Care of the Adult Patient Following Death (last Offices) Standard Operating Procedure (SOP) DOCUMENT CONTROL: Version: 2 Ratified by: Quality and Safety Sub Committee Date ratified: 27 February 2017 (specific amendments) Name of originator/author: Specialist Palliative Care Nurse Consultant Name of responsible Clinical Quality Group committee/individual: Date issued: 29 March 2017 Review date: October 2018 Target Audience All clinical staff working within St John s Hospice Inpatient Unit.
1. Aim The aim of this Standard Operating Procedure (SOP) is to provide further guidance to clinical staff working within St John s Hospice in relation to caring for a deceased patient and supporting their relatives. The physical care given to patients following death in a clinical setting has been traditionally referred to as last offices, however in this guidance we refer to it as care after death, a term more befitting of a multiple cultural society (Wilson and White, 2011). Continued compassionate, sympathetic, dignified and quality care for a patient, once they have died, and supporting their relatives is enormously important and a privilege. We only get one chance to get it right and so we need to ensure that we all understand the steps that are required in order to provide a seamless and co-ordinated pathway of care following death (Wilson and White, 2011, Wilson, 2015). We also need to recognise that we, as care givers and our colleagues, who are involved in the care process, may also be affected at this emotional and stressful time. The term relative used throughout this policy is applicable to all family members and friends of the dying/deceased patient. 2. Scope This standard operating procedure applies to all clinical staff working within the inpatient unit at St John s Hospice. Whilst the qualified nurses on the inpatient unit will need to have a detailed knowledge of the expected minimum standards in relation to their role in care after death, other clinical staff on other inpatient wards within the RDASH and community services, including medical staff, will need to have an awareness so they are able to answer any queries which patients or their families may raise if involved in Advanced Care Planning. 3. Link to Overarching Policy and/or Procedure This Standard Operating Procedure is overarched by the following policy which can be found on the RDaSH Trust Policy Web Site (http://www.rdash.nhs.uk/category/publications/policies/): Transfer of the Deceased into the care of another provider (expected and unexpected deaths) (Policies/ Clinical Policies/ Clinical General/End of Life Care) Staff also need to be familiar with the following procedural documents: Page 2 of 10
Last Offices (Current on-line edition) Royal Marsden Hospital Manual of Clinical Procedures, (Clinical Policies/Royal Marsden Clinical Procedures) Safer Manual Handling Operations Policy, (Policies/Corporate Policies/Health, Safety and Security) Personal Protective Equipment (PPE) Policy, (Policies/ Corporate Policies/ Health, Safety and Security) Standard Precautions Policy, (Policies/Clinical Policies/Infection Prevention and Control) Trust Cleaning Systems and Processes for the Environment, Patient Equipment and Medical Devices Policy, (Policies/Clinical Policies/Infection Prevention and Control) Blood and Body Fluid Spillages Policy, (Policies/ Clinical Policies/ Infection Prevention and Control) Decontamination Policy, (Policies/ Clinical Policies/ Infection Prevention and Control) Clinical Risk Assessment and Management Policy, (Policies/ Clinical Policies/ Clinical General/ Care, Treatment and Assessment) Verification of Expected Death Policy (Policies/ Clinical Policies /Clinical General/End of Life Care) National Guidance - Care after Death Guidance for staff responsible for care after death (http://www.hospiceuk.org/what-weoffer/publications) 4. Procedure Once a patient has died, it is imperative that a timely and sensitive process of care follows. The nurse in charge of a particular shift should oversee the care and delegate roles, as appropriate. The following should be adhered to: 4.1 The fact of death has occurred, immediately document the time of death. 4.2 If the relatives are not present, inform them as directed in the admission documentation. 4.3 Start the Checklist following the death of a patient 4.4 Does the patient need referring to the Coroner? See Transfer of the Deceased into the care of another provider (expected and unexpected deaths) for guidance. a. When an expected death occurs within 24 hours of admission to the hospice or when the patient had a known illness that requires referral to the coroner (e.g. Page 3 of 10
Mesothelioma) but dying was anticipated and expected, it is not necessary to involve the police. Formal arrangements have been agreed between the Coroner and St John s Hospice. The following process MUST be adhered to (Flowchart -appendix 1) i. On admission for all patients ensure that nurse who is identifying the patient and the nurse who has put the ID band on the patient has been documented in notes. ii. If the patient dies out of hours and death is either within 24 hours of admission or due to industrial related disease Relevant persons complete the following forms: 1. Identification statements for staff (appendix 2), 2. Identification statements for relatives (appendix 3). 3. Identification statements for funeral director (appendix 4). 4. Nurse may perform Verification of Expected Death as normal iii. Ring Steadman s Funeral Directors. If death within 24 hours they will transfer body to Steadman s, if industrial related death they will transfer body to DRI mortuary (for further examination). iv. Fax all 3 completed forms to 01302 736365 immediately. Send hard copies (with copy for patient s notes) in post the next working day. v. Next working day ward doctor will liaise with the coroner. If death within 24hours and body at Steadman s then arrangements can be made to move body to appropriate funeral home once discussed with coroner. b. The Coroner s jurisdiction extends to those who are detained under the MCA DoLS. If death is expected follow instructions for point a c. Has there been a complaint around the care of the patient or any clinical incidents prior to death? If yes, coroner referral will be required and death should be treated as not expected. d. If the death is unexpected (e.g suspicious circumstances, following recent serious incident, following recent fall). The body cannot be touched, the room needs to be secured to preserve evidence, police need notifying of an unexpected death immediately, informing and supporting for the family is essential for detailed instructions see Transfer of the Deceased into the care of another provider (expected and unexpected deaths). Page 4 of 10
4.5 Are there any religious requirements to be adhered to? For additional guidance see Royal Marsden Clinical Procedures, chapter Last Offices (requirements for people of different religious faiths) (Royal Marsden, 2015) e. Does the chaplain need to be notified? 4.6 Verification of an Expected Death should take place within one hour (best practice in inpatient setting) (Wilson and White, 2011, Wilson, 2015). For procedure follow Verification of an Expected Death policy f. Document clearly in the electronic patient record (SystmOne/ TPP) the rationale for any delay. g. If the expected death occurs out of hours and there is not a nurse on duty that is trained in verification of death the procedure is to contact Unplanned Care and document in the notes the reason for the delay. 4.7 Notify the Doctor or medical cover that the person has died and to request completion of the Medical Certificate of The Cause of Death (MCCD) at the earliest opportunity. h. If specific timeframes are required for religious requirements, ensure prior arrangement have already occurred and plan in place. 4.8 Personal care after death needs to be carried out within two to four hours of the person dying, to preserve their appearance, condition and dignity. i. Document clearly in electronic patient record (SystmOne/ TPP) the rationale for any delay 4.9 Give the relatives the what to do after death leaflet and discuss with the relatives a time appropriate with them to return to pick up the MCCD. 4.10 The body s core temperature will take time to lower and therefore transferring the deceased to the family appointed or trust appointed funeral director for refrigeration within four to six hours of death is optimum. j. Allow relatives to spend time with their loved immediately after death. k. When giving personal care after death, apply the cooler blanket and cover with hospice sheet. This will allow family to spend longer time with their loved one or allow family to come and see their relative in the hospice if they wish. Page 5 of 10
l. When family are not in the room (not arrived yet or have left), turn on air conditioning to its lowest setting and monitor the temperature of the room hourly (after the initial four hours following death). 4.11 Notify the Family appointed funeral director or trust appointed funeral director to collect the deceased. 5. For guidance regarding non-standard care after death and problems solving please refer to: The Royal Marsden Clinical Procedures Last offices problem solving (Royal Marsden, 2015). Verification of Expected Death Policy. (see Section 3. above) National Guidance for Care after Death (see Section 3. above) Transfer of the Deceased into the care of another provider (expected and unexpected deaths) policy. (see Section 3. above) 6. References 1. Wilson, J. White, C. (2011) Guidance for Staff Responsible for Care after Death. National End Of Life Care Programme and National Nurse Consultant Group. 2. Wilson, J (2015) Care After Death: Guidance for Staff responsible for Care after death. London. Hospice UK. 3. Royal Marsden Clinical Procedures (2015) available from www.rmmonline.co.uk/manual or via link on intranet - as line manager for password. Page 6 of 10
Appendix 1 PROCESS FOR DEATHS WITHIN 24 HOURS ADMISSION AND DEATHS RELATED TO INDUSTRIAL DISEASE THAT OCCUR OUT OF HOURS On admission for all patients: Ensure that nurse who is Identifying the patient and nurse who has put the ID band on the patient has been documented in notes If patient dies out of hours and death is either within 24 hours of admission or due to industrial related disease (commonly mesothelioma) i.e. need referring to coroner, then get the relevant forms: Identification statements for staff, relative and funeral director. Verify death as normal Ring Steadman s Funeral Directors. If death within 24 hours they will transfer body to Steadman s Funeral Directors, if industrial related death they will transfer body to DRI mortuary (for further examination) Fill out the two forms (staff and relative) (see example). Ensure Steadman s Funeral directors also fill out their form as well. Fax forms to 01302 736365 immediately. Send hard copies (with copy for patient s notes) in post the next working day Next working day ward doctor will liaise with the coroner. If death within 24hours and body at Steadman s then arrangements can be made to move body to appropriate funeral home once discussed with coroner. Page 7 of 10
Identification Statement for Staff Appendix 2 Page 8 of 10
Identification Statement for Relatives Appendix 3 Page 9 of 10
Identification Statement for Funeral Directors Appendix 4 Page 10 of 10