DC114-Verification of Expected Deaths by Registered Nurses Policy

Registration Number: {{org_field_registration_no}}

Verification of Expected Deaths by Registered Nurses Policy

1. Introduction and Purpose

{{org_field_name}} is committed to ensuring that the process of verifying expected deaths is handled with professionalism, dignity, and respect. This policy provides a clear framework for registered nurses (RNs) to verify expected deaths safely, competently, and in accordance with legal, ethical, and professional standards.

This policy aligns with the Care Quality Commission (CQC) guidelines, the Nursing and Midwifery Council (NMC) Code, and the national guidance on verifying expected deaths. It aims to provide clear procedures to protect the dignity of the deceased, support families, and ensure accurate documentation and reporting.

2. Scope of the Policy

This policy applies to all registered nurses employed by the company who are trained and competent to verify expected deaths. It covers deaths that occur in the service user’s home where the death has been anticipated due to terminal illness, advanced age, or other known medical conditions. It does not cover sudden or unexpected deaths, which must be referred to emergency services and the coroner.

3. Definition of Expected Death

An expected death is defined as the anticipated and natural death of an individual resulting from a known terminal illness, advanced progressive disease, or age-related decline. It is a death that has been planned for within the individual’s care pathway, ensuring all parties, including healthcare providers, the individual, and their family, are prepared for the event. This expectation is typically documented within an advance care plan, end-of-life pathway, or palliative care plan.

Expected deaths are usually accompanied by clear documentation from a GP, palliative care consultant, or other senior clinician, indicating that the death is anticipated. This documentation should be regularly reviewed as part of the individual’s care plan to ensure that the care team remains aware of the individual’s condition and prognosis.

4. Legal and Professional Framework

Registered nurses undertaking the verification of death must adhere to several legal and professional frameworks that ensure the process is conducted safely, respectfully, and within the bounds of the law:

NMC Code of Conduct: Nurses must adhere to the NMC Code, which emphasises professionalism, compassion, and integrity when delivering care, including end-of-life care. The code mandates that nurses practice within their competence and take accountability for their decisions.
CQC Regulations: The Care Quality Commission (CQC) Regulation 12 on safe care and treatment requires providers to ensure that care practices, including death verification, are performed safely and effectively.
Local NHS Trust Guidelines: Nurses must follow any additional guidelines provided by the local NHS trust regarding verifying deaths in community settings. These guidelines ensure that practices are consistent and reflect local healthcare protocols.
Mental Capacity Act 2005: Nurses must respect the individual’s autonomy, including adherence to any advance care plans or DNAR (Do Not Attempt Resuscitation) orders. The individual’s capacity to make decisions about end-of-life care should be documented and respected throughout the care process.

5. Eligibility for Nurse Verification of Death

Registered nurses are only permitted to verify an expected death when specific conditions are met to ensure the accuracy of the verification process and to protect all parties involved:

Expected Death Pathway: The individual must have been on an end-of-life care pathway, documented by a GP, palliative care team, or senior clinician. This documentation should clearly state that death is anticipated due to the progression of a known medical condition.
Advance Care Planning: There must be an advance care plan (ACP) in place, reflecting the individual’s wishes regarding end-of-life care. This plan should include preferences for place of death, resuscitation status, and any other specific care requirements.
DNAR Confirmation: A valid Do Not Attempt Resuscitation (DNAR) order must be in place, ensuring that no resuscitative efforts are initiated upon discovery of death. This order must be documented, signed by the responsible clinician, and available for review at the time of death verification.
Nurse Competency: Only registered nurses who have completed specific training in verifying deaths and have demonstrated competence through supervised practice are eligible to conduct verifications. Regular refresher training ensures that competency is maintained.

6. Procedure for Verifying an Expected Death

The process of verifying an expected death involves several critical steps to ensure that life has ceased, documentation is accurate, and the family is supported.

6.1 Initial Actions:

Upon discovering an expected death, the nurse should approach the situation calmly and professionally. The nurse must first confirm the environment is safe and respectful, ensuring that the service user is positioned with dignity. Curtains should be drawn if appropriate, and the room should be quiet and private.

The nurse must confirm the identity of the deceased by cross-referencing official documentation, such as the care plan, identification documents, or medical records. This step ensures that the verification process is conducted for the correct individual.

6.2 Verification Process:

The verification process involves a comprehensive assessment to confirm the irreversible cessation of life. The nurse must conduct the following checks systematically:

Absence of Respiratory Effort: The nurse must observe the chest for at least one full minute to confirm the absence of spontaneous breathing. This includes checking for chest rise and fall and listening for breath sounds.
Absence of Circulation: The nurse must palpate for a central pulse (carotid or femoral) while auscultating the heart using a stethoscope. This assessment should be performed for at least one full minute to ensure there is no cardiac activity.
Fixed and Dilated Pupils: Using a penlight, the nurse must assess pupil response to light. Pupils that are fixed and dilated, without any constriction when exposed to light, indicate the absence of neurological function.
Absence of Heart Sounds: The nurse must auscultate the chest for at least one minute to confirm the absence of heart sounds. Multiple locations on the chest should be checked to ensure accuracy.
Absence of Response to Pain: A painful stimulus, such as applying pressure to the nail bed, should be applied to assess the absence of responsiveness. The absence of any motor response further confirms death.

The entire verification process should take no less than five minutes. If any signs of life are detected during this period, emergency services must be contacted immediately, and resuscitation efforts must be initiated if appropriate.

6.3 Documentation:

Once the absence of life has been confirmed, the nurse must document the verification thoroughly. This includes:

The exact date, time, and location of death.
The identity of the deceased, confirmed through official documentation.
Detailed observations confirming the absence of respiratory effort, circulation, neurological function, and responsiveness.
Confirmation of the presence of an advance care plan and DNAR order.
Names and contact details of any family members or carers present at the time of death.

This documentation should be recorded in the service user’s care notes and reported to the GP, senior care manager, and, where appropriate, the local coroner. Any concerns about the circumstances of the death must be documented and escalated immediately.

7. Supporting the Family and Loved Ones

After verifying the death, the nurse must provide compassionate support to the family and loved ones. This includes offering clear explanations about the next steps, such as notifying the GP, arranging for the death certificate, and contacting the funeral home.

The nurse should allow the family time and privacy to spend with their loved one, ensuring that they feel supported throughout the process. If family members express distress or require further support, the nurse should signpost them to appropriate bereavement services.

8. Training and Competency Assessment

To maintain high standards, all registered nurses verifying expected deaths must complete formal training that covers the verification process, ethical considerations, and communication skills. This training includes both theoretical knowledge and practical assessments.

Competency assessments are conducted annually, ensuring that nurses maintain their skills and remain up to date with current best practices. Nurses are also encouraged to seek peer support and supervision when verifying deaths to ensure emotional resilience and professional accountability.

9. Incident Reporting and Escalation

If any concerns arise during the verification process, such as signs of trauma, unexpected deterioration, or inconsistencies with the documented care plan, the nurse must refrain from verifying the death and escalate the concern immediately.

Emergency services should be contacted, and the situation must be reported to the GP and the company’s senior management team. An incident report should be completed, detailing the observations and actions taken.

10. Confidentiality and Data Protection

All information related to the verification of death must be handled with the utmost confidentiality, in accordance with the General Data Protection Regulation (GDPR). Documentation should be securely stored and accessible only to authorised personnel.

Information should not be shared with third parties without consent, except when required for legal or safeguarding purposes. Any breach of confidentiality must be reported and addressed according to company protocols.

11. Monitoring and Continuous Improvement

To ensure continuous improvement and adherence to best practices, the company conducts regular audits of death verification records. These audits identify areas for improvement, ensuring that nurses follow the correct procedures and provide compassionate care.

Feedback from nurses, families, and other healthcare professionals is collected to refine the verification process. Training programs are updated based on emerging best practices and changes to national guidelines.

12. Conclusion

The verification of expected deaths by registered nurses is a critical process that ensures end-of-life care is managed with dignity, compassion, and professionalism. By adhering to this policy, {{org_field_name}} maintains high standards of care, protects service users and their families, and ensures compliance with regulatory requirements.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
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