Transcript for Confirmation of Death Training To be read in conjunction with NHS Lothian Clinical Education and Training Department powerpoint presentation (if no sound available on computer) SLIDE 1 – Title Slide Nurse Verification of Expected Death has now changed with the introduction of the NHS Lothian’s Confirmation of Death policy and procedure. The Confirmation of Death policy and procedure is aligned to the Scottish Government Confirmation of death circular (2017) and Framework for implementation (2018). This new policy, procedure and training enables registered healthcare professionals, identified by their line manager, to confirm death in any circumstance The information in this presentation is supported by NHS Education for Scotland Confirmation of Death resources, on Turas, and relates to Confirmation of Death in an adult patient SLIDE 2 – Learning Outcomes The aim of this training resource together with information from NHS Lothian Confirmation of Death policy and procedure is to support a safe, effective, person centred approach being taken by Registered Healthcare Professionals when confirming a death. Please take a moment to read through the learning outcomes. SLIDE 3 – Confirmation versus Certification Confirmation of death and certification of death are two separate processes. Confirmation of death is the confirmation that life has ceased, based on a physiological assessment. It can be performed by any suitably trained registered health care professional in any circumstance. Whereas Certification of Death is the issuing of the Medical Certificate of Cause of Death (MCCD) by the medical practitioner. This is required for families to be able to register the death and proceed with funeral arrangements. SLIDE 4- Confirming a death: NHS Lothian Policy/procedure Here are some of the key points from the Confirmation of Death policy & procedure, please take a moment to read them. To re-iterate, the most appropriate registered health care professional should confirm the death. It is preferable but not always necessary for the healthcare professional confirming death to have known or provided care for the person in life Staff will require sufficient information to make informed judgements when undertaking the clinical procedure of confirming death, for example 1 08/04/2020
When do I escalate? When are further precautions necessary? What communications and/or notifications are required? Within the procedure you do have the right to refuse to confirm death and to request the attendance of the responsible doctor/police if there are circumstances around death that raise concerns SLIDE 5- Roles and Responsibilities of Registered Healthcare professionals Here are the Roles and Responsibilities of registered health care professionals who have been identified to undertake Confirmation of Death Please take a moment to read through this slide With regard to training and competency requirements – this will include working through this presentation and viewing the linked video You can access further information, support and resources at the end of this presentation SLIDE 6 - Accountability & Professional Practice This slide considers the accountability of registered healthcare professional in relation to the clinical procedure of confirming death In order to be accountable RHCP’s need to be able to give a rationale for any action or omission when confirming a death. When considering your vicarious liability, if you are called to account for any action or omission, for your employer to assume responsibility for your actions you need to; • Have been acting within the course of your employed duties • Have been trained and educated for the role • Have been working to agreed policies and procedures HCP’s who confirm deaths will need to • Follow their regulatory body code of practice; for example the Nursing & Midwifery Council for a Registered Nurse • Have current knowledge about the confirmation of death and relevant communication skills • The competence for this skill is confirmed by a self assessment and discussion with your line manager and will need to be regularly reviewed • As an accountable practitioner you need to ask for help from a suitably qualified and experienced healthcare professional to carry out any action or procedure that is beyond the limits of your competence (NMC code of conduct 13.3) 2 08/04/2020
SLIDE 7 – Best practice at end of life In many circumstances patients will have these key documents in place. They demonstrate that the multi-professional team are in agreement that the patient is dying and this has been discussed with them and their family The expectation is you are going to confirm a reported death, but there may be exceptional circumstances when undertaking the confirmation of death procedure there is evidence of signs of life. Therefore in the absence of a DNACPR form confirming that resuscitation should not be attempted, the healthcare professional will use professional judgement to assess whether life preserving measures such as CPR should be initiated (NHSL Confirmation of Death Procedure 2020) Slide 8 – Reference to NHS Scotland DNACPR POLICY Further information can be accessed in the policy with regards to issues around DNACPR Slide 9- Dying process versus reversible deterioration In expected and unexpected scenarios you attend, it is important to consider if there are reversible causes. Having an awareness of conditions such as these listed on this slide, can support you to distinguish between the dying process and reversible causes of deterioration. These conditions may lead to a reduction in a patient’s conscious level and/or an altered breathing pattern and may have a reversible cause. Knowledge of these conditions can support you in your professional clinical judgement as to whether to escalate and call for emergency support. Slide 10 – Person Centred approach The approach you take and how you communicate with relatives when undertaking the clinical procedure of confirming death will have a lasting impact on them. I would like to emphasize the importance of the language you use, being sensitive and empathetic at this difficult time. You also need to be receptive to any questions and ideally have supporting information with you to clarify next steps. Examples of these are contained with the resources at the end of this presentation The recommended timeframe for confirming a death in a hospital setting is within one hour and in the community within 4 hours (RCN Confirmation or verification of death by registered nurses advice guide) 3 08/04/2020
Slides 11 & 12 – We are now going to play a 9 minute video resource that demonstrates the complete procedure of confirming a death and clinical signs you need to check. This has been developed by NHS Education for Scotland Please note, where the patient has suspected or confirmed COVID-19, you must adhere to the up to date infection prevention and control measures that include Personal Protective Equipment (PPE), which can be found at: https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/ Slide 13- Clinical Signs of Confirmation of Death checks : This slide shows the 5 clinical signs checks you are required to undertake to confirm death. These were shown in the linked video, but are highlighted for you here. Slide 14- Infection Risk in Deceased Patients These resources relating to the infection risk in a deceased patient, they are referenced at the end of this presentation • The National infection, prevention & control manual contains general guidance on standard and transmission based infection control precautions • Section 2.5 and Appendix 12 of the National infection, prevention and control manual give specific guidance about application of transmission based precautions to key infections in the deceased e.g. Hepatitis • NHS Lothian COVID base gives up to date information relating to specific PPE requirements if the patient is suspected or confirmed COVID-19 • Health Protection Scotland website provides specific information relating to deceased patients with suspected or confirmed COVID-19 in Primary and Secondary care settings. When you are undertaking the clinical procedure of confirming the death of a patient with suspected or confirmed COVID you need to • ensure you are wearing the appropriate personal protective equipment • avoid leaning towards the patient’s airway to listen or feel for absence of breath Please access this information from the websites listed e.g. Health Protection Scotland in order to view the most up to date version Slide15 – Examples of other hazards This slide is to make you aware of the importance of highlighting if a patient has a pacemaker or implantable cardiac defibrillator device or other battery powered 4 08/04/2020
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