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Verification of Expected Deaths by Registered Nurses Policy

1. Purpose This policy outlines the procedures and responsibilities of Registered Nurses at {{org_field_name}} in verifying expected deaths in a dignified, lawful, and professional manner. It ensures compliance with CQC regulations, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 – Safe Care and Treatment, and relevant national guidelines. The policy provides clear guidance to ensure the verification process is carried out sensitively and in accordance with legal requirements.

2. Scope This policy applies to all Registered Nurses employed at {{org_field_name}} who have undergone appropriate training in Verification of Expected Deaths (VoED). It does not cover the certification of death, which remains the responsibility of a medical practitioner (doctor). It applies only to expected deaths, where a care plan and agreement for verification have been previously established.

3. Legal and Regulatory Framework

• Regulation 12 – Safe Care and Treatment: Ensures procedures are in place for verifying deaths safely and legally.
• Regulation 17 – Good Governance: Requires accurate documentation and reporting.
• Nursing and Midwifery Council (NMC) Code of Conduct: Sets professional standards for registered nurses.
• The Births and Deaths Registration Act 1953: Governs the legal requirements for death registration.
• Confirmation (Verification) of Death Guidance – Royal College of Nursing (RCN): Provides professional guidance for nurses verifying deaths.
• Resuscitation Council (UK) DNACPR Guidelines: Ensures decisions align with end-of-life care plans.

4. Criteria for Verification of Expected Deaths

• The death must be expected, meaning the person was receiving palliative or end-of-life care and had a clear advance care plan.
• A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order or Advance Decision to Refuse Treatment (ADRT) must be in place.
• A Registered Medical Practitioner must have documented the person’s prognosis and agreed in advance that verification may be conducted by a Registered Nurse.
• The person must not have suspicious, unexpected, or unexplained circumstances surrounding their death.

5. Nurse Competency and Training

• Only Registered Nurses who have completed VoED training and demonstrated competency may verify deaths.
• Training must include:
  • Clinical assessment of death.
  • Legal and professional responsibilities.
  • Documentation requirements.
  • Communication with families and healthcare professionals.
• Competency must be reassessed annually or if changes in legislation occur.

6. Verification Procedure

• Initial Checks:
  • Confirm the individual’s identity using two forms of identification (e.g., care record, ID bracelet).
  • Review their advance care plan, DNACPR order, and ADRT (if applicable).
• Clinical Examination (Following Local Protocols):
  • Observe for 5 minutes to confirm absence of:
    • Respiratory movement (no breathing).
    • Central pulse (absence of carotid or femoral pulse).
    • Heart sounds (absence confirmed with stethoscope).
    • Pupillary reaction (fixed, dilated pupils in both eyes).
    • Response to pain stimulus (none observed).
  • A second verification may be conducted after 10 minutes if required by local guidance.
• Recording the Time of Death:
  • The time recorded is when verification is completed, not when death occurred.
  • Document findings clearly in the care record and relevant forms.
• Notifying Appropriate Persons:
  • Inform the GP or out-of-hours medical team.
  • Notify the Registered Manager and senior care team.
  • Contact the next of kin in accordance with the end-of-life care plan.

7. Communication and Family Support

• The Registered Nurse verifying the death must provide sensitive and clear communication to the family or representatives.
• Offer emotional support and ensure that families understand the next steps.
• Provide information on bereavement support services available at {{org_field_name}}.

8. Documentation and Record-Keeping

• Verification of Death Form:
  • Full name and date of birth of the deceased.
  • Date and time of verification.
  • Confirmation that criteria for expected death were met.
  • Findings of the clinical examination.
  • Name, signature, and Nursing & Midwifery Council (NMC) PIN of the verifying nurse.
• Care Records and Incident Reporting:
  • Document all actions taken and communication with family and healthcare professionals.
  • If the death is unexpected or suspicious, report to the police and coroner.

9. Referral to the Coroner

• The death must be referred to the coroner if:
  • The cause of death is unclear or unexpected.
  • There is any suspicion of neglect or abuse.
  • The death is due to an accident, self-harm, or external factors.
  • The person had no prior medical diagnosis of a terminal condition.
• The Registered Nurse must not remove any medical devices (e.g., catheters, feeding tubes) if the coroner is involved.

10. Infection Control Considerations

• Standard infection prevention and control (IPC) measures must be followed during verification.
• Personal Protective Equipment (PPE) must be used if the individual had a known infectious condition.
• Follow local guidance for handling infectious deaths, including COVID-19 protocols if applicable.

11. Safeguarding Considerations

• If there are concerns regarding abuse, neglect, or poor care, the death must be reported under the CH13-Safeguarding Adults from Abuse and Improper Treatment Policy.
• All safeguarding concerns must be escalated immediately to the Registered Manager and Local Safeguarding Adults Board (LSAB).

12. Staff Support and Debriefing

• Emotional well-being support is available for staff following the verification of death.
• A debrief session should be offered, particularly if the death was distressing.
• Access to occupational health and counselling for staff experiencing emotional impact.

13. Related Policies

• CH12-Safe Care and Treatment Policy
• CH13-Safeguarding Adults from Abuse and Improper Treatment Policy
• CH18-Risk Management and Assessment Policy
• CH27-Staff Supervision, Training, and Development Policy
• CH34-Confidentiality and Data Protection (GDPR) Policy

14. Policy Review

• This policy will be reviewed annually or sooner if required by CQC regulation updates or national guidance changes.
• Any procedural amendments will be communicated to all relevant staff

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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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