Notification of a Death Record of Death C120002 Cremation cert
Notification; the registered nurse is responsible for notifying family, medical staff, telephone officer and mortality coordinator or the Duty Nurse Manager after hours Registrar or house officer for patients team is responsible for reporting to and discussing death with the consultant Registrar or house officer for the team are responsible for completing the record of death for every patient death Registrar or house officer notify the patient s GP If coroner takes jurisdiction s/he will notify the Police to attend Cremation certificate filled in for every patient unless they are definitely for burial
Medical staff must examine the patient and ascertain that life is extinct and record this before the patient is transferred to the Mortuary
If the patient dies away from their home ward negotiate with the NIC of the ward to ascertain the most appropriate place for the family & the deceased patient to spend time prior to mortuary transfer Enter information on PMS Staff may not contact funeral directors Extinction of life No palpable carotid pulse for a minimum of two minutes No heart sounds heard for a minimum of two minutes No breath sounds heard for a minimum of two minutes No response to centralised stimuli Fixed and dilated pupils (no pupil response to light)
Pallor mortis Livor mortis Rigor mortis Algor mortis
Pallor mortis; a paleness of the body begins almost immediately due to lack of blood circulation Livor mortis; dependent lividity caused by gravity influenced blood pooling that becomes fixed. Rigor mortis; complex chemical reactions cause a gradual stiffening of the muscles, voluntary and involuntary (may cause an involuntary exhalation of air) rigor is influenced by pre morbid factors such as drugs, exhaustion, illness & infection. Rigor passes between 24 72 hours Algor mortis; death chill at about 8 hours the body starts cooling rapidly
Lie the patient flat on top of mortuary sheet, straighten limbs & close eyes Ensure the deceased is identified by two legible bracelets on an arm & a leg Ask the family if there are any special instructions
Chemotherapeutic alerts; biotoxic agents within 48 hours body bag + biohazard sticker Radioactive Isotopes alerts; contact physicist on call to check radiation levels before release to mortuary Biotech alerts; pacemaker, implanted defibrillator, spinal stimulators Consider a body bag if the person: has an infectious disease or is leaking copious fluids Cover wounds with op site Prepare the deceased with hygienic & aesthetic consideration Dress the deceased Place patients dentures Prepare the deceased for the family to spend time with them if appropriate
Nursing notes must include: If deterioration & death were sudden Notification of medical staff timeline Notification & presences of whanau Treatment immediately prior to death Time of death Time & name of last person to see the patient alive Details of disposition of patient property & valuables Documentation of extinction of life by RMO All notes accompany the deceased person to the mortuary
Spiritual maters Patient jewellery Relatives contact the Funeral Director Post mortem or consent for organ donation is the responsibility of the medical officer
Offer religious / spiritual support with chaplaincy service Identify and document jewellery which is to stay with the deceased Property must be recorded and if returned to relatives documented in the clinical notes, or bagged labelled and delivered to lodge (via ward) it may be collected from the orderlies lodge at any time Damaged / cut clothing can be discarded but must be documented in the clinical notes No medications are to be returned with the belongings of the deceased Valuables are released from the revenue office during office hours, money will be returned in form of a cheque Valuables & money record on deceased patient property book and place in valuables envelope E10 0830-1700 deliver to revenue office out of hours > duty manager for placement in duty office safe
The coroner will usually insist on jurisdiction in cases where death was: a person admitted from outside custodial care from an unknown cause suicide or poisoning a direct or subsequent effect of injury during or as a delayed result of surgery or anaesthesia or procedure
Once the coroner has taken jurisdiction no-one may visit the person without the coroners consent Death within 24 hours of admission is not alone a prerequisite for coronal enquiry The body is in the Coroner s possession from the time of death; removal of some devices may significantly obscure the outcome of the coronial or criminal investigation so if unsure leave it The coroner is a lawyer and may have no medical expertise therefore if advice is needed contact the forensic pathologist or an independent senior medic. In general all lines and drains are left in situ plus ETT & fluids. Deaths that must be reported under section 14(2) Coroners Act 2006; Without known cause; suicide, or unnatural or violent Medical staff feel unable to sign death certificate During medical surgical or dental operation or treatment Occurring while woman was giving birth or as result of pregnancy Detained in intuitions under section 9 (alcoholism & drug addiction act 1966) Placed in residence under children, young person and their families act Child or young person in custody of an iwi or cultural social service, child and family support service Patient in section 2(1) compulsory assessment and treatment; Mental health act 1992 Patient in section 3(1) compulsory care and rehabilitation ; Intellectual disability act 2003 Prisoner section 3(1) corrections act 2004 Custody of police Control of security officer section 3(1) corrections act 2004
Any death likely to become a Coroner s Case, do not alter or absent anything from the body Leave all drains, lines & catheters, tubes in-situ Retain contents of drains and catheter bags Spigot all lines & tubes
Manage excess blood & body fluids Secure all lines in-situ Ensure all fluid volumes are recorded accurately Endotracheal tube? Severe gas or air embolism requires urgent consultation with the Forensic Pathologist on call Arrange for transfer to the Mortuary using the mortuary trolley via the orderlies Escort the deceased to the mortuary Support relatives viewing the deceased in the Mortuary Viewing room
Auckland & Christchurch are the national sites for the performance of high risk Post Mortems The deceased is to be transported in a body bag Following post mortem either burial or routine cremation are appropriate CJD, hep b & c, SARS, HIV, TB
A nurse must escort all patients to the mortuary The orderlies will arrange the Mortuary trolley or bed as appropriate Transfer to be conducted discretely via quieter corridors for the dignity of the deceased & whanau Transfer to the mortuary is required within four hours of death At the mortuary the nurse verifies the deceased against the case notes with the orderly and records in the mortuary receipt book Babies may be carried to the mortuary
Pronouncing Life Extinct Routine forms required Record of Death Form Death Certificate Cremation Certificate Other forms which may be required Deceased Person Certificate Certificate for Coroner as to Cause of Death Requisition for a Hospital Post Mortem Forms Incident form
Pronouncing Life Extinct: registered medical officer must attend the patient to pronounce life extinct. Including appropriate examination and documentation of such, including time of notification, time of examination The patient must not be transferred to the mortuary until this has been completed Routine forms required: Record of Death Form: must be completed for all CH deaths, required as a medico-legal receipt and indicates due consideration of Coroner referral has occurred Death Certificate: must be completed for all noncoronial cases where the medical practitioner is satisfied that the death was a natural consequence of the death concerned Cremation Certificate: completed for patients who are for cremation. The certificate is double sided and the RMO completing this certificate must have seen the patient before and after death and be the same doctor who fill out the death certificate
Other forms which may be required: Deceased Person Certificate: this is a police form required to be completed by the RMO from the treating team if the Coroner takes jurisdiction Certificate for Coroner as to Cause of Death: infrequently used certificate used when a coroner takes jurisdiction over a case but dose not require a post-mortem The certificate in lieu of Post-mortem should be completed by a senior registrar or consultant Requisition for a Hospital Post Mortem Forms: may only be completed for clinical autopsies (noncoronial) where the doctor is required to complete all death certificate forms before the autopsy. The family must give written permission on the Consent Form ref 0235 Clinical notes: document to accurately reflect what occurred in a manner that can stand up to scrutiny. A chronological record of care that must continue to be useful long after the care event.
When death occurs in theatre the theatre staff must assume the Coroner will take jurisdiction over the body
Burwood: no mortuary TPMH: mortuary CH & CWH: city mortuary CWH: 2x garden rooms for infants (3 rd & 5 th floors)
Coronial autopsies are carried out by the Coroner s Pathologist where the Coroner takes jurisdiction The police attend as the Coroner s agent & sign the body into the mortuary The police require someone to identify the body Team doctor complete a Deceased Person Certificate for the police A body under Coronial jurisdiction cannot be released until the autopsy is complete and a signed Coroner s Order for Disposal is obtained together with a Certificate for Cremation after Post mortem obtained by the attending pathologist