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Registration Number: {{org_field_registration_no}}

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Verification of Expected Deaths by Registered Nurses Policy

1. Purpose

The purpose of this policy is to provide clear guidance on the verification of expected deaths by registered nurses working for {{org_field_name}}. This policy ensures that the verification process is carried out safely, legally, and in line with professional standards, while maintaining dignity, sensitivity, and respect for the deceased and their family.

This policy complies with the Regulation and Inspection of Social Care (Wales) Act 2016, Care Inspectorate Wales (CIW) guidelines, Nursing and Midwifery Council (NMC) Code of Practice, and Welsh Government protocols for death verification. It provides a structured framework for registered nurses to confirm that death has occurred while ensuring that the certification of death remains the responsibility of a medical practitioner.

2. Scope

This policy applies to:

• Registered nurses employed by {{org_field_name}} who have been assessed as competent to verify expected deaths.
• Service users receiving palliative or end-of-life care where death is anticipated and managed under an agreed care plan.
• Care staff, family members, and other professionals who may be present at the time of death.
• GPs, emergency services, and other external professionals involved in the verification and certification process.

It covers:

• The legal distinction between verification and certification of death.
• Criteria for expected deaths.
• Verification procedures and required documentation.
• Communication with families and healthcare professionals.
• Escalation procedures in cases of uncertainty.
• Staff training, competency, and governance.

3. Principles of Verification of Expected Deaths

3.1 Definition of Expected and Unexpected Deaths

An expected death is one that occurs as a result of a known, advanced, and irreversible medical condition, where death is anticipated and has been documented in an Advance Care Plan (ACP) or palliative care plan. The death must have been foreseen by a medical professional, such as a GP or palliative care consultant, and the service user must not have any suspicious or unexplained circumstances surrounding their passing.

An unexpected death occurs when a service user dies suddenly, without a clear medical cause, or under suspicious circumstances. Registered nurses must not verify unexpected deaths, and these must be immediately reported to emergency services.

3.2 Legal Distinction Between Verification and Certification of Death

• Verification of death is the formal process of confirming that death has occurred. This can be performed by a competent registered nurse who has received appropriate training.
• Certification of death is the process of identifying the cause of death and issuing a Medical Certificate of Cause of Death (MCCD). This can only be carried out by a doctor or coroner.

3.3 Criteria for Registered Nurses to Verify an Expected Death

A registered nurse employed by {{org_field_name}} may verify an expected death if:

• The death was anticipated and documented in the service user’s end-of-life care plan.
• The GP or lead clinician has previously assessed the service user as nearing end of life.
• There are no suspicious circumstances, unexplained injuries, or indications of abuse or neglect.
• The registered nurse has completed the necessary training and has been deemed competent in death verification procedures.

If any doubts arise regarding the expected nature of the death, the nurse must not proceed with verification and must contact emergency services and the GP immediately.

3.4 Verification Procedure for an Expected Death

Step 1: Preparing for Verification

• Ensure infection prevention and control measures are followed.
• Confirm that the individual had an advance care plan and that their death was anticipated.
• Check identity of the deceased, using personal details recorded in their care plan.
• Inform family members or representatives and provide compassionate support.

Step 2: Clinical Verification of Death

The registered nurse must conduct a full assessment to confirm that death has occurred. This includes checking:

1. No response to verbal or physical stimuli (e.g., no reaction to a firm trapezius pinch).
2. No signs of breathing for at least one minute:
   • Observe for chest movement.
   • Listen for breath sounds using a stethoscope.
   • Feel for airflow from the nose and mouth.
3. No central pulse for at least one minute:
   • Check for carotid pulse using a stethoscope.
4. Pupillary response is absent:
   • Shine a pen torch into both eyes; pupils should remain fixed and dilated.
5. No heart sounds for at least one minute:
   • Use a stethoscope to confirm absence of heart activity.

Step 3: Documentation

The registered nurse must record the following details in the service user’s care record:

• Full name and date of birth of the deceased.
• Date, time, and location of death.
• Absence of vital signs and findings from verification checks.
• Names of family members or witnesses present at the time of death.
• Notification details (GP, next of kin, care coordinator, emergency services if applicable).

A Verification of Death Form must be completed and retained for regulatory purposes.

Step 4: Informing the Appropriate Authorities

After verification, the registered nurse must:

• Inform the GP or out-of-hours doctor to arrange certification of death.
• Notify the next of kin, ensuring support is offered.
• Contact funeral services, if pre-arranged in the care plan.
• If the death is unexpected or suspicious, immediately escalate to emergency services and the police.

3.5 Escalation Procedures for Complex or Suspicious Cases

A registered nurse must not verify death if:

• The cause of death is unknown or unclear.
• The service user sustained an injury prior to death, such as a fall or unexplained bruising.
• The death was sudden and not documented as expected.
• There are concerns regarding safeguarding, abuse, or neglect.
• The service user was subject to a Do Not Attempt Resuscitation (DNAR) order, but death was not anticipated imminently.

In these cases, the nurse must:

1. Immediately contact emergency services (999) and the GP.
2. Preserve the scene and do not move the deceased until instructed.
3. Document all observations and actions in detail.
4. Report the incident to the Registered Manager and CIW as per safeguarding protocols.

3.6 Training, Competency, and Governance

• Only registered nurses with specific training in verifying expected deaths can undertake this role.
• Training must be renewed every two years, with competency assessments conducted by senior clinicians.
• Nurses must be familiar with CIW, NMC, and Public Health Wales guidelines.
• Regular audits of verification records must be conducted to ensure compliance with legal and professional standards.

4. Efficiency in Managing the Verification Process

To ensure the verification of death process is efficient and legally compliant, {{org_field_name}} implements:

• Standardised verification checklists and documentation forms.
• Clear reporting structures to ensure timely notification to healthcare professionals.
• Dedicated training programmes for registered nurses.
• Regular audits and quality assurance reviews.
• Support systems for staff and families during end-of-life care.

These measures ensure that death verification is carried out professionally, compassionately, and in full compliance with regulatory requirements.

5. Related Policies

This policy should be read alongside:

• End-of-Life Care and Palliative Support Policy (DCW41)
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13)
• Incident Reporting and Serious Event Review Policy (DCW22)

6. Policy Review

This policy will be reviewed annually or sooner if there are changes to legislation or best practice guidelines.

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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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