Trust Policy and Procedure Bereavement Policy Document Ref. No: PP(16)252 For use in: For use by: For use for: Document owner: Status: All areas of the Trust All Trust staff The dying, their relatives and the deceased Samantha Hobson on behalf of the End of Life Operational Group Approved Contents Page 1 Purpose of Policy 2 2 Background 2 2.1 National 2 2.2 Local 3 3 Staff Responsibilities 3 4 Operational Issues and Local Policies/Protocols/Guidelines 4 5 Principles 4 6 Bereavement Pathway for Expected and Unexpected Death 5 6.1 Expected Death 6 6.2 Unexpected Death 8 7 Additional Information for Specific Departments 9 8 Education and Training 10 9 Review and Monitoring 10 10 Additional Resources and References 11 Source: Palliative Care Team Issue date: November 2016 Page 1 of 13
1 PURPOSE OF THE POLICY Patients die in hospital and such deaths occur in all age groups, involve all cultures and religious backgrounds and may be expected or unexpected. Providing help and support to the dying and those bereaved is an essential aspect of health care. The purpose of this policy is to promote best practice in the event of death and bereavement, by providing staff with an effective framework to guide their practice and helping them to identify relevant policies and guidelines. This policy forms the basis for the Bereavement Manual on the hospital intranet. 2 BACKGROUND 2.1 National Following inquiries at Bristol Royal Infirmary and Royal Liverpool Children s hospital in 2001 (1), the Chief Medical Officer recommended that, all NHS Trusts should provide support and advice to families at the time of bereavement (2). Since then, work has been undertaken by the Department of Heath and across the NHS to improve services. The NHS Chief executive again reminded Trusts of this important area during 2004. (3) Standards for Better Health (July 2004) set out the level of quality that healthcare organisations will be expected to meet in the domains of: safety, clinical and cost effectiveness, governance, patient focus, access and responsive care, care environment and amenities, and public health. These seven domains are designed to cover the full spectrum of healthcare as defined in the Health and Social Care Act 2003. Core standard C13 (a) from this document states that healthcare organisations should have systems in place to ensure that: Staff treat patients, their relatives and carers with dignity and respect. The NICE guidelines on improving supportive and palliative care for adults with cancer, 2004 (4) highlighted the benefits of different forms of spiritual care to enhance the quality of service that the NHS can deliver. These were also supported by the Department of Health document, When a patient Dies, Advice on Developing Bereavement Services in the NHS which was significantly updated in 2011 to include legislative changes such as the Mental Capacity Act, 2005 and large scale policies such as the End of Life Care Strategy, 2008(6). The End of life care for adults NICE quality standard (QS13) 2013 (5) has three relevant statements which cover care after death, verification of the body and bereavement support. These are based on the End of life care strategy: quality markers and measures for end of life care (2009) The Care Quality Commission is an independent regulator of health and adult social care in England. End of life care, including bereavement support services are one of the core areas they inspect. This includes basic nursing care, specialist Palliative care, chaplaincy, and bereavement support and mortuary services (7). Source: Palliative Care Team Issue date: November 2016 Page 2 of 13
2.2 Local The West Suffolk Hospital NHS Trust formed the Bereavement Steering Group in June 2006. Chaired by the Executive Chief Nurse, this looks at the services the hospital already provide, appraise the gaps and prioritise developments. Members of the group all have an interest or a direct involvement in dealing with death and bereavement. In 2008 this group amalgamated with the Procedures Following Death Group to form the West Suffolk Hospital End of Life Operational Group. 3 STAFF RESPONSIBILITIES The Chief Executive Will ensure the Trust has a policy for bereavement. Executive Chief Nurse Will ensure that this policy is implemented operationally and monitored as part of the Clinical Governance Strategy Clinical Directors and General Managers Will ensure this policy is disseminated and implemented within their areas of responsibility. Those managers and directors who have a specific remit for services involved with bereavement will ensure communication regarding changes within their service. Matrons and Service Managers Will ensure all staff in their areas are aware of and understand the policy and that it s implemented into practice locally. Will investigate failures to comply with the policy and ensure corrective action is taken to prevent a recurrence. Ward Managers Will ensure all staff are aware of, and comply with, the policy. Will ensure that failures to comply with the policy are reported via the datix reporting system and ensure corrective action is taken to prevent a recurrence. All staff Will adhere to Trust policy Will report all failures to comply with policy via the datix reporting system Will use this policy in conjunction with all other Trust policies that relate to bereavement. 4 OPERATIONAL ISSUES AND LOCAL POLICIES/PROTOCOLS/GUIDELINES The principles outlined in this policy apply to the whole range of deaths that occur in the West Suffolk Hospital. In addition, there are specific local protocols in relation to the following: In Patient Theatre Critical Care Services Accident and Emergency Woman and Child Services Pathology Services Source: Palliative Care Team Issue date: November 2016 Page 3 of 13
5 PRINCIPLES The following principles are outlined in the When a Patient Dies guidance for professionals on developing bereavement services (2011) Personalised care The person who is reaching the end of life, their family and carers should be kept at the centre of all bereavement service provision. Choice and control for the individual should be promoted to ensure that the individual, their family and carers are continuously included in the care planning process. Accurate, timely, clear and detailed information should be offered to ensure informed choices are made. Sensitive, honest and clear communication is essential between professionals, individuals, families and carers if personalised and timely care is to be achieved. Legal rights Ensure that individual s legal rights are protected at all times. All legislation should be adhered to, in particular: The Mental Health Act 2007 The Mental Capacity Act 2005 The Equality Act 2010 The Health and Social Care Act 2008 The Data Protection Act 1998 The Births Deaths and Marriages Act 1953 The Coroners Act 1988 and amended rules 1984 The Human Tissue Act 2004 The Health and Safety at Work Act 1974 Dignity and respect Bereavement services must embrace the principles of dignity and respect in care, which includes, but is not limited to, providing an environment that promotes privacy. Additional respect of meeting personal, spiritual and faith beliefs is important to meet the holistic needs of the individuals, families and carers. Working collaboratively with hospital chaplaincy leads will be vital in ensuring these needs are met. Family and carers are partners in care Recognition of the significant contribution that families and carers of people facing the end of their life make to meeting the needs of that individual from diagnosis through to the terminal phase of illness, at the time of death and following death. Equality The Equality Act 2010 contains an integrated public sector equality duty, requiring public sector bodies and organisations carrying out functions to have due regard for the need to eliminate discrimination, advance equality of opportunity and foster good communication. Source: Palliative Care Team Issue date: November 2016 Page 4 of 13
Recognising the need for bereavement care and support Ensure that bereavement services recognise and incorporate the three components of bereavement support as identified in Improving Supportive and Palliative Care for Adults with Cancer (2004) 1. Grief is a normal reaction to bereavement. Some people who are bereaved may lack an understanding of grief so accessible information should be provided on grieving and how to access support services, including services for children and young people if required. 2. Some adults, children and young people who are bereaved may require some direct support over and above that which family and friends can provide. 3. A number of people who are bereaved will require more intense, specialist support, usually involving access to professionals. Early recognition and referral is essential. This component includes provision for meeting the specialist needs of people with learning disabilities, children and young people who are bereaved. Skilled workforce As detailed in the End of Life Care Strategy, it is important that bereavement care is provided by a workforce that has relevant skills and knowledge to undertake that care. It is equally important that professionals and volunteers have access to support and supervision to undertake their role. 6 BEREAVEMENT CARE PATHWAYS FOR EXPECTED AND UNEXPECTED DEATHS The following pathways provide the healthcare team with a framework, linking together relevant policies, resources and information. Source: Palliative Care Team Issue date: November 2016 Page 5 of 13
6.1 Bereavement Care Pathway for EXPECTED Death (1) CARE PRIOR TO DEATH (2) POINT OF DEATH (3) CARE OF BODY (4) ADMINISTRATION (5) CARE OF BEREAVED 1 Care Prior to Death Policies, Guidelines*, Information and Useful Links (*all available on Pink Book) 1.1 Where death is expected it is important for bereavement care to commence before an individual dies. Staff should give patients the option of speaking to a chaplain regarding the spiritual support available for the patient and family members, often at the point where information regarding diagnosis and/or prognosis is communicated to individuals, their family and carers. The way in which diagnosis and prognosis is communicated to people can have a significant impact on bereavement; therefore relevant clinicians need to be skilled and experienced in good communication. Last Days of Life/Care of the Dying guideline Breaking bad news policy. EPARS Policy Patient Wills Policy Privacy, Dignity and Respect for Patients End of Life Care Policy Mental Capacity Act and the Independent Mental Capacity Advocate IMCA Policy 1.2 Staff should be familiar with the tools and resources available to ensure best practice in the care of the dying and be aware of the location in the clinical area. There are templates on ecare for last days of life care which include prompts for discussion around organ and tissue donation. 2 Point of death 2.1 Verification of death. There is a template on ecare documentation for verification of death Religious and spiritual guidelines on Chaplaincy section on the WSH website. Contact the Chaplaincy 01284 713486 End of Life. The Facts. Booklet if Rapid Discharge home to die (Marie Curie website) End of Life Care pages on Pink Book Last days of life rounding tool on ecare ##lastdaysoflifemedical/nursing checklist document template on ecare Verification of Expected Death (Nurses) Confirmation of death (Academy of Medical Colleges)) e-care document template ##verificationofdeath Source: Palliative Care Team Issue date: November 2016 Page 6 of 13
2.2 Immediate communication and care of the bereaved in the clinical area. If the patient has agreed to donate their tissues please contact tissue services on 08004320559 (24hr phone line) and inform bereavement support officer Breaking bad news guideline Care After Death guideline Information and Help for the Bereaved Booklet Viewing guideline Last Days of Life, Care of the Dying information booklet 2.3 Property and valuables Patient Property Policy 2.4 Notification of death Please inform the Bereavement support Officer as soon as possible. Ext 3410 2.5 Care of body: Care of the deceased Specific guidance is available for safe handling of heavy patients. Notification of Death Form (kept in Clinical Area) Care after Death including infection control and identification. Religious and spiritual guidelines on Chaplaincy section on the WSH website. Contact the Chaplaincy on 01284 713486/713771 Handling Patients and Safe Handling of Loads 2.6 Transfer of body within the Hospital Transport of bodies within hospital guideline (Porters) Release of body directly from the ward guideline 3 Care of Body - Mortuary Care of the body Further examinations 4 Administration 4.1 Bereavement Support Officer. Located in the General Office Ext:3410 4.2 Completion of The medical Certificate of Cause of Death in Bereavement support Office Care and Respect in Death: Good Practice Guidance for Mortuary Staff. DOH (2006) Consent for Post Mortems Dealing with Coroner (Police) bodies Operational policy Patient Wills guideline Guidance from certificate book Good practice guidance Procedure for inquest arrangements 4.3 Communication around death Health Records Policy e-care discharge summary Informing the GP Ward Clerk Handbook 5 Care of the Bereaved Information and Help for the Bereaved Booklet Signposting bereavement services Additional information leaflets available from Bereavement Support, including details of Source: Palliative Care Team Issue date: November 2016 Page 7 of 13
spiritual support and resources available on request through the Chaplaincy office 01284 713486/713771. Source: Palliative Care Team Issue date: November 2016 Page 8 of 13
6.2 BEREAVEMENT CARE PATHWAY FOR UNEXPECTED DEATH (1) AT POINT OF DEATH (2) CARE OF THE BODY (3) FURTHER EXAMININATIONS AND ADMINISTRATION (4) CARE OF BEREAVED 1 At Point of Death Policies, Guidelines, Information and Useful Links Resuscitation Policy Incident Reporting and Management Policy Patient Documentation (Nursing guidelines) Privacy, Dignity and Respect for Patients Health Records Policy 1.2 Verification of Death There is a template on e-care documentation for verification of death Only doctors and site coordinators*(see note) can verify unexpected deaths. 1.3 Immediate Communication and Care of the bereaved in the clinical area. If the patient has agreed to donate their tissues please contact tissue services on 08004320559 (24hr phone line) and inform bereavement support offer Verification of death guideline (Nursing) e-care document template ##verificationofdeath Breaking Bad News Policy Religious and spiritual guidelines on chaplaincy section on the WSH website. Contact the Chaplaincy 01284 713486/713771 If patient or relatives have requested chaplaincy involvement at time of death a Chaplain should be call through the switchboard. Information and Help for the Bereaved Booklet. Care After Death and Viewing guideline 1.4 Property and Valuables Patient Property Policy 1.5 Notification of death. Please inform the Bereavement support Officer as soon as possible. Ext 3410 1.6 Care of body: Care of the Deceased Specific guidance is available for safe handling of heavy patients. Notification of Death Form (kept in clinical area) Care After Death including infection control and identification. Religious/Spiritual guidelines on chaplaincy WSH website. Contacts on intranet (Chaplaincy) Handling Patients and Safe Handling of Loads Source: Palliative Care Team Issue date: November 2016 Page 9 of 13
1.7 Transfer of body within the Hospital Transport of bodies within hospital (Porters) Release of body directly from the ward guideline 2 Care of body: Mortuary Policies, Guidelines, Information and Useful Links 2.1 Care of the body Care and Respect in Death: Good Practice Guidance for Mortuary Staff. DOH (2006) (Link as above) Removal of body from hospital Mortuary Viewing Guideline 3 Further examinations and administration Discussion with coroner office 3.1 If Medical Certificate of cause of death can be issued continue as above (Expected death) 4 Care of the Bereaved Dealing with Coroner (Police) bodies Consent for Post Mortems Procedure for inquest arrangements Guidance from certificate book Good practice guidance e-care discharge/deceased summary Information and Help for the Bereaved Booklet Chaplaincy Department, with Bereavement support, are at hand to advise on bereavement support available in the hospital and community. Signposting bereavement services Additional information leaflets if appropriate 7 ADDITIONAL INFORMATION FOR SPECIFIC DEPARTMENTS DEPARTMENT Critical Care A&E (including death on arrival) POLICIES, GUIDELINES AND WRITTEN INFORMATION Critical Care Information on Death and Bereavement. Critical Care Section on Pink Book Coroner and Deaths. A&E Section Pink Book Sudden Unexpected Death in Infancy (SUDIC) Protocol Procedure Guide in the Event of Adult Loss in A&E When Sudden Death Occurs - Coroners and Inquests When a Baby Dies Suddenly and Unexpectedly Woman and Child Services Management Following Stillbirth or Neonatal Death, Feb 2016 Following Delivery of a Non-Viable Fetus, February 2016 Management of Intrauterine Death, February 2016 Action to be Taken in the Event of a Sudden Infant Death, February 2015 Maternal Death, February 2016 Pathology services Disposal of Foetal Material Guidelines Source: Palliative Care Team Issue date: November 2016 Page 10 of 13
8 EDUCATION AND TRAINING Education and Training in End of Life Care is disseminated throughout the Trust via: Palliative care practice development nurse role Foundation years training programme and CMT Audit presentation through medical/surgical steering groups. Palliative care multidisciplinary link days End of Life Care Study days The Trust recognises that good communication skills are essential in care of the dying and bereavement care. Development of communication training, which is tailored to the specific needs of different staff groups will be taken into account. Advanced Communication training is available. 9 REVIEW AND MONITORING The West Suffolk NHS Foundation Trust will review and monitor bereavement care through the End of Life Care Operational Group. Quarterly meetings will focus on: 1 Review and development of current and new policies, guidelines and written information. 2 Analysis of datix reports regarding death and bereavement. 3 Analysis of complaints data regarding death and bereavement to address poor/inconsistent practice. 4 Review and dissemination of audits relating to End of Life Care 5 Monitoring of end of life care education through End of Life Group This group will be accountable to the Patient Experience-Committee Information will be maintained on the intranet and information will be reviewed every two years. 10 ADDITIONAL RESOURCES AND REFERENCES Nice Care after Death bereavement support link: http://www.nice.org.uk/guidance/qualitystandards/endoflifecare/careafterdeathberea vementsupport.jsp NHS Choices Organ donation: http://www.nhs.uk/conditions/organ-donation/pages/donationprocess.aspx Dying Matters: http://www.dyingmatters.org/ End of Life resource link: http://www.nhs.uk/planners/end-of-life-care/pages/what-is-end-of-life-care.aspx Source: Palliative Care Team Issue date: November 2016 Page 11 of 13
End of Life Care pages Pink Book: https://www.wsh.nhs.uk/extranet/endoflifecare/westsuffolkhospitalendoflifecare. aspx The bereavement pathway. Cruse: http://www.bereavementpathways.org.uk/bereavement-timeline-new.html Guidance for care after death (2015) second edition: http://www.ehospice.com/uk/default/tabid/10697/articleid/14937/ References: 1 The report of the public inquiry into children s heart surgery at the Bristol Royal Infirmary 1384-1995: learning from Bristol. Department of Health, 2001. The Royal Liverpool Children s Hospital Inquiry Report. Department of Health, January 2001, www.dh.gov.uk 2 The Removal, Retention and Use of Human Organs and Tissue from Postmortem Examination. Advice from the Chief Medical Officer. Department of Health, Department for Education and Employment, Home Office, January 2001, www.dh.gov.uk 3 Chief Executives Bulletin. Department of Health, 1 April 2004, www.dh.gov.uk 4 Improving Supportive and Palliative Care for Adults with Cancer. National Institute for Health and Clinical Excellence, March 2004 5 End of life care for Adults: NICE Quality standards QS13 2013 https://www.nice.org.uk/guidance/qs13/chapter/quality-statement-14-careafter-death-bereavement-support 6 End of Life Care Strategy, Department of Health, July 2008. www.dh.gov.uk/publications 7 CQC website www.cqc.org.uk Author(s) Dr Rosemary Wade, Consultant in Palliative Medicine Samantha Hobson, Practice Development Nurse, Palliative Care Team. Other contributors Dr Mary McGregor, Consultant in Palliative Medicine Approvals and endorsement: End of Life Operational Group October 2016 Clinical Standards Committee Consultation Critical Care, Midwifery Issue no 4 File name Bereavement Policy November 2016 Supersedes 3 Equality Assessed Yes Implementation Internet. Corporate Managers Monitoring: (give brief details how See point 9.0 Review and Monitoring this will be done) Other relevant policies/documents Policies and documents listed in Pathways. and references Source: Palliative Care Team Issue date: November 2016 Page 12 of 13
Additional Information Source: Palliative Care Team Issue date: November 2016 Page 13 of 13