 This policy does not cover the care of the non-viable foetus, stillborn baby or Neonatal death within Maternity or Neonatal services; please see following Documents for further information and advice: Policy for the Sensitive Disposal of Foetal Remains, Trust ref: B3/2007 Certification of Stillbirth and Neonatal Deaths on Labour Ward, Trust ref: C33/2010. Support for Women and Families Where the Outcome for the New-born Baby is Poor or Suspected to be Poor, Trust ref: C23/2011.
4 DEFINITIONS
Last Offices: The term last offices relates to the care given to a body after death.
Last Offices Care of the Deceased Patient UHL Policy Page 3 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 5 ROLES AND RESPONSIBILITIES
5.1 Chief Nurse – Executive Lead for this policy Responsible for informing the Trust Board of changes in practice and relevant information.
5.2 Registered Medical Staff Responsible for examining the deceased patient, declaring and documenting that life is extinct and assessing whether referral to H.M. Coroner is required.
Responsible for completing the appropriate Medical Certificate for Cause of Death for non-coronial cases.
5.3 Registered Nursing and Midwifery Staff Are responsible for preparation of the deceased patient, completion of the Notification of Death Form, ensuring availability of personal protective clothing on the ward, initiating transfer to the mortuary, recording the date and time of release of the deceased from the ward, informing portering and mortuary staff of manual handling/infection/other known risks and providing support for the bereaved.
5.4 Care Assistants Under the supervision/instruction of a registered nurse or midwife may prepare the deceased patient for transfer to the Mortuary; management of the deceased’s property in accordance with the “Management of Patient Property Policy and Procedures”(B24/2007).
5.5 Portering Staff Sole responsibility for the transfer of the deceased, maintaining the safety, dignity and care of the deceased whilst in transit, as well as cleaning and disinfecting equipment after use.
5.6 Ward Clerks Responsible for transferring the deceased patient’s case notes to Bereavement Services office; management of the deceased’s property in accordance with the “Management of Patient Property Policy and Procedures” Trust ref: B24/2007.
5.7 Duty Managers Responsible for the identification and administration at the point of release out of hours, under the “Policy for the Handling and Release of the Deceased and Products of Conception Outside of Normal Hours” and “Policy and Procedures for the Urgent Certification and Release of Deceased Outside of Normal Working Hours”. Inform Line Manager/Duty Manager immediately and follow their instructions. Duty Manager can be contacted by Switchboard.
5.8 Mortuary Department Staff Responsible for the provision of personal protective equipment in the mortuary, disinfectant and spill kits for their use.
Last Offices Care of the Deceased Patient UHL Policy Page 4 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 5.9 Bereavement Services Responsible for the revision and printing of Notification of Death forms and the "Helpful Information Following a Death" booklet. Responsible for liaising with families in office hours regarding the viewing of the deceased.
5.10 Medical Examiners (Where Medical Examiners are in post) Responsible for the provision of advice on whether or not a death should be referred to the H.M. Coroner. Responsible for the provision of advice on how a death should be certified (e.g. how the Medical Certificate of the Cause of Death should be completed).
Responsible for advising the appropriate team when review of a death is likely to provide information of relevance to the quality of healthcare provided during life.
5.11 UHL Facilities Responsible for the provision of manual handling training for portering staff, provision and maintenance of portering equipment.
6 POLICY STATEMENTS This policy is supported by the following procedures and all staff must follow these when caring for the deceased patient.
Procedure / Process / Standard Appendix Declaring Life Extinct Appendix One Actions to be taken for Suspicious Death Appendix Two Review Referral to and Contact with H.M. Coroner Appendix Three Communication with the Family Appendix Four Post-Mortem Examination/Taking Tissue Samples After Death Appendix Five Removal of Endotracheal Tubes (ET) Appendix Six Preparation of the Deceased Adult (“Last Offices”) Appendix Seven Preparation of the Deceased Child (“Last Offices”) Appendix Eight Transfer to the Mortuary Appendix Nine Risk of Infection and Use of Body Bags Appendix Ten Cultural and Religious Requirements Appendix Eleven
7 EDUCATION AND TRAINING REQUIREMENTS
7.1 Any education and training requirements regarding this policy should be identified to the Line Manager through the appraisal process and addressed in the individual’s personal development plan.
7.2 How to perform last offices is included in the Health Care Assistant induction programme.
8 PROCESS FOR MONITORING COMPLIANCE 8.1 Key Performance Indicators/Audit Standards
Last Offices Care of the Deceased Patient UHL Policy Page 5 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 9 EQUALITY IMPACT ASSESSMENT If the policy will have any impact on equality, this should be described here. Otherwise the statements below should be inserted (see section 6.6 of the UHL Policy for Policies for more detail): 9.1 The Trust recognises the diversity of the local community it serves. Our aim therefore is to provide a safe environment free from discrimination and treat all individuals fairly with dignity and appropriately according to their needs. 9.2 As part of its development, this policy and its impact on equality have been reviewed and no detriment was identified. 10 LEGAL LIABILITY
The Trust as an employer will assume vicarious liability for the acts of its staff, including those on honorary contracts, providing that:
• Staff have undergone any suitable training identified as necessary under the terms of this policy or otherwise • Staff have been fully authorised by their Line Manager and their Directorate to undertake the activity • Staff fully comply with the terms of any relevant policies and/or procedures at all times • Only depart from any relevant Trust Guidelines providing that such departure is confined to the specific needs of individual circumstances. in healthcare delivery, such departure shall only be undertaken where, in the judgement of the responsible Clinician it is fully appropriate and justifiable – such decision to be fully recorded in the patient’s notes.
Staff are recommended to have Professional Indemnity Insurance cover in place for their own protection in respect of those circumstances where the Trust does not automatically assume vicarious liability and where Trust support is not generally available. These circumstances will include, but are not limited to, those situations where the above criteria do not apply or are not observed, private treatment (which may include Samaritan Acts) and criminal investigations. Suitable Professional Indemnity Insurance Cover is generally available from the various Royal Colleges and Professional Institutions and Bodies. For further information, contact Assistant Director (Head of Legal Services) on extension: 8960. 11 SUPPORTING REFERENCES, EVIDENCE BASE AND RELATED POLICIES 11.1 Related Policies Certification of Stillbirth and Neonatal Deaths on Labour Ward, Trust reference: C33/2010. Consent to Post Mortem Examination Policy, Trust reference: B9/2010 Guidelines Following a Death of a Child, Trust reference: C40/2006 Maternal Death: Guidelines for the Management of Maternal Death, Trust reference: C2/2007 Management of Patient Property, Trust reference: B24/2007 Policy for Organ and Tissue Donation, Trust reference: B4/2012 Policy and Procedures for the Urgent Certification and Release of the Deceased Outside Normal Hours, Trust reference: B12/2013
Last Offices Care of the Deceased Patient UHL Policy Page 6 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents Policy for the Handling and Release of the Deceased and Products of Conception Outside Normal Hours, Trust reference: B23/2010 Policy for the Sensitive Disposal of Foetal Remains, Trust reference: B3/2007 Sudden Unexpected Death in Infancy/Childhood Protocol, Trust reference: C94/2006 Support for Women and Families Where Outcome for the New-born Baby is Poor or Suspected to be Poor, Trust reference: C23/2011
11.2 Useful Links Muslim Burial Council of Leicestershire http://www.mbcol.org.uk
Undertakers of Leicestershire http://www.uk-funerals.co.uk/funeral-directors/leicestershire.html
11.3 Contact Telephone Numbers *H.M. Coroner for Leicester and South Leicestershire 0116 4541030 *H.M. Coroner for North Leicestershire and Rutland 0116 3057732 (*normal working hours only)
Muslim Burial Council of Leicester (MBCoL) Salim Mangera: 07833 533490 Out of Hours Funeral Co-ordinator Contact No: 07803 240493 Adam Sabat: 07801 101786
Orthodox Jewish Community Rabbi Shmuel Pink Contact via Hospital Switchboard
12 PROCESS FOR VERSION CONTROL, DOCUMENT ARCHIVING AND REVIEW This document will be uploaded onto SharePoint and available for access by Staff through INsite. It will be stored and archived through this system. The policy was first approved in 2006 and has been reviewed by a multi-professional group consisting of representatives from UHL Nursing and Midwifery, Head of Chaplaincy, Bereavement Services, Mortuary, Pathology and Portering. The “Last Offices” review group will be responsible for reviewing the policy at regular intervals, six months after approval initially and then no more than three years apart (or earlier in response to changes in National guidelines). Progress will be reported through the UHL End of Life Board. The contributors to the Last Offices Review Group include, in alphabetical order, the following: Bereavement Services & Chaplaincy End of Life and Palliative Care Committee Head of Nursing, Clinical Support, Imaging, EMPATH Infection Control Medical Staff as listed in this policy Mortuary Nursing Education team Pathology Portering
This document will be uploaded onto the Policy and Guideline Library (PAGL) on INsite and archived through this system.
Last Offices Care of the Deceased Patient UHL Policy Page 7 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents POLICY MONITORING TABLE
Element to be Lead Tool Frequency Reporting arrangements Lead(s) for acting Change in practice and monitored on lessons to be shared recommendations Turnaround times of Mortuary Database Monthly Reported at CSI and Matthew Rogers residency within the Manager DATIX/Serious monitoring and EMPATH Quality & Safety Mortuary Manager mortuary Incidents/Complaints presentation at Committee. Meeting minutes CMG Quality & are submitted to HTA and Safety meeting Clinical Pathology Association Turnaround times for Mortuary Database Monthly Reported at CSI and Matthew Rogers post-mortem for Manager DATIX/Serious monitoring and EMPATH Quality & Safety Mortuary Manager H.M. Coroners and Incidents/Complaints presentation at Committee. Meeting minutes hospital CMG Quality & are submitted to HTA and Safety meeting Clinical Pathology Association To audit compliance Mortuary Database Monthly Audit results will be Matthew Rogers with this policy the Manager DATIX/Serious monitoring presented on a regular basis Mortuary Manager Mortuary Manager Incidents/Complaints to the Mortuary Management will undertake a team and escalated through monthly audit of the EMPATH and CSI Quality & reception and Safety Committee identification of the deceased patient To audit compliance Porters/Director Notification of Death Daily monitoring Reports to be generated Hannah Small - with turnaround of Estates and forms/DATIX though PLANIT system as Deputy Logistics times of Porter Facilities required or requested Manager request to collect through the End of Life and deceased to transfer Palliative Care Committee to the mortuary Covers on mortuary Mortuary/ Observation Daily monitoring To be escalated to Head of Hannah Small - trolleys Portering Portering Services Deputy Logistics Services Manager
Last Offices and Care of the Deceased Patient Policy Page 8 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents The deceased Mortuary Database Monthly Audit results will be Matthew Rogers patient will be Manager DATIX/Serious monitoring presented on a regular basis Mortuary Manager identified correctly; Incidents/Complaints to the Mortuary Management the Notification of Notification of Death team and escalated through Death form forms EMPATH and CSI Quality & completed Safety Committee accurately and transfer to the Mortuary will be appropriate.
Last Offices and Care of the Deceased Patient Policy Page 9 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents DECLARING LIFE EXTINCT
APPENDIX ONE
Last Offices and Care of the Deceased Patient Policy
1. Declaring Life Extinct:
1.1 Verification of death must take place prior to the transfer of the deceased patient to the mortuary.
1.2 Declaring Life Extinct is a clinical process sometimes known as ‘verifying death’ rather than a legal one. Any member of medical staff may assess the patient for signs of life and declare that the patient has died.
1.3 Procedure: a) Systematically assess the patient for signs of life: - Check the patient does not respond to painful stimuli - Check there is no cardiac output • Palpate carotid or femoral pulse for a minimum of one minute • Use a stethoscope for a minimum of one minute to ensure there are no heart sounds present - Check the absence of respiratory effort • Looking and feeling for the rise and fall of the chest, at the same time listening for any signs of respiration for a minimum of one minute • Checking there a no breath sounds present by listening with a stethoscope for a minimum of one minute - Check both pupils are fixed, dilated and unresponsive - Check both pupils for no reaction to light with a torch b) Document time of death in patient’s case notes c) Confirmation of verification of death must also be noted on the verification of death form
Last Offices Care of the Deceased Patient Policy Page 10 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 2. Assessing whether a death is suspicious:
2.1 Death is considered to be suspicious where a person’s death is not anticipated or when a body is found and it is immediately apparent that something untoward has occurred to bring about that person’s demise, whether accidental, self-inflicted, inflicted by others, or medically unaccountable.
2.2 Suspicious deaths will normally need to be referred to the H.M. Coroner for investigation. If there is any doubt as to whether referral to the H.M. Coroner is justified or not, advice should be sought in the first instance from the duty Medical Examiner. The name and telephone number of the duty Medical Examiner is available from the Bereavement Office or from Switchboard.
2.3 In these cases, the scene must be managed carefully to preserve evidence and senior Trust staff informed immediately (Line Manager and Duty Manager). Detailed procedures are listed below:
3. Actions to be taken for suspicious death - see APPENDIX TWO
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Last Offices and Care of the Deceased Patient Policy
1. What should be done?
a) Immediately call the Crash Team and commence resuscitation. If resuscitation is not successful:
b) DO NOT TOUCH ANYTHING. Do not touch anything on the body, the surrounding area or personal effects. If there is any evidence of drug abuse, do not touch or move the evidence. If the Crash Trolley is not implicated in the incident, it may be removed and restocked.
c) Screen off the area, wherever possible, to maintain the dignity of the deceased patient.
d) Inform Line Manager/Duty Manager immediately and follow their instructions. Duty Manager can be contacted via Switchboard.
e) ALL equipment must be kept in situ. This includes intravenous lines, central lines, arterial lines, catheters, chest drains and any disposable equipment. A list of all equipment present at the time of death must be completed and filed in the case notes.
f) DO NOT PERFORM LAST OFFICES; do not wash the deceased, change their clothes or bed linen.
g) The deceased patient may be collected by H.M. Coroner’s removal service. If this does not happen the Line Manager/Duty Manager will authorise transfer to the Mortuary; place the deceased patient in a body bag and document clearly on the Notification of Death Form that this was a suspicious death.
h) Preserve the scene of death until authorised to clear it by the Line Manager/Duty Manager or Police even after the deceased patient has been transferred to the Mortuary.
Last Offices Care of the Deceased Patient Policy Page 12 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 2. Who should be informed?
a) It is not the remit of frontline staff to report such incidents to external agencies (including, but not limited to the police); this responsibility shall be reserved to senior management dependent on the nature of the incident.
b) Inform patient’s Consultant immediately, if deceased was an in- patient.
c) Appropriate manager(s) within the department.
d) Next of Kin/Relatives should be informed and supported (see “Communication with the Family”). Communication with the next of Kin/relatives should be (in hours) via the Clinical Management Group Head of Nursing and the Clinical Director (out of hours) via the Director on-call. It is important to be clear about the procedures and further investigations that are conducted in suspicious circumstances.
e) Immediate reporting to the Corporate Safety Team and Duty Manager within normal working hours. Outside of normal working hours, the Duty Manager will cascade this information as appropriate to the on-call Managers and Director on-call, who will ensure that the H.M. Coroner is informed by the Clinicians at the appropriate time.
f) The Corporate Safety Team will ensure that other interested parties external to the Trust are informed, as appropriate. Suspicious deaths will normally need to be referred to the H.M. Coroner for investigation. If there is any doubt as to whether referral to the H.M. Coroner is justified or not, advice should be sought in the first instance from the duty Medical Examiner. The name and telephone number of the duty Medical Examiner is available from the Bereavement Office or from Switchboard.
g) If the deceased patient is below the age of 18 years, the Safeguarding Team must be informed via Switchboard immediately.
Last Offices Care of the Deceased Patient Policy Page 13 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents REVIEW REFERRAL TO AND CONTACT WITH H.M. CORONER APPENDIX THREE
Last Offices and Care of the Deceased Patient Policy
1. Referral to H.M. Coroner
If the patient dies out of hours, but there is no need for urgent release, the H.M. Coroner should be contacted the next working day as normal.
The only circumstances when the H.M. Coroner should be contacted out of hours is if a patient dies out of hours and there is a requirement for urgent certification and release of the deceased (refer to section 3).
3.1 Urgent Certification and Release of Deceased Out of Hours 3.2 Child Death 3.3 Organ Donation
2. Reporting Deaths
If there is any doubt as to whether referral to the H.M. Coroner is justified or not, advice should be sought in the first instance from the duty Medical Examiner. The name and telephone number of the duty Medical Examiner, if available, is available from the Bereavement Office or from Switchboard.
In the absence of advice from a Medical Examiner, deaths should be reported to H.M. Coroner if any of the following apply: -
2.1 The deceased was not attended by a Registered Medical Practitioner during their last illness.
2.2 The deceased was not attended by a Registered Medical Practitioner immediately after death or within 14 days preceding death.
2.3 The death is sudden, unexplained, violent and unnatural or attended by suspicious circumstances.
2.4 The cause of death is unknown, or if there is any doubt regarding the cause of death.
2.5 The deceased is a child in foster care.
Last Offices Care of the Deceased Patient Policy Page 14 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 2.6 The death occurred in the following circumstances:
a) After an operation of invasive procedure necessitated by injury or disease within the preceding 12 months.
b) During an operation.
c) Before recovery from the effects of any anaesthetics.
d) The death may be related to a medical procedure or treatment whether invasive or not.
2.7 When it is believed there is a possibility the death was due to neglect, ill- treatment, self-neglect or abortion.
2.8 Still birth where there was any possibility of the child being born alive.
2.9 The deceased was detained under the Mental Health Act.
2.10 Where it is believed the death is due to any kind of poisoning including alcohol, drugs either taken in therapy, in addiction, in suicide or accidently.
2.11 When death occurs either directly or indirectly, following an injury or accident, including those associated with road traffic accidents of any date. Injuries may include burns, scalds, choking or other effects of foreign bodies, suffocation, concussion, wounds, drowning and effects of heat or cold, sunstroke, lightning, fractures, electricity, electric shock.
2.12 The deceased is a person detained in prison or in any other place of detention or a person who has recently been in police custody.
2.13 The deceased was in receipt of a disability pension/war pension.
2.14 When the death is believed to be due to an industrial injury, conditions associated with service in H.M. Forces, or due to actual or suspected industrial diseased or industrial poisonings as detailed below: -
a) Diseases of the Lungs: - • Any form of Pneumoconiosis, Asbestosis and Mesothelioma, Beryliosis.
Last Offices Care of the Deceased Patient Policy Page 15 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents • Any Lung Disease qualified by an occupational term (e.g. Farmers Lung). b) Other Diseases if Occupationally Related e.g. • Any form of barotrauma, Weils disease, hepatitis B or C, Anthrax • Malignancy related to any form of industrial exposure • Any form of industrial toxicity or poisoning.
2.15 At the request of the H.M. Coroner for Leicester and South Leicestershire, certain treatment-related infections, which are considered to have caused or contributed to death must be referred to H.M. Coroner for Leicester and South Leicestershire. In most cases, there will be no requirement for an autopsy, but the final decision rests with the H.M. Coroner.
The following types of cases should be referred:
• Within 24 hours of admission to hospital • Deaths due to hospital acquired Clostridium Difficile infection • Deaths due to hospital acquired MRSA infection • Deaths due to infection following iatrogenic neutropenia • Deaths due to infection following immunosuppressive therapy for transplantation autoimmune or other disease. • Deaths due to infection of any indwelling medical equipment • Any other case where medical treatment may have contributed to the development of a fatal infection. • Signs of life before 24 weeks of pregnancy – discussion of these cases with the UHL legal team and H.M. Coroner is advised. • Where a fall has taken place in the 12 months prior to the death.
2.16 Any maternal death should also be referred to the H.M. Coroner, but in many cases a Medical Certificate of Cause of Death may be written and no post mortem will be requested.
The Senior Coroner in Leicester has indicated that a trained Medical Examiner may authorise the certification of death as being due to natural causes in some of the above circumstances principally in relation to paragraphs 2.6(a). 2.6(d) and 2.15, where the Medical Examiner is satisfied that death is entirely due to natural causes. In such cases, a discussion between the certifying doctor and the Medical Examiner is essential. That discussion must be documented and the Registrar of Deaths must
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A Medical Examiner should also be consulted in case where there is ‘any doubt as to the cause of death’ (paragraph 2.4 above) or where there is any doubt as to how the Medical Certificate of the Cause of Death should be completed.
The duty Medical Examiner, if available, can be contacted by telephone, the phone number of the current duty Medical Examiner can be obtained from the Bereavement Office or from Switchboard.
The H.M. Coroner’s Office can be contacted by telephone on 0116 454 1030. DO NOT contact the H.M. Coroner’s office for advice on whether referral is needed unless it has been proved impossible to contact a Medical Examiner within a reasonable time.
3. Out of Hours Contact with the H.M. Coroner
H.M. Coroner has provided guidance for medical staff on Out of Hours contact with the H.M. Coroner that has been agreed with the Medical Director (August 2010).
3.1 Certification and Urgent Release of Deceased Out of Hours
Medical staff should NOT attempt to make contact with the H.M. Coroner in respect of body release. Medical staff should contact the Duty Manager for advice and where appropriate any initial contact MUST be made by the Duty Manager. Where a Duty Manager is busy this does not mean that medical staff are thereby at liberty to contact the H.M. Coroner.
It is accepted that medical staff may come under pressure to contact the H.M. Coroner from the families of deceased. However, the H.M. Coroner has clearly stated what they require of use and that the medical staff need to be very clear with families that University Hospitals of Leicester NHS Trust will adhere to the H.M. Coroner’s requirements.
Last Offices Care of the Deceased Patient Policy Page 17 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents Only the Duty Manager may contact the H.M. Coroner and in deciding whether to make contact the Duty Manager shall consider the following stipulations laid down by the H.M. Coroner: -
a) If the urgent release of the body of a decease patient is required out of normal working hours where the doctor believes that the death requires referral to the H.M. Coroner, contact with the H.M. Coroner can be made via the UHL Duty Manager ONLY. The H.M. Coroner can be contacted by the Duty Manager at the following times only: - • Out of Hours Weekdays between the hours of 4pm and 9pm • Weekends and Bank Holidays between the hours of 8am and 9pm
There are no exceptions to this rule irrespective of the personal beliefs or age of the deceased.
b) If, following an out-of-hours consultation with the Duty Manager, the H.M. Coroner agrees that the Medical Certificate of Cause of Death can be issued by a doctor, the doctor will be asked to provide contact details of the deceased’s next of kin. This is so that the H.M. Coroner can confirm the next of kin that they are satisfied with the cause of death before the paperwork is issued (Pink A) to the Leicester Registrar. A death cannot be registered until the H.M. Coroner’s form has been received by the Leicester Registrar.
c) If the patient dies out of hours, but there is no need for the urgent release, the H.M. Coroner should be contacted the next working day as normal.
d) If the deceased was in custody or was detained under the Mental Health Act, or DoLS the body cannot be released and the police must be informed via the Duty Manager.
3.2 Child Death
If a child dies in hospital and medical staff want to seek advice on how to proceed on matters other than body release (e.g. removal of tubes etc.) then contact can be made with the H.M. Coroner at the same times stipulated for Certification and Release of Deceased Out of Hours e.g.
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Medical staff should contact the Duty Manager to obtain the H.M. Coroner’s contact details.
3.3 Organ Donation
Please refer to the “Policy for Organ and Tissue Donation”.
Anyone requiring further information on this should contact Professor Jonathan Thompson, UHL Clinical Lead for Organ Donation.
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APPENDIX FOUR
Last Offices and Care of the Deceased Patient Policy
1. Introduction
1.1 Relatives often remember the way in which the news of the death of a loved one was broken to them. The way that the news was given and subsequent actions may influence the bereavement process.
1.2 Breaking bad news over the telephone is never easy, but sometimes it is unavoidable. It is important to tell the truth when giving such sensitive information over the phone and try and support that person as much as possible.
2. Breaking Bad News
2.1 Prior to informing the next of kin that a patient has died, it is essential to confirm the correct information e.g. that the correct patient and their relatives are identified.
2.2 For those patients on having palliative/end of life care, it should already be established how the next of kin wish to be contacted during the night. Therefore, breaking bad news should be expected.
2.3 In circumstances of sudden death, informing the next of kin that an accident or sudden illness has occurred and requesting their presence at the hospital can be justified. The intention is to prevent harm and maximise benefit by imparting news in a supportive environment. It may be more appropriate to involve the Police, if not already involved, and ask them to visit the next of kin.
2.4 Where the death of an inpatient takes place outside of the ward area the breaking of bad news should be undertaken by the ward clinical team.
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3.1 Consider the following before making the decision to break bad news over the telephone:
a) Whether it is appropriate to break bad news over the telephone. b) Whether you are the most appropriate person to deliver this news. c) What knowledge the next of kin/bereaved may have about the patient’s condition prior to death. d) When that person last saw the patient. e) The age and health of the person. f) How far the next of kin may have to travel to reach the hospital. g) Communication barriers; speech, hearing or language. h) Whether they wanted to be contacted over the telephone or during the night/have any previous discussions taken place?
3.2 Once the decision has been made to break the bad news over the telephone:
a) It is essential to confirm the correct information, e.g. that the correct patient and their relatives are identified. b) Do not imply or state that the patient is alive at the time of the call if they are not, as omitting truth or facts may later appear suspicious. c) Make sure you will not be disturbed or interrupted when making the call. d) Check their location and whether they are alone. If they are alone, staff must take this into account when breaking bad news. e) State who you are when calling and whether you have met or spoken to them previously. f) Acknowledge the difficulty of having this conversation over the phone as this will reduce the negative impact and serve as a warning shot. g) Be direct and clear with the information you give. Confirm that death has occurred – use the words ‘is dead’ or ‘has died’.
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4. Care of the Deceased Patient’s Family
The experiences of those grieving can very much affect the grieving process in the short and long term. The response of relatives and important others are not always going to be the same and may vary significantly. It is important that staff respect and are sensitive to the grief response of relatives and important others.
4.1 It is essential that a lead is taken from the family with regards to their needs. They may have religious or cultural needs that they wish to demonstrate, even if the patient does not have a religion recorded. They may ask to see a member of the chaplaincy or ask to contact a specific person. It is appropriate to ask if they wish anyone else to be contacted.
4.2 In each circumstance, where possible privacy should be offered.
4.3 Family and important others may not wish to see the deceased.
4.4 Family may wish to speak to a Doctor or ask questions regarding the time before the patient’s death e.g. ‘who was with them’ and ‘were they in pain’.
4.5 Do not use medical language. At such times a lot of information is not absorbed by relatives and it may be necessary to reiterate the information or give them written information.
4.6 Family members should not be rushed to leave the ward and refreshments should be offered.
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4.8 The family should be advised to contact Bereavement Services using the numbers in the ‘Helpful Information Following a Death’ booklet on the next working day. The Bereavement Services staff will take their details and advise them on the next steps for the death certification procedure. DO NOT advise the family on how long it may take for the Medical Certificate of the Cause of Death (MCCD) to be completed.
5. Viewings
5.1 No viewings may take place on the ward, other than in the following circumstances:
• Within the Maternity Unit(s) where the condition of the mother may prevent her from attending the mortuary. In this situation, a midwife or nurse may accompany the porter to the mortuary to transport the baby back to the Maternity Unit for viewing. Please refer to Appendix Seven “Transfer to the Mortuary”.
• When the patient has just died and the family are en-route to the hospital discretion is permitted to allow sensitivity to the needs of the patient’s family, bearing in mind that the deceased patient should ideally be transferred to the mortuary within 4 hours of death (see Appendix Six on “Preparation of the Deceased Adult/Child (Last Offices)”.
5.2 The use of the mortuaries viewing facilities will be dependent on availability. Bereavement Services or the hospital/Duty Manager will establish availability with mortuary staff before confirming the viewing to the relatives.
5.3 Requests for viewing outside of normal working hours must be referred to the Duty Manager. Preparation of the deceased patient for viewings is not part of the porter’s duties and nursing staff must forward requests for viewings through the Duty Manager.
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5.5 See Flow Chart below for requests for identifications and viewings within the mortuaries at UHL.
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1. Taking Samples After Death When Not Part of a Post Mortem Examination
1.1 The Human Tissue Act (2004 – HT Act) governs post mortem activity, including any tissue samples that are taken after death.
1.2 The HT Act defines this as any sample which may contain cells (including urine), and therefore includes every possible sample which may be taken. Locks of hair are not covered by the HT Act.
1.3 The HT Act is enforced by the Human Tissue Authority (HTA) and failure to comply can result in withdrawal of HTA licence, a fine and up to three years imprisonment.
1.4 At UHL, the situation is that:
1.4.1 NO sample can be taken after death without explicit consent from a close relative usually the next of kin. 1.4.2 Samples can only be taken on premises with HTA Pathology License. 1.4.3 Individuals taking such samples must be trained to do so: this would usually be medical staff, but could include Nurses and Midwives. 1.4.4 Samples can only be used for the purpose specified (usually diagnosis of disease or identification of genetic abnormalities).
1.5 Such tissue samples will almost always be taken as part of a formal post mortem examination (see UHL Policy for Post Mortems). However, on rare occasions such samples may be required out with a post mortem examination. This would usually occur when a patient dies unexpectedly, or dies before important diagnostic samples can be taken, and where delaying the taking of the sample until a post mortem can be organised may reduce the chance of a useful result (e.g. cytogenetics). This would
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1.6.1 The mortuaries at Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. 1.6.2 Emergency Department, Leicester Royal Infirmary 1.6.3 Children’s Intensive Care Unit, Leicester Royal Infirmary 1.6.4 Paediatric Intensive Care Unit, Glenfield Hospital 1.6.5 Labour Wards, Leicester Royal Infirmary and Leicester General Hospital 1.6.6 Neonatal Units, Leicester Royal Infirmary and Leicester General Hospital
1.7 No samples are to be taken after death in areas that are not specified on the HTA Pathology Licence, as listed in 14.6.
1.7.1 If samples may be required to be taken in patients who die in other areas, the body must be moved to the mortuary before any sample can be taken and the duty Mortuary Technician should be called.
1.8 The procedure for taking samples after death out with post mortem examination is listed below.
2. Procedure for Taking Samples after Death without Post Mortem Examination.
2.1 Wherever possible important diagnostic samples to be taken before death.
2.2 If the deceased patient is likely to require a post mortem, then samples should be taken during the post mortem.
2.3 If the clinical team believes that a sample should be taken immediately after death and post mortem is not required or it is believed that waiting for a post mortem may jeopardise the value of a sample (e.g. cytogenetics) then samples can be taken after death.
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2.4 Samples can only be taken in areas specified on the HTA Pathology Licence, which are as follows:
2.4.1 The mortuaries at the Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital 2.4.2 Emergency Department, Leicester Royal Infirmary 2.4.3 Children’s Intensive Care Unit, Leicester Royal Infirmary 2.4.4 Paediatrics Intensive Care Unit, Glenfield Hospital 2.4.5 Labour Wards, Leicester Royal Infirmary and Leicester General Hospital 2.4.6 Neonatal Units, Leicester Royal Infirmary and Leicester General Hospital
2.5 If there is any doubt over the need for a sample then the advice should be sought from a senior member of the clinical team or one of the individuals named under ‘responsibility’ on the next page.
3. Consent
3.1 Consent must be based on an understanding of what the procedure involves; this applies to those seeking consent, as well as to those giving it. 3.2 Discussion must be face-to-face if possible, so that all necessary issues and questions are addressed and all parties are clear about what is agreed. A comfortable, private room should be used. 3.3 When discussing the PM examination or retention of tissue, some relatives may wish to know in considerable detail what will be done to the body, organs or tissue. In such cases the procedure should be explained with careful use of language, but honestly and fully. Others will not want as much or even any detail, and this should be respected; however, sufficient information should be provided to ensure that valid consent is in place. 3.4 At the end of the meeting, relatives should be provided with a record of the discussion and of the agreement reached. Please see attached link
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3.5 Consent must be fully informed
3.6 Consent will usually be given by the parent or guardian and should be documented on either:
3.6.1 Post mortem consent form 3.6.2 Treatment consent form
3.7 In the context of a coronial post mortem, consent is given by the H.M. Coroner.
3.8 The HT Act provides a detailed hierarchy on who can give valid consent:
3.8.1 Spouse or partner (including civil or same sex partner). The HT Act states that, for these purposes, a person is another person’s partner if the two of them (whether of different sexes or the same sex) live as partners in an enduring family relationship. 3.8.2 Parent or child (in this context a child may be of any age and means a biological or adopted child). 3.8.3 Brother or sister 3.8.4 Grandparent or grandchild 3.8.5 Niece or nephew 3.8.6 Stepfather or stepmother 3.8.7 Half-brother or half-sister 3.8.8 Friend of long standing
3.9 An individual lower in the hierarchy cannot over-rule consent of someone higher on it, but if there is disagreement in a family over whether or not a sample should be taken, then clinicians are advised to carefully consider the situation before proceeding in taking a sample. 3.10 The reason for taking the sample and exactly what samples have been taken must be documented fully in the medical case notes. 3.11 Consent must also include the wishes of the family with regard to disposal of any residual tissue that may remain after analysis has taken place. The
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4. Sudden Unexpected Death in Infancy/Childhood (SUDIC)
4.1 For child deaths on any ward, Paediatric Intensive Care Unit, Neonatal Intensive Care Unit, the Postnatal Wards and Emergency Department: See detailed procedures for taking samples in SUDIC protocol (DMS number 10142).
5. Responsibility:
5.1 The HT Act requires that named individuals have responsibility to ensure that this process complies with the HT Act.
5.2 The Designated Individual for University Hospitals of Leicester, with legal responsibility for compliance with the HT Act, is Dr Angus McGregor, Head of Service Histopathology.
5.3 Designated Persons, who manage services in line with the requirements of the HT Act, are:
5.3.1 Dr Pillai, Head of Service, Emergency Department 5.3.2 Dr A Currie, Consultant Neonatologist 5.3.3 Mrs C Oppenheimer, Consultant Obstetrician 5.3.4 Dr J Whitelaw, Consultant Paediatric Intensivist 5.3.5 Dr M Duthie, Consultant Paediatric Intensivist
5.4 ANY member of staff seeking consent or taking a sample is personally responsible for ensuring compliance with this policy.
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Removal of Endotracheal Tubes after Death
H.M. Coroner has given University Hospitals of Leicester clear instructions on the management of Endotracheal tubes following the death of a patient in sudden or suspicious circumstances.
Endotracheal tubes MUST NOT be removed where death is sudden, suspicious or referred to the H.M. Coroner.
Ensure family are aware endotracheal tube has been left in situ, and reassure them they will be able to view deceased without ET tube when H.M. Coroner’s investigations have been completed, either in the Mortuary viewing room or at the Funeral Directors.
Document presence of ET tube on the Notification of Death form/Infant Bereavement Notification Form, to inform Mortuary Staff.
ET tubes may be removed if it is clear when death is verified that referral to the H.M. Coroner is not required. If there is any doubt the ET tube must be left in place until referral is clarified.
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Action Rationale Do not follow this procedure if the death is considered Evidence must be preserved suspicious or may be referred to H.M. Coroner. for a forensic investigation into the cause of death for The deceased patient may be collected from the place of the Policy and/or H.M. death by H.M. Coroner’s removal service. If this is not Coroner. required authority for removal must be given by the Line Manager or Duty Manager and the deceased patient placed directly into a body bag and transferred to the Mortuary.
The only other action that should be taken is to ensure correct identification bands are on the deceased patient and document any equipment in use (including batch numbers if available).
If the deceased was an inpatient and they die outside of the ward that they are an inpatient on for example Imaging or Therapies the Last Offices should be performed by the ward staff in the area the inpatient died, as they are trained in this procedure. The deceased should then be transferred to the mortuary as per Appendix Eight. Communication with the next of kin should be carried out by the clinical ward staff see Appendix Three. 1. Equipment list: Not applicable
- Disposable plastic aprons and gloves
- Mouth care equipment
- Identification bands (x2)
Disposable gown or patient’s own clothes or nightwear
- Bowl, soap, towel and disposable cloths, comb
- Micropore tape
- Clinical waste bag
- Valuable property bag and green property bag
- Clean sheets
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- Clean sheet
Extra equipment may include:
- Dressings, bandages, gauze, wicks
- Cannula bungs
- Body bag
2. Put on gloves and apron Standard (universal) precautions must be followed for any contact with bodily fluids. To reduce risk of contamination and cross- infection
3. Lay the patient on his/her back with assistance of other To maintain the patient’s member/s of staff (adhering to UHL Manual Handling dignity and for future Procedures and Safer Handling Policy). management of the body, as rigor mortis occurs 2-6 hours after death, with full intensity within 48 hours and then disappearing within another 48 hours.
Ensure a pillow is placed underneath the head To assist with drainage from Support the jaw by placing a pillow or rolled up towel on the head and promote jaw the deceased’s chest underneath the jaw. closure.
• Do not tie the jaw unless otherwise guided by family members Lines removed after death leak profusely.
Remove only mechanical aids such as syringe drives Instruction received from etc. and secure the sites with gauze and tape to syringe H.M. Coroner regarding the driver sites and document actions in nursing removal of lines and tubes. documentation. All lines must be left in situ and capped off with a blind end cannula bung. Document all lines To alleviate distress caused left in on the Notification of Death form. by medical devices left in situ. ET tubes must not be removed where death is sudden, suspicious or referred to the H.M. Coroner. To prevent haemostasis in the hands, which can cause ET tubes may be removed if it is clear when death is permanent and unsightly verified that referral to the H.M. Coroner is not required. mottling. If there is any doubt the ET tube must be left in place until referral is clarified.
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4. Close the patient’s eyes by applying light pressure to the To maintain the patient’s eyelids for 30 seconds dignity and for aesthetic reasons. Closure of eyes will also provide tissue protection in case of corneal donation.
5. If a catheter is in-situ, gently drain the bladder by Because the body can pressing on the lower abdomen. Leave catheter bag continue to excrete fluids insitu. after death. 6. Pack orifices with gauze if fluid secretion continues or is Leaking orifices pose a anticipated. If excessive leaking of bodily fluids occurs, health hazard to staff coming consider suctioning. Consider body bag if there is into contact with the body. excessive body fluid leakage. 7. Exuding wounds should be covered with a clean Open wounds post a health absorbent dressing and secured with an occlusive hazard to staff coming into dressing. If a post mortem is required, existing contact with the body. dressings should be left in situ and covered with an additional dressing. 8. Open drainage sites may need to be sealed with an Open drainage sites pose a occlusive dressing. health hazard to staff coming into contact with the body. If a post mortem is required drainage tubes, etc. should be left in situ.
Last Offices Care of the Deceased Patient Policy Page 33 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents Wash the patient, unless requested not to do so for For hygienic and aesthetic religious/cultural reasons (please refer to sections on reasons. As a mark of individual faiths). Family members must not perform respect and a point of Last Offices without a member of staff being present. closure in the relationship between nurse/midwife and It may be important to family and carers to assist with patient. washing, thereby continuing to provide the care given in the period before death. Post death shaving causes razor burn as the skin is no longer self-lubricating. Funeral Directors are best placed to Do not shave the deceased. If shaving is necessary, it perform this procedure as they should be performed prior to death using an electric would apply a massage cream razor if possible. W here not possible a normal razor can to the face some time prior to be used and massage cream / moisturiser must be preparation of the deceased. applied immediately afterwards. Any razor burn marks caused by shaving cannot be disguised by the Funeral Director, causing disfiguremen and upset to the families. 9. Clean the patient’s mouth using a foam stick to remove For hygienic and aesthetics any debris and secretions. reasons. To maintain the integrity of the face shape. Clean dentures and replace them in the mouth if possible. If not ensure they accompany the body.
Suction may be necessary to clear fluids from the patient’s mouth. Check with the patient’s family if there is any jewellery To meet with legal that they would like to be left on the deceased. requirements and relatives wishes. Sikh patients may wear a bangle on their wrist, which should not be removed.
Remove all other jewellery (in the presence of another member of staff). If jewellery does not come off easily leave it on and document it on the Notification of Death form. Any jewellery left on the deceased must be documented on the Notification of Death form.
Any patient property that is not taken by the family (including the jewellery that is removed) must be documented in the ward’s property book and bagged in yellow and green bags in accordance with the Management of Patient Property Policy and Procedures (B24/2007). 10. Ensure the patient is clothed during transfer to the To maintain dignity. mortuary e.g. night clothes, hospital gown or shroud. Patients should NOT be sent to the mortuary without being appropriately and decently attired.
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Place one label on the deceased’s right wrist, and one label on their right ankle. It is acceptable for this to be their current identification bracelet, and one other. If the right limbs are missing, place identification label on the left limbs.
12. Complete Notification of Death form (including To ensure legal, correct and addressograph label) and hand to porter when deceased easy identification of the patient is transferred to mortuary. body in the mortuary. 13. Sensitivity should be used when preparing the To comply with the Gender transsexual deceased patient to maintain strict Recognition Act 2004. confidentiality of previous gender including discussion with the family.
14. Non-infectious/non-leaking bodies should be wrapped in To maintain the deceased a clean white sheet. patient’s dignity
15. Body bags should be used for the following cases: Minimise the risk of transmission of infectious a) Hepatitis B & C, HIV, TSE (including CJD) and diseases. active tuberculosis where the patient has not successfully completed a course of antibiotics.
b) Known or suspected intra-venous drug abuse.
c) Forensic and suspicious death including death in custody (place deceased patient in body bag with minimal intervention from nursing staff).
d) Recently administered active unsealed source radioactive material for cancer treatment.
e) Where leakage and discharge of body fluids or faeces is likely (this include patients from Intensive Therapy Unit, High Dependency Unit, Renal W ards, immediate post-operative patients, patients with large pressure sores, trauma, burns, gangrenous limbs and infected amputation sites).
16. Dispose of equipment according to infection control To minimise risk of cross- principles. Remove gloves and apron and wash hands infection and contamination with soap and water.
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c) Other ward factors such as ward rounds, catering rounds, drug rounds and visiting times.
d) Potential threat of any aggression or conflict (transfer may be delayed until area secure).
18. Prepare ward area for arrival or porters with To ensure the safe, legal and concealment trolley by drawing curtains and remove dignified transfer of the unnecessary equipment to allow concealment trolley to deceased patient to the be placed next to the bed. mortuary.
19. Greet porters on their arrival, confirm identity of To ensure the safe, legal and deceased patient (S number on ID bands) and assist dignified transfer of the with transfer by ensuring bed brakes are locked, bed deceased patient to the and trolley are at the same height and patslide used for mortuary. lateral transfer.
20. Take notes and property to Bereavement Services office To ensure Bereavement within 3 hours of patient’s death (or by 10am the Services Officers can deal following working day if out of hours) during office hours appropriately with relative’s by hand delivering a copy of the Notification of Death enquiries. form completed by the Porters.
21. Provide appropriate support and reassurance to other Other patients and visitors patients and visitors to the ward may be aware that a death has occurred.
22. Record all details and actions within the nursing To record the time of death, documentation names of those present and names of those informed.
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Last Offices and Care of the Deceased Patient Policy
Action Rationale
Do not follow this procedure if the death is Evidence must be preserved for a considered suspicious or may be referred to H.M. forensic investigation into the cause Coroner. of death for the Policy and/or H.M. Coroner. The deceased patient may be collected from the place of death by H.M. Coroner’s removal service. If this is not required authority for removal must be given by the Line Manager or Duty Manager and the deceased patient placed directly into a body bag and transferred to the Mortuary.
The only other action that should be taken is to ensure correct identification bands are on the deceased patient and document any equipment in use (including batch numbers if available).
If the deceased was an inpatient and they die outside of the ward that they are an inpatient on for example Imaging or Therapies the Last Offices should be performed by the ward staff in the area the inpatient died, as they are trained in this procedure. The deceased should then be transferred to the mortuary as per Appendix Eight. Communication with the next of kin should be carried out by the clinical ward staff see Appendix Three.
Last Offices Care of the Deceased Patient Policy Page 38 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 1. Equipment list: N/A - Disposable plastic aprons and gloves - Mouth care equipment - Identification bands (x2)
Disposable gown or patient’s own clothes or nightwear - Bowl, soap, towel and disposable cloths, comb - Micropore tape - Clinical waste bag
Valuable property bag and green property bag - Clean sheets - Sharps box - Clean sheet
Extra equipment may include: - Dressings, bandages, gauze, wicks - Cannula bungs - Body bag
Extra equipment for Infants/Children or Young People: - Child’s clothes (or whatever family want the child dressed in) - Children’s Hospital Bereavement Pack - Nappies if the deceased is a baby - Toothbrush and toothpaste
2. Approach child’s family to explain the last offices Family orientated care and procedure and gain verbal consent to undertake the gives the family an opportunity procedure whilst encouraging participation if for closure whilst recognising appropriate (Not appropriate if H.M. Coroner’s case, that child is still part of their death under suspicious circumstances or child family. protection issues are a query).
Discuss the option of taking a lock of hair, These keepsakes will act as a photograph, hand or footprint with the parents before memory of the child for the last offices are performed. family.
There is also an option to have the child’s name To allow the family on-going entered into the Children’s Hospital Book of support. Remembrance kept within Children’s Intensive Care Unit, Children’s Hospital, Leicester Royal Infirmary and also in the chapel at the Glenfield Hospital.
Last Offices Care of the Deceased Patient Policy Page 39 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 3. Some families may request to take the child’s body To ensure that all legal issues home before last offices are performed. This can be have been considered. arranged if appropriate, but must be arranged via the hospital mortuary.
Please refer to the procedure in Children’s Hospital Bereavement Pack and contact the Duty Hospital Manager for advice.
Discuss with the family the option of transfer to To provide the family with Rainbows Children’s Hospice, for use of the “quiet additional time and support up room” facility. Refer to hospice for further until the time of support/information as needed. A transfer letter to burial/cremation. Rainbows will be required – please contact Rainbows for further instruction. 4. Put on gloves and apron Standard (universal) precautions must be followed for any contact with bodily fluids. To reduce risk of contamination and cross- infection.
5. Lay the infant or child on their back with assistance To maintain the patient’s of another member of staff if the patient is an older dignity and for future child (adhering to the manual handling policy). management of the body, as rigor mortis occurs 2-6 hours If possible lay limbs out straight, close mouth and after death, with full intensity shut eyes by applying light pressure to the eyelids within 48 hours and then for 30 seconds but do not force. disappearing within another 48 hours. Closure of eyes will Remove excess bedding and pillows leaving a sheet also provide tissue protection underneath the child and cover the child and a single in case of corneal donation. pillow underneath the head if appropriate.
In older children consider supporting the jaw by placing a pillow or rolled up towel on the child’s chest underneath the jaw.
• Do not tie jaw unless otherwise guided by family members.
Remove only mechanical aids such as syringe drives etc. and secure the sites with gauze and tape to syringe driver sites and document actions in nursing documentation. Lines must be left in situ and capped off with a blind end cannula bung. Document all lines left in on the Notification of Death form.
ET tubes must not be removed where death is sudden, suspicious or referred to the H.M. Coroner.
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Ensure family are aware ET tube has been left in situ, and reassure them they will be able to view deceased without ET tube when H.M. Coroner’s investigations have been completed, either in the Mortuary viewing room or at the Funeral Directors.
6. If a catheter is in-situ gently drain the bladder by Because the body can pressing on the lower abdomen. Leave catheter bag continue to excrete fluids after in-situ. In infants/younger children use a nappy to death. retain urinary secretions. 7. Pack orifices with gauze if fluid secretion continues Leaking orifices pose a health or is anticipated. If excessive leaking of bodily fluids hazard to staff coming into occurs, consider suctioning. contact with the body.
8. In older children/young people you may need to pack The dressing will absorb any orifices with gauze if fluid secretion continues or is leakage from the wound site. anticipated. Open wounds pose a health hazard to staff coming into In younger children and babies use a nappy to retain contact with the body. If a secretions. If excessive leaking of bodily fluids post mortem is required, occurs, consider suctioning. existing dressings should be left in-situ and covered.
9. Open drainage sites may need to be sealed with an Open drainage sites pose a occlusive dressing. health hazard to staff coming into contact with the body. If a post mortem is required drainage tubes, etc. should be left in-situ.
10. Wash the infant or child, (allowing family to For hygienic and aesthetic participate as appropriate) unless requested not to reasons. As a mark of respect do so for religious/cultural reasons (please refer to and a point of closure in the sections on individual faiths). Family members must relationship between not perform last offices without a member of staff nurse/midwife and patient. being present (continued overleaf).
It may be important to family and carers to assist with washing, thereby continuing to provide the care given in the period before death.
11. If necessary clean the infant/child’s mouth using a For hygienic and aesthetic foam stick to remove any debris and secretions. reasons.
Otherwise clean the child’s teeth using their own toothbrush and toothpaste.
Last Offices Care of the Deceased Patient Policy Page 41 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents 12. If family want jewellery to be removed then do so To meet with legal and give to the family (in the presence of another requirements and relatives nurse) and record on the Notification of Death form. wishes.
• Sikh’s may have a bangle on that should not be removed.
If jewellery does not come off easily or parents want to leave it on the child, document its presence on the Notification of Death form.
Jewellery remaining on the patient should be documented on the ‘Notification of Death’ form. Record the jewellery and other valuables in the patient’s property book and store the items according to UHL policy.
13. Dress the child in parent’s choice of clothing or To maintain dignity and nightclothes as appropriate. include family in the procedure.
14. Ensure two identification bracelets with the following To ensure correct and easy information are present: identification of the body in the mortuary. - Patient’s S number - Date of Birth - Name
Place one label on the infant or child’s right wrist, and one label on their right ankle. It is acceptable for this to be their current identification bracelet, and one other. If the right limbs are missing, place identification label on the left limbs.
15. Complete Notification of Death form (including To ensure correct and easy addressograph label) and hand to porter when identification of the body in the deceased patient is transferred to the mortuary. mortuary.
16. Support family to say goodbye to infant or child on Family Orientated Care and to ward before transfer to the mortuary. Ensure they ensure that the family has an are aware of visiting arrangements in the mortuary opportunity for closure whilst and with the Funeral Director. recognising that child is still part of their family. Family to leave ward or department area prior to transfer.
17. Non-infectious/non-leaking bodies should be Actual or potential leakage of wrapped in a clean white sheet. fluid, whether infection is present or not, poses a health hazard to all those who come
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18. Body bags should be used for the following cases: Minimise the risk of transmission of infectious a) Hepatitis B & C, HIV, TSE (including CJD) diseases. and active tuberculosis where the patient has not successfully completed a course of antibiotics.
b) Known or suspected intra-venous drug abuse.
c) Forensic and suspicious death including death in custody (place deceased patient in body bag with minimal intervention from nursing staff).
d) Recently administered active unsealed source radioactive material for cancer treatment.
e) Where leakage and discharge of body fluids or faeces is likely (this include patients from Intensive Therapy Unit, High Dependency Unit, Renal Wards, immediate post- operative patients, patients with large pressure sores, trauma, burns, gangrenous limbs and infected amputation sites).
19. Dispose of equipment according to infection control To minimise risk of cross- principles. Remove gloves and apron and wash infection and contamination hands with soap and water.
20. Request transfer of deceased patient to mortuary by Decomposition occurs rapidly, contacting porters. Inform porters of any relevant particularly in hot weather and factors: in overheated rooms. Transfer to the mortuary must a) Deceased patient weighing more than 200kg occur in a respectful and (may need to contact Manual Handling dignified manner, ensuring Team or Duty Manager out of hours for that members of the public are advice). not exposed to the sight of a deceased child during transfer b) If body bag has been used, including reason and that staff are not placed why (leaking fluids, risk of infection, under unnecessary risk. radiopharmaceuticals, other).
c) Other ward factors such as ward rounds, catering rounds, drug rounds and visiting times.
Last Offices Care of the Deceased Patient Policy Page 43 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents d) Potential threat of any aggression or conflict (transfer may be delayed until area secure).
Concealment container or trolley to be used for all transfers to the mortuary. Give porters estimate as to the length/size of child, so the appropriate concealment trolley/cover is brought to ward:
- Neonatal transport container - Half-size “child” concealment trolley or cot/bed concealment cover - Full size “adult” concealment trolley or bed concealment cover.
Document time porter requested. Family members must not accompany porters during transfer to the mortuary.
21. Prepare ward area for arrival or porters with To ensure the safe, legal and concealment trolley by drawing curtains and remove dignified transfer of the unnecessary equipment to allow concealment trolley deceased patient to the to be placed next to the bed. mortuary. 22. Greet porters on their arrival, confirm identity of deceased patient (S number on ID bands) and assist with transfer by ensuring bed brakes are locked, bed and trolley are at the same height and patslide used for lateral transfer. 23. Take notes and property to Bereavement Services To ensure Bereavement office within 3 hours of patient’s death (or by 10am Services Officers can deal the following working day if out of hours) during appropriately with relative’s office hours by hand delivering a copy of the enquiries. Notification of Death form completed by the Porters.
24. Provide appropriate support and reassurance to Other patients and visitors other children and visitors to the ward. may be aware that a death has occurred.
25. Record all details and actions within the nursing To record the time of death, documentation. names of those present, and names of those informed.
26. Allow the family to take the child’s belongings with The administrative department them and offer the appropriate information to allow cannot begin to process the them to contact Bereavement Services on the next formalities such as the death working day. certificate or the collection of property by the next of kin until the required documents are in its possession.
Relevant information on support groups should also To ensure the family receive on- be offered to the family before they leave the ward going support.
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Transfer the patient records, etc. to Bereavement To ensure that the family do Services with the second copy of the Death not receive any appointments Notification form. or letters regarding the child and allow those staff who have been involved with the child to visit the family.
27. You must ensure that there is a system in place for To provide on-going support. other professionals involved in the child’s care to be informed (such as GP, community nurses, Health Visitor, Rainbows Children’s Hospice, or Service Co- ordination Scheme).
You must ensure that, when possible, the family have a follow-up appointment in place with the child’s consultant before they leave the hospital.
28. Transfer property, patient records etc. to Documentation/case notes Bereavement Services. Soiled property should be etc. needed to process the stored in individual bags, and properly identified. death certificate or property collection.
If deceased is under 18 years of age – copy case notes for Child Death Overview Panel.
Last Offices Care of the Deceased Patient Policy Page 45 of 61 V4 Approved by Policy and Guideline Committee on 3 June 2016 Trust Ref: B28/2010 Next Review: May 2022 – extension agreed at PGC 21/05/2021 NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents TRANSFER TO THE MORTUARY APPENDIX NINE Last Offices and Care of the Deceased Patient Policy
1. Introduction
1.1 The Portering Department is responsible for undertaking the transfer of deceased patient from the ward/department/Emergency Department/place of death to the Mortuary.
1.2 All transfers will be undertaken in a safe and dignified manner.
1.3 Body to be collected within 1 hour of the request for transfer to the Mortuary being made.
1.4 Family and friends are not able to accompany the porters whilst they collect or transfer the deceased patient to the Mortuary.
2. Equipment
2.1 In order to maintain the privacy and dignity of the deceased patient, visitors and staff in any surrounding area, an appropriate concealment trolley will be used for all transfers:
a) Neonatal transport container (held on Delivery Suite) b) Half-size “child” concealment trolley or cot/bed concealment cover c) Full-size “adult” concealment trolley or bed concealment cover d) Bariatric concealment trolley or bariatric trolley cover
2.2 Concealment trolleys will be stored out of public view when not in use, and will be used in a dignified and professional manner at all times (even when empty).
2.3 The concealment trolley and its cover should be checked to make sure it is in good working order prior to use, and cleaned and disinfected with a 10% dilution of Distell (available in the Mortuary) after every transfer. Appropriate Personal Protective clothing must be worn when disinfecting and cleaning the trolley.
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3.1 Request for transfer:
a) Ward staff to request transfer of deceased patient to the mortuary by contacting porters on extension 7888.
b) Ward staff to inform porters of any relevant factors, including which concealment trolley to be used, whether patient is more than 200kg and as well as whether body bag has been used and if so, reason why:
• The use of a body bag and Personal Protective Equipment is sufficient to protect those handling the deceased patient from leaking fluids, infections or radiopharmaceuticals.
c) Ward staff to inform porter of any other factors that may affect transfer, including ward rounds, catering rounds, drug rounds, visiting times or potential issues with family members.
d) If there are any potential threat of aggression or conflict. Portering staff will decide whether to delay transfer until an escort from security is available.
3.2 Collection of deceased patient from ward:
a) Ward staff are responsible for ensure the deceased patient is prepared and Notification of Death form completed prior to portering staff arriving to collect the patient.
b) Ward staff are responsible for preparing the ward area prior to the arrival of portering staff, ensuring that curtains are drawn to maintain privacy (unless deceased patient is in a single room) and any unnecessary equipment has been removed to allow placement of the concealment trolley next to the deceased patient’s bed.
c) A minimum of 2 porters are required for the transfer of all deceased patients, and more for bariatric patients.
d) Porters will collect (and assemble) the correct concealment trolley or concealment over, ensure it is in good working order
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e) Ward staff must be available to assist the porters, and confirm the identification of the deceased patient.
f) Nursing staff and porters will us appropriate Personal Protective Equipment during the transfer of the deceased patient from their bed to the concealment trolley.
g) Once privacy has been ensured (closing single room door or curtains around the bed space) the frame and cover of the concealment trolley can be removed and the trolley positioned laterally to the bed. It is essential that the castors of the bed and trolley are locked and both are at the same height.
h) A patslide should be used to transfer the deceased patient from the bed to the trolley.
i) Once the deceased patient is on the concealment trolley the framework and cover should be replaced, maintaining the privacy and dignity during transfer to the mortuary.
3.3 Notification of Death form:
a) Ward staff are responsible for ensuring the correct identification labels are on the deceased patient, and that the Notification of Death form has been completed.
b) Portering staff will take one copy of the Notification of Death form with the deceased patient to the mortuary.
c) Out of hours portering staff will also deliver an additional copy of the Notification of Death form to Bereavement Services.
3.4 Transfer of Deceased Patient to the Mortuary:
a) Personal Protective Equipment should not be used during transfer to the mortuary.
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3.5 Reception of Deceased Patient into the Mortuary:
a) On arrival into the mortuary, porters must make sure the mortuary is secure, transfer the deceased patient into the fridge room and adopt appropriate Personal Protective Equipment. See section 6 below for details of accommodation of the deceased.
b) The Hydraulic Hoist must be used to remove an empty tray from the temperature controlled accommodation, and the frame and cover removed from the concealment trolley. The height of the hoist and concealment trolley must be the same and the castors locked for safe transfer.
c) A patslide must be used to transfer the deceased patient from the trolley to the tray.
d) The deceased patient must remain securely wrapped at all times, to protect their privacy and dignity.
e) The tray must be returned to its original position and the door secured. Portering staff must document the first initial of the forename and the name of the deceased patient on the name plate on the exterior of the door, and the Mortuary Register must be completed.
f) The concealment trolley and cover must then be disinfected and cleaned, the framework and cover replaced and Personal Protective Equipment removed and disposed of.
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4. Transfer of Patients from Non-Ward Areas
Transfer of patients who have died in non-ward areas, such as theatres, catheter labs etc. should follow the above procedures for transferring patients within the hospital. Transporting patients on open beds/trolleys, without the use of a concealment cover, is NOT acceptable practice, as it compromises the dignity of both patients and their relatives.
5. Transfer of Babies from the Maternity or Neonatal Unit
5.1 The transfer of the deceased baby (including the non-viable foetus, stillborn baby and neonatal deaths) from the Maternity or Neonatal Unit will follow the procedure as outlined above.
5.2 A Midwife or Nurse may accompany portering staff during the transfer, but must not transfer the deceased baby on their own.
5.3 The Notification of Death Form is not completed in these cases. Instead an Infant Bereavement Notification Form will be completed by ward staff, and a clinical summary and post-mortem request form (if necessary). Ward staff area responsible for the accuracy and completion of this paperwork and portering staff will deliver the forms as outlined in section 3 above. Pregnancy loss form is completed for pre-sixteen week non-viable foetus and an Infant Bereavement Notification Form is completed for post-sixteen week gestation to the 28th day after birth.
5.4 Ward staff may occasionally request that the deceased baby is brought back to the Maternity or Neonatal Unit for viewing, if the condition of the mother is such that she is unable to attend the mortuary. This is the only time that it is acceptable for any deceased patient to return to the ward area and must be carefully managed:
- Ward staff should accompany portering staff to the mortuary to confirm the identity of the deceased baby and complete the
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- Ward staff are responsible for:
- Attending the mortuary with portering staff
- Confirming the identity and ensuring the deceased baby is presentable before viewing takes place
- Maintaining the privacy, dignity and security of the deceased baby on the ward
- Ensuring there is minimal impact on any other patients, visitors or staff
- Supporting the mother and any visitors during the viewing
- Preparing the deceased baby for transfer back to the mortuary.
Please note: the deceased baby cannot be released to the family direct from the wards. All releases must be through the mortuary, even out of hours (refer to UHL ‘Policy for the Handling and Release of the Deceased and Products of Conception Outside Normal Hours’ for full procedure).
6. Bariatric Patients
6.1 Ward staff must inform portering staff if the transfer of the deceased patient is likely to post a manual handling risk and/or weighs more than 200kg.
6.2 Portering staff may decide to visit the ward to visually assess the deceased patient in order to use the most appropriate and respectful method of transport.
6.3 In certain circumstances, transfer to the mortuary may be delayed additional staff and/or equipment is located. The method of transport will be adapted to suit each of the three hospital sites dependant on availability of equipment.
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6.5 Once appropriate staff and equipment are available, transfer should follow the procedure outlined in section 3 above.
7. Accommodation of the Deceased
Leicester Royal Infirmary
1) Deceased from the Emergency Department(ED) and the community are placed in designated fridges refer to poster in each Mortuary for details.
2) Deceased that are forensic cases are to be placed into P&Q. These are locked and access limited to technical staff. If technical staff are unavailable, forensic cases can be placed in D to L then transferred at an appropriate time.
3) Paediatric and neonatal cases are to be placed in A on level 5.
Internal hospital deaths except ED are to be placed in R to X inclusive. 4) Bariatric patients are to be placed in C; patients that arrive in the department on a bed are to remain on a bed at the far end of the fridge room until assessed by Mortuary staff.
Contingency for LRI Stage 1 The storage facility in the loading area of the LRI Mortuary will be used to accommodate deceased when all other spaces are occupied at LRI. Stage2 If the implementation of stage1fails to resolve accommodation issues then the Senior Porter will contact the Duty Manager who will contact the On-call Technician via switchboard. The On-call Technician will confirm availability of spaces at the other two UHL Mortuaries will be established. The On-call Technician will relocate deceased to other sites.
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Deceased to be placed in spaces (to the right when accessing the department) A-G inclusive. Babies will be placed in B.
Contingency for LGH
Stage1 Spaces (to the left when accessing the department) 1-40 inclusive will be used to accommodate deceased when all other spaces at LGH are occupied.
Stage2
If the implementation of stage1 fails to resolve accommodation issues then the Senior Porter will contact the Duty Manager who will contact the On-call Technician via switchboard. The On-call Technician will confirm availability of spaces at the other two UHL Mortuaries will be established. The On-call Technician will relocate deceased to other sites.
Glenfield Hospital
Spaces 1-30 inclusive are to be used to accommodate deceased. The spaces in Neonate and Paediatric room are to be used to accommodate babies.
Contingency for Glenfield Hospital
Stage 1
Vacant spaces in the neonate room will be used to accommodate deceased when all other spaces at Glenfield Hospital are occupied.
Stage 2
If the implementation of stage 1 fails to resolve accommodation issues then the Senior Porter will contact the Duty Manager who will contact the On-call Technician via Switchboard. The On-call Technician will confirm the availability of spaces at the other two University Hospitals of Leicester Mortuaries. The On-call Technician will relocate the deceased to other sites.
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Last Offices and Care of the Deceased Patient Policy
1. Spread of infection 1.1 The risks of infection from a patient rarely increase after death and can be prevented by the use of standard precautions including the use of appropriate Personal Protective Equipment. 2. Performing last offices 2.1 Because it is not possible to rule out an underlying infection in every case, it is advisable that Nursing staff perform last offices with the same protective precautions as when the patient was alive; this includes disposable gloves and apron when handling the deceased.
2.2 Overt use of protective measures can cause distress. Protective clothing should be removed after handling the deceased and hands washed thoroughly before meeting the family.
3. Communication 3.1 If a patient has died with a known or suspected infection, it is the legal responsibility of those performing last offices to ensure those who care for the deceased after death are informed of the potential risk of infection.
3.2 The persons who need to know include next of kin, portering staff, mortuary staff and funeral director.
3.3 Ward staff should use the Notification of Death form to communicate the nature of infection and the precautions required. This will ensure the specific diagnosis remains confidential, even after death.
3.4 Relatives may be unaware of the true nature of the infection and an individual’s right to confidentiality continues after death, but the bereaved relatives must be advised on how to avoid risk of infection to themselves.
3.5 Specific questions about the nature of the infection from the next of kin should be referred to the doctor who confirmed that the patient had died.
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4.2 Body bags are to be used for the following cases:
- Hepatitis B & C, HIV, TSE (including CJD) and active tuberculosis where the patient has not successfully completed a course of antibiotics
- Known or suspected intra-venous drug abuse
- Forensic and suspicious death including death in custody (place in bag with minimal intervention from nursing staff)
- Recently administered active unsealed source radioactive material for cancer treatment.
- Where leakage and discharge of body fluids or faeces is likely (this includes patients from ITU, HDU, Renal Wards, immediate post-operative patients, patients with large pressure sores, trauma, burns, gangrenous limbs and infected amputation sites.
4.3 Detailed advice about the use of body bags and specific infections (not covered in this document) should be sought from the Pathology Consultant Clinical Microbiologist (ext.6507).
4.4 The deceased patient must be clothed (e.g. night clothes, hospital gown or shroud) even when contained in a body bag, irrespective of the reason why, in order to maintain their privacy and dignity.
4.5 The inappropriate use of body bags can cause unnecessary distress to relatives. Where a body bag is used and is necessary and the actual use is unidentifiable (not recorded on the Death Notification Form) unnecessary distress can also occur.
4.6 If the exterior of the bag in advertently comes into contact with potential sources of infection, clean and disinfect the exterior with a Chlorclean solution.
4.7 The deceased can remain unwrapped (i.e. clothed, but not wrapped in a sheet) within the bag, but a sheet must be wrapped around the exterior of
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5. Notification of Death Form
5.1 The body bag section of the Notification of Death form has a checklist with a table of some frequently encountered conditions that require a body bag:
5.2 A more comprehensive list of infections and conditions are listed in the tables below: Known or Suspected Infections that Do Not Require a Body Bag
Infection View Embalm Wash & dress Degree of Risk Acute encephalitis Chickenpox/shingles Cryptosporidiosis Low
Clostridium Difficile (C.diff) Dysentry Medium
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Legionelliosis
Measles Meningitis (except meningococcal) Low Mumps Methicillin-resistant Staphylococcus aureus (MRSA) Rubella Tetanus Whooping Cough Food poisoning Hepatitis A Acute Poliomyelitis (Polio) No Medium Leptospirosis (Weil’s disease) Malaria Yes with caution X Not advised.
Known or Suspected Infections that Require a Body Bag Infection Transmitted Embalm Wash & View Degree of dress risk Diphtheria Meningococcal Septicaemia Air-borne (with or without meningitis) Medium Paratyphoid Ingestion Fever Tuberculosis Air-borne Typhoid fever Ingestion Hepatitis B, C Blood-borne X X and HIV Anthrax Air-borne & contact with X X X broken skin High Transmissible spongiform encephalopathies Neurological X * * e.g. Creutxfeldt Jakob disease Yes with caution X Not advised *Yes but not after post-mortem Note: The level of risk to those caring for the deceased after death is assessed with the assumption that Standard Personal Protective clothing is worn. Table summarised from advice published by the Health Protection Agency.
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APPENDIX ELEVEN Last Offices and Care of the Deceased Patient Policy
The following are only suggestions and can be used in conjunction with the Green “Diversity in Healthcare” folder produced by the University Hospitals of Leicester (April 2003). Folders are available within the clinical area.
-Primarily it is essential that any religious beliefs held by the patient are identified on admission, or prior to death, so that nursing staff can adhere to the needs of the patient, relatives and important others.
-Individual requirements will vary even among members of the same religion. Varying degrees of adherence and orthodoxy exist within all the world’s religions. The identified religion may occasionally be offered to indicate an association with particular cultural and national roots, rather than to indicate a significant degree of adherence to a particular religion.
- It is essential where a specific need is identified, a lead should be taken from the family.
- When requesting a member of the Chaplaincy to visit a patient, contact switchboard and ensure you clearly state the patient’s religion.
Requirements for people of different religious faiths
Many requirements and preferences for religious and cultural reasons are already covered by the normal infection prevention measures in this policy. For example where gloves are being worn for infection prevention reasons, this also prevents physical contact between the healthcare worker and the deceased, which in some religions would not be acceptable if the worker were not the same gender as the deceased.
The following table gives indications of additional measures that may be appropriate for various religions.
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If a special ring is placed on the finger of the patient it should not be removed. A request may be made for a Buddhist monk or nun to be present. Buddhism As there are a number of different schools of Buddhism, relatives should be contacted for advice on how the body should be treated. The relatives may request, for the body to be left for a period of time, while prayers are said.
Christianity Relatives may request a hospital chaplain or priest from their own church to offer prayers.
Roman Catholic families may request the presence of a Roman Catholic priest.
Hinduism A Hindu patient or relative may request the services of a priest during the last stages of life.
Where possible the body should not be handled before consulting the relatives.
Hindu’s often prefer nursing staff of the same sex as the patient to handle the body. The deceased should always be covered by a plain white sheet.
Where possible preparation for this eventually should be made by moving the dying person to a single room, so that other patients or visitors are not disturbed by these expressions of grief at the time of death.
Support the jaw.
Do not remove threads or jewellery. Cremation frequently occurs soon after death, and speedy completion of the death certificate will aid this process.
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The family may request that the body is turned to face towards Mecca (head first). Mecca is South East of Leicester. Muslim patients are usually buried as soon as possible after death.
Jainism No special requirements
Judaism Many Jews would prefer someone from the Jewish faith to touch the body.
Traditionally the body is left for about 8 minutes before being moved while a white feather is placed across the lips and nose to detect any signs of breathing.
The body should be handled as little as possible.
The patient should not be washed and should remain in the clothes in which they died.
The family may request the jaw is tied up. It is often seen as a religious duty for Jewish people to stay with the body until burial. Mormon (Church of Relatives may advise staff if the patient wears a one or two Jesus Christ of piece sacred undergarment. If this is the case, relatives may the Latter Day dress the patient in these items. Saints)
Muslim See Islam
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The eldest son may wish to take the lead for the Last Offices. Sikhism Do not remove the‘5Ks’which are personal sacred objects: Kesh: Do not remove head covering-turban (men)/ duppata(women) Kanga: Do not remove semi-circular comb, which fixes hair Kara: Do not remove any bracelets Kachh: Do not remove special shorts worn as underwear. Seek advice from family if soiled. Kirpan: Do not remove miniature sword if worn.
Zoroastrian The family may wish to be present during, or participate in, (Parsee) the preparation of the body. Orthodox Parsees are likely to require a priest to be present. The family may provide specific clothing to be worn, called the Sadra.
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