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Verification of Expected Deaths by Registered Nurses Policy

1. Purpose

The purpose of this policy is to provide a structured framework for registered nurses within {{org_field_name}} to verify expected deaths in a safe, dignified, and lawful manner. The policy ensures that nurses carry out the verification process in accordance with Care Quality Commission (CQC) regulations, the Nursing and Midwifery Council (NMC) Code of Practice, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and local safeguarding and coroner protocols.

This policy ensures that verification of expected deaths is carried out with respect, sensitivity, and professionalism, maintaining the dignity of the deceased while ensuring that legal and professional responsibilities are met. Additionally, it provides guidance for staff to support families and liaise effectively with relevant authorities, ensuring that all procedures are completed without unnecessary distress.

2. Scope

This policy applies to all registered nurses employed by {{org_field_name}} who have been assessed as competent to verify expected deaths. It also applies to:

• Healthcare support staff involved in end-of-life care.
• General Practitioners (GPs) and medical professionals collaborating with our service.
• Next of kin and family members of the deceased individual.
• External agencies, including coroners, funeral directors, and emergency services where applicable.
• Regulatory bodies such as the CQC, who may review the verification processes as part of inspections and governance.

This policy does not apply to cases of unexpected death, suspicious death, or death requiring a coroner’s inquest, where a medical practitioner or emergency services must be contacted. It is critical that nurses adhere strictly to these guidelines to avoid misclassification of death, ensuring that forensic or investigatory needs are met when necessary.

3. Related Policies

This policy should be read alongside:

• SL10 – End-of-Life Care Policy – Ensures compassionate and person-centred care for individuals approaching the end of life.
• SL13 – Safeguarding Adults from Abuse and Improper Treatment Policy – Prevents neglect or abuse concerns related to end-of-life care.
• SL17 – Incident Reporting and Management Policy – Outlines how to record and report any concerns related to death verification.
• SL19 – Handling and Storage of Medications Policy – Ensures appropriate documentation of medication administration before death.
• SL30 – Health and Safety Policy – Covers workplace safety and hygiene measures during and after death verification.
• SL45 – Complaints and Whistleblowing Policy – Provides channels for staff to report concerns about end-of-life care practices.

4. Definition of Expected Death

An expected death is defined as the anticipated and inevitable death of a person due to progressive illness, terminal disease, or end-of-life care. The person will have a care plan in place, agreed by a medical professional, documenting the expected nature of death.

To qualify as an expected death, the following must apply:

• The person has a known diagnosis that will lead to a natural death.
• A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) order is in place, indicating that no resuscitation should be attempted.
• The death was anticipated by the medical team and is documented in the individual’s care records.
• There are no suspicious circumstances requiring police or coroner involvement.

5. Legal and Regulatory Framework

Verification of expected death by a registered nurse is legally permissible under UK law, provided the nurse has the appropriate training and competency assessment. The legal framework includes:

• The Births and Deaths Registration Act 1953 – Governs the registration of deaths and specifies who is authorised to verify and certify death.
• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Ensures safe practices in end-of-life care and death verification.
• The NMC Code (2018) – Outlines professional duties of registered nurses in the verification process, including maintaining accurate documentation and ensuring dignity in care.
• Local Coroner’s Guidelines – Establishes when a death must be reported for inquest or further investigation.
• The Human Tissue Act 2004 – Regulates the lawful handling, removal, and storage of human tissue following death.

6. Responsibilities of the Registered Nurse

Registered nurses verifying expected deaths must:

• Be trained and assessed as competent in verifying deaths.
• Adhere to CQC standards and NMC guidelines.
• Confirm that the death is expected and documented in the care plan.
• Ensure that no suspicious circumstances require escalation to emergency services or a coroner.
• Provide sensitive and compassionate support to family members present.
• Complete accurate documentation and notify relevant authorities in a timely manner.
• Ensure that proper hygiene and infection control measures are maintained throughout the verification process.

7. Process of Verifying an Expected Death

7.1 Pre-Verification Checks

Before verifying the death, the registered nurse must:

1. Check the care plan – Ensure the death is expected and anticipated, with clear documentation from the GP or medical consultant.
2. Review advance care plans and DNACPR orders – Ensure that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is documented.
3. Confirm patient identity – Check the deceased person’s identity against care records.
4. Observe for any suspicious circumstances – If concerns arise, escalate immediately to the police and coroner.
5. Ensure appropriate timing – Verification must take place within a reasonable timeframe following death.

7.2 Physical Assessment of Death

The registered nurse must confirm the irreversible cessation of life using a structured five-sign assessment:

1. Absence of Pulse:
   • Check for a carotid pulse (neck) for at least one full minute.
   • If no pulse is detected, proceed to the next step.
2. Absence of Heart Sounds:
   • Use a stethoscope to listen for heart sounds for at least one full minute.
   • If no sounds are heard, proceed to respiratory assessment.
3. Absence of Respirations:
   • Observe the chest for movement.
   • Listen with a stethoscope for breath sounds for at least one full minute.
   • Check for nasal airflow using a mirror or cold metal instrument.
4. Fixed and Dilated Pupils:
   • Use a penlight to check the reaction of both pupils.
   • Pupils must remain unresponsive to light.
5. Pallor and Coldness of the Skin:
   • The body should show signs of post-mortem changes, such as pallor and a gradual drop in temperature.

After completing the above assessments, if all five signs confirm the absence of life, the registered nurse can verify the death.

7.3 Documentation of Death Verification

The registered nurse must document:

• Full name, date of birth, and NHS number of the deceased.
• Date and time of verification.
• Findings of the five-sign assessment.
• Confirmation that the death was expected and documented in medical records.
• Any observations regarding the condition of the body.
• Details of any family members present.
• Notification to the GP and relevant authorities.

A Death Verification Form must be completed and stored in the person’s care file.

8. Policy Review

This policy will be reviewed annually, or sooner if legislative changes occur. Staff will be informed of updates and provided with further training if required.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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