Rapid Response to Sudden Unexpected Child Death

Standard Operating Procedure 10 (SOP 10) Rapid Response to Sudden Unexpected Child Death Why we have a procedure? This procedure sets out the Rapid Response to be undertaken by the Dudley (BCPFT) Rapid Response Team following the unexpected death of a child. The policy follows the guidance in Working Together to Safeguard Children (2015) and the West Midlands Multi Agency Protocol for responding to Sudden Unexpected Death in Infants and Children (SUDIC) under 18 (2012). The purpose of this procedure is to provide a consistent and coordinated approach to the unexpected death of a child. The procedure underpins the West Midlands Multi Agency Protocol and provides specific guidance to BCPFT Dudley staff who work in collaboration with partner agencies. This will help those agencies and staff involved to: Support the child s family In conjunction with the coroner establish the cause of death Identify contributory factors What overarching policy the procedure links to? Safeguarding Children Policy Which services of the trust does this apply to? Where is it in operation? Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all Who does the procedure apply to? Paediatric experienced practitioners who have completed the Trust s Rapid Response to an Unexpected Death of a Child training. When should the procedure be applied? On notification of an unexpected child death [Standard Operating Procedure (SOP 9) Reporting and Responding to a Child Death]. An unexpected death is when the death of a child was not anticipated as a significant possibility 24 hours before the death, or where there was a similarly unexpected collapse leading to, or precipitating, the events that led to the death (Working Together 2015). Unexpected deaths can include: Homicide/suicide Rapid Response to Sudden Unexpected Child Death Page 1 of 24 Version 1.0 October 2016

Accidental death Natural causes The process covers all children up to the age of 18 years (excluding both those babies born who are stillborn and planned terminations of pregnancy carried out within the law). How to carry out this procedure The Elements and Timeline of the SUDIC response in Working Together 2015 Immediate Response (24 hours) It is expected that the immediate management of unexpected deaths will be undertaken by those health personnel first called and/ or in attendance when a child has died unexpectedly, for example, Ambulance Service, General Practitioner, Midwife, Consultant Paediatrician on-call, A/E Department Staff and / or other Hospital Ward/ Department Staff. This process will be in line with the West Midlands SUDIC Protocol (2012). The designated person/nurse on-call for the Rapid Response Team should be notified of the child s death at the same time as the Police, Coroner and Children s Social Care. The responsibility for further management and support of the family will then, usually, Rapid Response to Sudden Unexpected Child Death Page 2 of 24 Version 1.0 October 2016

rest with the Rapid Response Team in conjunction with the Police, Social Care and BCPFT Dudley staff. Once notified of a child s unexpected death the Senior Investigation Officer (SIO), Consultant Paediatrician and nurse on-call, decide the level of rapid response necessary, dependent upon the circumstances of the child s death. In certain groups of children, e.g. Critically ill children, neonates who never leave hospital, certain aspects may vary. When a child with a known life limiting and or life threatening condition dies in a manner to at a time that was not anticipated, the Consultant Paediatrician on call, and the rapid response team will liaise closely and promptly with members of the medical, palliative or end of life care team to jointly determine how best to respond to that child s death. When a child dies unexpectedly in a non-hospital setting the SIO, Designated Paediatrician /Nurse on-call/sio should make a decision about whether a visit to the environment where the child died should be undertaken. There is a presumption that this would always take place for infants who die unexpectedly at home or collapse unexpectedly at home and subsequently die at hospital. The home visit is conducted by a designated paediatrician where possible, Nurse oncall and the SIO. It should be undertaken within 24 hours. The home visit gives the opportunity to review the history taken in the A/E department and may provide more detailed information about the events leading up to the death. The history proforma (SUDC protocol) will be used to guide and record the information gathering. Home Visit The Nurse on-call will receive a telephone call from either Police, Paediatrician, Named Nurse Dudley Group Foundation Trust, or the Safeguarding Childrens Team notifying them of the child death 0-18years The home visit needs to take place as soon as possible following the death, usually within a 24 hour period There may be a multiagency discussion prior to the home visit including Paediatrician, Police, Nurse on-call, GP, HV, midwife, Social Worker or relevant others depending on the age of the child The Police SIO and the health professional on arrival at the home will talk to the parents and observe the death scene Remember as nurses, you are not undertaking any forensic investigation. This is the role of the investigating officers. It is the Nurse role to gather background information about the events that led up to the death and to talk to the parents in the environment where the collapse or death occurred This is a pertinent time in the process as the parent s account of what happened is often different to the information already collected by the Paediatrician in the hospital setting. The Police SIO and Nurse must decide who will lead the questionnaire as a team in the process It is paramount that the nurse does not challenge the parents as to why the accounts may be different, it is important to remember that often the information gathered at the home visit is richer and more detailed as the parents/carers memories are triggered by the immediate environment of the tragedy. The Nurse must be supportive. This will help make clear what did or did not happen The Nurse must treat the parent s/carers with the utmost sensitivity allowing them to go at their own pace to use their own words. Let the parents/carers decide where the initial discussions take place as you will be visiting more than one room, let the parents/carers decide in which order each room is visited Rapid Response to Sudden Unexpected Child Death Page 3 of 24 Version 1.0 October 2016

The Nurse will take a narrative account of events leading up to the death, including places visited, people who have been in contact, visited the home and activities, note any changes from usual practice over the last few weeks Take a family medical history, details of any alcohol consumption and smoking in the household. Record any recent exposure to infection. Use your assessment skills during the process and the Scene Visit: Reviewing the Circumstances of the Death (Appendix 1) When parents/carers are ready, obtain a detailed account of last feed, sleep, and final account events which led to the collapse/death. This should be taken at the exact place where the collapse/death occurred where possible Ask where each parent/carer was and any other person in the household. Ask about the last feed if baby, or meal, how the child was put down to sleep, what position where they in when they were last seen. Record who last saw and/or heard the child, where they were and was there anything unusual The Nurse needs to observe the physical surroundings, reviewing the scene and record all information carefully within the Scene Review: Reviewing the Circumstances of the Death (Appendix 1) Rapid Response to Sudden Unexpected Child Death Page 4 of 24 Version 1.0 October 2016

The police will record the temperature of the room and sketch a detailed plan of the room, inspect the ventilation and heating and take any photographs or videos The Nurse using their assessment skills also needs to note the temperature of the room. Does it feel cold/warm/hot? Observe the environment, is the home cluttered, unkempt. Particular attention should to be paid to the room in which the child collapsed/died Was the floor cluttered? Was there enough room for an adult to stand between the child s cot/bed? If on a sofa, the immediate environment around the sofa, type of sofa, pillows, cushions, type of fabric. Any clutter on bed/cot/sofa. Was the bed/cot/sofa up against a radiator/heater/window? Has the bed/cot got an appropriate mattress? Is the cot/bed defective in any way? Observe the bedding, amount, layers and pillow. Was the bedding clean or dirty? Ask again, exactly what was the position of the baby/child when put to sleep and when found After the discussion, provide the parents/carers/family with the SUDIC bereavement information pack (Appendix 2). After the home visit, the Nurse and Police SIO will review all the information. If there is anything that could raise concerns about the possibility of abuse or neglect having contributed to the child s death. If there are any concerns about any of the surviving children in the household. Appropriate procedures should be followed SOP 1: Referrals to Childrens Social Care (Working Together 2015, DSCB Safeguarding Policy and Procedures) Sensitivity and respect to different faiths and cultures must be paid. For example, Muslims commence their burial process within 24 hours. The parents/carers must be informed sensitively and considerately that a Post Mortem is a legal requirement and why. A case discussion meeting should be held in accordance with DSCB Child Death Procedures within 48 hours. Rapid Response to Sudden Unexpected Child Death Page 5 of 24 Version 1.0 October 2016

Following Immediate Management (48 hours) In all cases a review discussion/meeting will take place following the preliminary results of the post-mortem examination becoming available, normally within 5-7days following the death. The discussion will involve the designated paediatrician, the SIO, Children s Services, Lead Nurse, and other relevant professionals. All relevant agencies should be invited. The purpose of the discussion/meeting is to ensure: All agencies are informed and updated Any concerns are identified and managed All professionals are working together Information/records should be updated Continued support for the family If the initial post mortem findings suggest evidence of abuse or neglect as a possible cause of death, the Police Child Abuse Unit and Children s Services should be informed immediately, and the Serious Case Review processes should be followed. If there are child protection concerns regarding children living in, or in contact with, the household a strategy meeting under child protection procedures must take place. The initial information sharing and planning meeting/discussion should include: Rapid Response to Sudden Unexpected Child Death Page 6 of 24 Version 1.0 October 2016

Health The lead paediatrician/designated health professional, the named health visitor or school nurse for the child, children s community nurse, the community midwife if appropriate, the general practitioner and the ambulance service. Local Authority Children s Social Care The children s social care team manager. Police The public protection unit detective inspector. Other contributors Education (where the child was attending school or nursery), Named professionals for child protection, mental health professionals (CPN or psychiatrists) and any other agency/person who have knowledge of the family/child and may have a contribution to make. 3 4 Months Following Death Final case review meeting The Local Authority will convene the final case review following the final results of the post mortem being available. The Designated Paediatrician, Police, Lead Nurse and Children s Services should always attend, in addition to the other professionals involved with the death/family. The purpose of this meeting is to: Give the opportunity to review all findings from the history. Examination of the environment of the death, post mortem and any investigations Establish the cause of death or causes of death following a full review of all information Identify any contributory factors intrinsic to the child, related parental care or wider family and environmental factors Specifically address any evidence of child abuse, neglect or poor parental care. In no evidence is identified to suggest maltreatment this should be documented as part of the minutes Identify the continuing needs of the family, including information and care of current and /subsequent children Identify potential lessons to be learnt Inform the coroner s inquest Provide support for all professionals involved Update and completion of information/records Agree how detailed information about the cause of the child s death will be shared, and by whom, with the parents, and who will offer the parents ongoing support The meeting minutes should be sent to each agency involved. A copy of the Final Report will also be made available to the Dudley Child Death Overview Panel. Rapid Response to Sudden Unexpected Child Death Page 7 of 24 Version 1.0 October 2016

Appendix 1 The Scene Visit: Reviewing the Circumstances of Death Name Date of death / / Date of Birth / / Date of Scene Visit Time / / Professionals conducting Scene Visit Police Child Protection Officer Name Address Telephone Email Paediatrician or other nominated healthcare professional Name Address Telephone Email Social Care Representative Name Address Telephone Email Other Name Address Telephone Email Other Name Address Telephone Email Family member present Name Relationship to the child Rapid Response to Sudden Unexpected Child Death Page 8 of 24 Version 1.0 October 2016

A: Review of the history Builds on the initial history taken in the emergency department, allowing the circumstances leading up to the death to be explored in depth Narrative account of the events leading to the death over the last 24-48 hours Places the child and their parents/carers have been People they have come into contact with All activities undertaken Rapid Response to Sudden Unexpected Child Death Page 9 of 24 Version 1.0 October 2016

When and where the child was last seen or heard alive Presentation of the child during the last 24-48 hours their mood, disposition and health Indicate anything that represents a change from usual practice Include exposure to infection, alcohol, smoking (both prescription and elicit), drugs or other harmful substances Family History Include ages, occupations, relevant medical history and social background of household members including the child. History of illness, disease, substance misuse, violence, presence and temperament of pets/animals. Rapid Response to Sudden Unexpected Child Death Page 10 of 24 Version 1.0 October 2016

B: Environment where the child died Evaluation of the scene where the child died: where the child has died at home, the room and environment can be observed. In other situations this may involve a separate visit to the scene of the death. Size of the room Is the room cramped? The Room Is there room for an adult to stand beside the cot/bed? What is the size of the room? What is the orientation of the room (East/West facing etc.) Contents of the room Is more than 50% of the floor space visible? Is there at least one clear surface? What are the contents of the room What is the position of the furniture and cot in relation to the heaters and radiators? Ventilation in the room What windows, doors and other openings are there? What sources of heat/cooing are in the room? When are these switched on and off? What temperature are they set at? What is the current temperature? Rapid Response to Sudden Unexpected Child Death Page 11 of 24 Version 1.0 October 2016

What is the temperature taken from inside a drawer to estimate the temperature hours before? Cleanliness of the room Is there rubbish on the floor/surfaces? Is there an accumulation of unwashed dishes or food? Is there excrement on the floor? Hazards in the room Is there a smell of gas? Is there damp or mould? Are there any faulty appliances or fixings? Any evidence of cigarette, alcohol or drug use? Parents/carers should indicate any changes that have occurred in the room in the time between the child being found collapsed/dead and at the time of the visit Is there any evidence of neglectful care? Rapid Response to Sudden Unexpected Child Death Page 12 of 24 Version 1.0 October 2016

Over-wrapping or over-heating Is there evidence of over wrapping or over heating? The sleep environment How many layers was the baby wrapped in? Potential restriction to ventilation or breathing Is the sleeping space cluttered? Is there adult size bedding or pillows? Is there any risk of smothering? Potential Hazards Is the cot, moses basket or pram on a secure base? Are there gaps in the mattress? If a pushchair was used, was the baby strapped in securely and safely? Is there anything overhanging the sleeping space other that a cot mobile? Are there any other hazards in the room? Sleeping position What position was the child placed down to sleep in? What position was the child found in? What were the positions of other persons in the sleeping environment? Where there any potential or actual obstruction to the airways? Rapid Response to Sudden Unexpected Child Death Page 13 of 24 Version 1.0 October 2016

Parent/carer information and support Parents aware of purpose of the home visit Yes No Parent aware of how the information collected will be stored and used Parents aware of the follow support available to them Yes Yes No No Person Completing the Visit: Designation Name Address Telephone Email Rapid Response to Sudden Unexpected Child Death Page 14 of 24 Version 1.0 October 2016

C: Diagram of the Environment Rapid Response to Sudden Unexpected Child Death Page 15 of 24 Version 1.0 October 2016

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Date/Time/Venue Reason for Contact and Summary of Visit & Agreed Actions Signature Rapid Response to Sudden Unexpected Child Death Page 18 of 24 Version 1.0 October 2016

Date/Time/Venue Reason for Contact and Summary of Visit & Agreed Actions Signature Rapid Response to Sudden Unexpected Child Death Page 19 of 24 Version 1.0 October 2016

Appendix 2 Dudley Child Death Overview Panel The Child Death Review (England) Information for families Rapid Response to Sudden Unexpected Child Death Page 20 of 24 Version 1.0 October 2016

Government legislation requires that when a child dies a Child Death Review must be carried out. This is because in doing so we may find ways of doing things differently that help other children and families in the future and hopefully prevent further such child deaths. We understand that this is a very stressful time but feel it is important to tell you briefly about our role in the review. The following information helps to explain the process that has to happen following the death of a baby, child or young person under the age of 18 years old. The Review of Each Child s Death Information about each child and how they died is collected together and summarised into an anonymised report. The information may come from records held by hospitals, local health services (e.g. GPs, Health Visitors and School Nurses), Schools, Police, Children s Social Care and other agencies that knew the child. The report also includes details about the home and family circumstances so that the Panel can fully understand the events leading up to the child s death. The Child Death Overview Panel that includes doctors, other health specialists, children s social care staff, education staff and the police meets regularly to look at the reports. The Panel will look at all the information surrounding each child s death, to better understand how and why children die and possibly recommend ways to improve how things are done for children and their families in Sandwell in the future. The Panel is also there to ensure families have the right support following their child s death. Rapid Response to Sudden Unexpected Child Death Page 21 of 24 Version 1.0 October 2016

Can Families Contribute to the Review? Yes. We may not need to speak to you directly about this review, but you can contact us at any time to share any issues surrounding your child s death which you feel would be of value to the panel s discussion. All the information we gather will be treated with the greatest respect and in strictest confidence. Findings, recommendations or reports will not name your child or family. How Do I Contact the Panel? To share any information that you have or ask any questions please write to the Child Death Overview Panel office at: CDOP Designated Person Safeguarding Childrens Team Cross Street Health Centre Cross Street Dudley DY1 1RN 01384 366210 We cannot give you individual feedback from the Panel but you are welcome to read our anonymised annual report that is available via the following web site: http://safeguarding.dudley.gov.uk Sources of bereavement support include: A Child of Mine http://www.achildofmine.co.uk Child Death Helpline 0800 282 986 www.childdeathhelpline.org.uk Child Bereavement Charity 01494 568900 www.childbereavement.org.uk The Lullaby Trust 0808 802 6868 www.lullabytrust.org.uk June 2013 Rapid Response to Sudden Unexpected Child Death Page 22 of 24 Version 1.0 October 2016

Where do I go for further advice or information? Flemming, P. Blair, P. Sidebotham, P. And Haylor, T. (2004) Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach. BMJ Vol 328. 331-334 Sidebotham, P and Flemming, P (2007). Unexpected Death in Childhood. A Handbook for Practitioners. John Wiley and Sons Ltd. London. West Midlands Best Practice Multi-Agency Protocol for the Management of SUDDEN UNEXPECTED DEATHS IN INFANTS & CHILDREN (SUDIC) UNDER 18 (2012). Working Together to Safeguard Children. A guide to inter-agency working to safeguard and promote the welfare of children (2015). HM Government. Department for schools and families. Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies Members of the rapid response team will regularly access network meetings, clinical supervision and de-briefing sessions with the designated nurse/lead nurse for child death review. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment The rapid response to sudden unexpected child death will be initiated for all unexpected child deaths. The service will respond in a sensitive manner to all families, adapting appropriately to meet any cultural or disability needs. Please refer to overarching policy Data Protection Act and Freedom of Information Act Under the Children Act 2004 Dudley Safeguarding Children Board has a statutory duty to collect and analyse information about each child death with a view to identifying: Any case giving rise to the need for a serious case review Any matters of concern affecting the safety and welfare of children in their area Any wider public health or safety concerns arising from a particular death or from a pattern of deaths in their area The disclosure of information about a deceased child is, therefore, to enable the Local Safeguarding Children Board to carry out its statutory functions relating to child deaths Please refer to overarching policy Rapid Response to Sudden Unexpected Child Death Page 23 of 24 Version 1.0 October 2016

Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-SAFE-SOP-09-10 New Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Safeguarding Executive Director of Nursing, AHPs and Governance Dudley Named Nurse Children and Adult Safeguarding Steering Group September 2016 Month/year SOP was approved October 2016 Next review due October 2019 Disclosure Status B can be disclosed to patients and the public Review and Amendment History Version Date Description of Change 1.0 Oct 2016 New SOP developed to support overarching Safeguarding Children Policy Rapid Response to Sudden Unexpected Child Death Page 24 of 24 Version 1.0 October 2016