{{org_field_logo}}

{{org_field_name}}

---

Registered Nurse Verification of Expected Deaths Policy

Policy Statement

This policy applies where {{org_field_name}} uses or, in line with local policies is expected or permitted to use, registered nurses to verify an expected death of a person using services. Similar procedures apply to the registered nurse verification of an expected death of a person using services at home or in the case of a person using care home services.

This policy should be used with reference to the policies on end-of-life care and death of a person using services. The policy should also be in line with policies determined by local clinical commissioning groups and medical practitioners.

It recognises that the legal framework for the procedures involved in the event of death is the Births and Deaths Registration Act 1953.

Verification of death can be undertaken by a registered nurse with the appropriate training and deemed competent to do so. However, they should check with their employer’s policies to determine local agreements regarding the circumstances under which this may be done.

In the event of a death, either expected or sudden, this policy complies with all required procedures and provides support to bereaved relatives, friends and other people using services who may be affected.

In the event of death of a person using services with suspected or confirmed coronavirus, comply with the Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19.

The UK Health Security Agency’s guidance Covid-19 Transmission From the Deceased concluded more research is required to understand the risk of transmission from handling the bodies of deceased persons with suspected or confirmed Covid-19 and they cannot eliminate risk for staff caring for the deceased.

Verification of an Expected Death by a Registered Nurse

This policy understands an expected death to be one where the cause has been known in advance and there are no reasons for suspecting that when the death does occur it is the result of anything unanticipated and there are no suspicious circumstances.

Verification of death can be undertaken by a registered nurse with appropriate competency, in agreement with local policies. Standard infection control precautions need to be observed undertaking the verification procedure as per the Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19.

The Coronavirus Act 2020 introduced easements to death certification processes and cremation forms during the pandemic and was repealed on 24 March 2022.

Currently there is no relaxation of Deprivation of Liberty Safeguards (DoLS) associated with the coronavirus pandemic and homes should ensure that they adhere to DoLS guidance until such time as new safeguards are in place.

The Deprivation of Liberty Safeguards (DoLS) is to be replaced with the Liberty Protection Safeguards (LPS).

This system will apply to England and Wales only and was postponed until April 2022. The Government then announced in December 2021 the planned implementation date for LPS of April 2022 could not be met. There is no new implementation date at this time.

Verification of death differs from certification of death, which is signing a death certificate; this can only be done by a medical practitioner.

Registration of Death

Prior to the Coronavirus Act 2020, it was a requirement that the medical practitioner had attended the deceased within 14 days.

Whilst the Coronavirus Act 2020 has been repealed, the following provisions are continuing:

• if a doctor has not seen the deceased in the 28 days prior to their death or any time after death they can complete the medical certificate of cause of death. However the registrar would need to refer the medical certificate of cause of death (MCCD) to the coroner. This time period will remain at 28 days and not revert to pre-pandemic 14 days.
• ability for medical practitioners to send MCCDs to registrars electronically. The MCCD can be scanned or photographed and sent from a secure email account to registrars as an attachment.

The form Cremation 5, which was suspended during the pandemic, will not be re-introduced after the Coronavirus Act expires and has now permanently been abolished.

Definition of an Expected Death Permitting Registered Nurse Verification (under normal circumstances)

The person using services will have been subject to an end-of-life plan and have been seen by a medical practitioner (usually GP) at some point in the usually (though not limited to) previous 28 days. The GP will have authorised nurse verification of the expected death and will issue the death certificate on receipt of the verification of the death.

{{org_field_name}} is aware that in many instances a person’s death will be verified by a medical practitioner (who will proceed to issue the death certificate). Registered nurse verification occurs when a medical practitioner is not available for some reason and because the law does not require a GP or medical practitioner to view the dead body before issuing a death certificate, it is lawful for the death to be verified by a registered nurse, provided that he or she is qualified and competent to carry out and record the necessary procedures.

It is the right of the verifying nurse to refuse to verify death and to request the attendance of the responsible GP or the police if there is anything unusual.

{{org_field_name}} understands that to be “qualified and competent” to verify an expected death, the nurse must be able to comply with the Code of Conduct issued by the Nursing and Midwifery Council, which places specific responsibilities on registered nurses to keep their professional knowledge and competences up to date. The verifying nurse can also be expected to have achieved the competence framework developed by a partnership of palliative care organisations and published with guidance by Hospice UK (2019).

Registered nurses must acknowledge the limits of their professional competence and carry out practice and accept responsibilities only for those activities in which they are competent.

To be competent to verify an expected death they must have attended the appropriate training and have been evaluated against the current verification of death occupational standards and signed off as being competent to act as a verifier.

{{org_field_name}} is aware that the use of registered nurses to verify expected deaths is subject to local policies and protocols determined by clinical commissioning groups and allied medical services, which will also arrange for the necessary training to be provided and assessed.

The RN is responsible for identifying from the clinical notes, any infectious diseases, radioactive implants, implantable medical device — Instigate process for deactivation of implantable cardiac defibrillator (ICD) — if not already deactivated.

There are certain circumstances in which the coroner must legally be informed of an expected death. If the death could be a result of an industrial disease or related to the deceased’s employment, for example asbestosis or mesothelioma, or if the deceased person has had a surgical procedure or significant injury in the 12 months prior to their death, the nurse may verify the death, but the GP will need to refer this to the coroner.

Care providers might, as a result of local agreements, employ registered nurses, who are competent to verify expected deaths at home or in a care home or might have access to one if needed.

Managing bodies of deceased with Covid-19

If a person using services dies of suspected Covid-19 in {{org_field_name}}, all staff must comply with the Health and Safety Executive’s guidance on Handling the Deceased with Suspected or Confirmed Covid-19: Managing Bodies of Deceased with Covid-19.

This states that while risk of transmission from Covid-19 from the deceased is low, there may be ongoing risk of infection from handling body fluids and tissues where infection is suspected or confirmed. The exact duration that SARS-CoV-2 can remain infectious in body fluids and tissues in a deceased body is unknown. Standard infection control precautions (SICPs) and transmission-based precautions (TBPs) should be sufficient to protect those handling the deceased with suspected or confirmed Covid-19 while the deceased person remains in {{org_field_name}} environment.

Precautions are outlined which includes:

• use of PPE as per guidance
• maintaining a safe distance (at least 2m) from the bereaved and avoid contact with others with suspected or confirmed Covid-19 infection. Ask others to leave the room and any areas the deceased will travel through as they are moved
• place a barrier, such as a cloth or mask, over the mouth of the deceased when moving them to try and prevent the release of droplets from the respiratory tract
• body bags are not deemed essential but could minimise infection risk. They are recommended where leakage of bodily fluids is likely
• cloth wrappings (shrouds or wraps) and coffins may be used to manage the risk of contact transmission but are not a replacement for body bags, where recommended.

This guidance remains under review and may be updated in line with the changing situation as required.

Procedure

When a registered nurse verifies a death he or she must:

1. establish the identity of the person who has died
2. have available an official form (provided locally), which will already have authorised the nurse to carry out the verification procedure (authorisation usually having been given by the person’s GP)
3. conduct an examination in line with the established clinical protocol (ie clear absence of pulse, heart, breathing and eye movements, etc), based on the Academy of Medical Colleges Code of Practice for the Diagnosis and Confirmation of Death
4. be clear from the examination and accompanying information that there would be no grounds for not completing the verification of death form (where there are, the GP should be immediately notified with a view to notifying the coroner: see the death of a person using services policy)
5. complete the verification of death form
6. communicate the verification of death form to the person’s GP practice so that the death certificate can be issued as soon as possible.

The responsible doctor will then complete the death certificate as soon as practical and within the legal time limits.

The RN verifying the death should also acknowledge the emotional impact of the death and ensure the bereaved family and friends are offered support and written information about “the next steps” with regards to the deceased.

Reference

• Covid-19 Supplement to the Infection Prevention and Control Resource for Adult Social Care (updated 2023), available on the GOV.UK website
• Registered Nurse Verification of Expected Adult Death (RNVoEAD) Guidance (2^nd edition 2019), available on the Hospice UK website
• Confirmation or Verification of Death by Registered Nurses (2023) available on the RCN website

---

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

Copyright ©2024 {{org_field_name}}. All rights reserved