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Death Verification

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As a new F1 in August, it can feel like quite a daunting task to verify a death, particularly if you have never seen this done before. This step by step guide will take you through the process of death verification to help make this task easier as you settle into your new role.

Verifying a Death
You will usually be asked to verify a death by nursing staff from the ward the patient is on. When you arrive at the ward
  • Speak to the nursing staff looking after the patient to find out some background information on what has happened
  • Review the notes especially if you do not know the patient. Check the resuscitation status and read the notes so you are aware of the events leading up to the patient’s death.
  • If there are family are present, greet them and offer your condolences. Explain that you are there to verify the death and you could offer them the option of staying in the room or waiting outside whilst you do this. 
Assessment
A code of practice for confirmation of death exists, however each hospital may have its own protocols which you must familiarise yourself with. The patient must be observed for a minimum of 5 minutes to establish irreversible cardiopulmonary arrest has happened.
  • Confirm the identity by checking their hospital wrist band 
  • General inspection of the patient and the bedside area looking for any obvious signs of life, any monitoring attached the patient, skin colour and general appearance
  • Check if the patient is unresponsive to verbal/painful stimuli 
  • Ausculate and observe for absence of respiratory effort for 3-5 minutes
  • Look for continual absence of heart sounds on auscultation or asystole on ECG monitoring for 3-5 minutes
  • Check the central pulses are absent for 3-5 minutes
  • Check for the absence of eye reflexes - pupils to light & corneal reflex (latter is rarely performed)
  • Check for any devices such as a pacemaker (which may need to be removed if the patient is cremated)
Documentation
  • Make sure your documentation is clear and legible. Some trusts have specific paperwork to fill out for a verification of death
  • Depending on whether you are using paper or electronic notes, ensure the patient's details (name, DOB, address) and location are documented. 
  • Document if anyone was with the patient when they died and who it was that first noted the patient was deceased
  • Document your assessment in full
  • The time of death which is when you completed the confirmation 
  • Include in your notes any conversations with family members and any concerns raised by either family members or staff looking after the patient 
  • At the end of your notes include the following information about yourself: Name, Bleep/ contact number, Grade, GMC number
Example
Dr Jacob Smith FY1
GMC: 1234567
Bleep: 007

Asked to see patient by Staff Nurse Jack as patient showing no signs of life
In room: Daniel Doe (brother)

Identify confirmed as "John Doe" with wristband
Patient is in bed showing no signs of life
They are unresponsive to any stimuli
Pupils are fixed and dilated
No central pulses felt for 5 minutes
No respiratory effort for 5 minutes
No heart sounds auscultated for 5 minutes
No concerns from staff or family of the patient

Death confirmed at 16:00 on 17th August 2019

By Dr Shamilah Rahman

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