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Verification of Expected Death by Registered Nurses Policy

1. Purpose

The purpose of this policy is to establish clear guidance on the Verification of Expected Death (VoED) by Registered Nurses within {{org_field_name}}, ensuring compliance with Care Inspectorate Scotland regulations, Nursing and Midwifery Council (NMC) standards, and Scottish Government guidelines. This policy ensures that the process of verifying expected death is conducted with dignity, professionalism, and in a legally compliant manner. It sets out the roles, responsibilities, and procedures for registered nurses carrying out VoED, ensuring a compassionate, efficient, and well-documented approach that aligns with best practices in domiciliary care.

2. Scope

This policy applies to all Registered Nurses (RNs) employed by {{org_field_name}}, agency nurses, and staff involved in end-of-life care. It covers the verification of expected deaths in home care settings, ensuring that staff understand their legal authority, procedural requirements, and professional responsibilities. It applies only to expected deaths where a doctor has confirmed that death was anticipated due to a known medical condition. This policy does not cover unexpected deaths, suspicious deaths, or deaths requiring coroner involvement, which must be reported immediately to emergency services and the relevant authorities.

3. Related Policies

This policy should be read alongside:

• End-of-Life and Palliative Care Policy, which provides guidance on supporting individuals in their final stages of life
• Incident Reporting and Management Policy, which ensures proper documentation and reporting of deaths
• Safeguarding Policy, ensuring that all deaths are reviewed appropriately to prevent concerns of neglect or harm
• Infection Prevention and Control Policy, outlining hygiene measures when handling deceased individuals
• Lone Working Policy, providing guidance for nurses conducting VoED independently in home care settings

4. Legal and Regulatory Framework

This policy aligns with:

• The Adults with Incapacity (Scotland) Act 2000, ensuring decisions respect the individual’s rights
• The Registration of Births, Deaths and Marriages (Scotland) Act 1965, governing the certification of death
• The Nursing and Midwifery Council (NMC) Code (2018), outlining professional responsibilities of registered nurses
• Care Inspectorate Scotland Guidelines, ensuring safe and dignified verification of expected deaths
• Scottish Government VoED Guidance, permitting registered nurses to verify expected deaths in specified circumstances

5. Definition of Expected Death

An expected death is one that:

• Occurs due to a known, diagnosed condition where the prognosis has been clearly documented by a medical practitioner
• Has been anticipated within an established end-of-life care plan
• Is not sudden or unexpected and does not require coroner or police involvement
• Has been discussed with the person (where possible), their family, and healthcare professionals to ensure appropriate planning

The VoED process does not involve establishing the cause of death, which remains the responsibility of a medical practitioner who will issue the Medical Certificate of Cause of Death (MCCD).

6. Responsibilities of Registered Nurses

Registered Nurses carrying out VoED must:

• Ensure they have received formal VoED training and are deemed competent to verify expected deaths
• Follow national and local guidelines, maintaining compliance with NMC Code of Conduct and Care Inspectorate Scotland regulations
• Ensure that expected death has been confirmed in advance by a medical practitioner and documented in the individual’s care plan
• Verify death with professionalism, dignity, and sensitivity, ensuring family members are supported appropriately
• Complete and document the VoED process thoroughly, ensuring records are accurate and submitted promptly

7. Pre-Verification Considerations

Before verifying an expected death, the registered nurse must:

• Check the individual’s care plan, confirming documentation that death was anticipated and VoED by a registered nurse was authorised
• Ensure that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order is in place where appropriate
• Confirm the last recorded clinical observations, including deterioration in health indicating end-of-life progression
• Establish the circumstances of death, confirming there are no suspicious, unexpected, or unexplained factors requiring coroner involvement
• Ensure a second trained professional is present where required, depending on local policies and risk assessments

8. Verification of Death Process

The following step-by-step procedure must be followed when verifying an expected death:

8.1 Personal Preparation

• Ensure that appropriate personal protective equipment (PPE) is worn if necessary
• Ensure that all equipment required for verification (e.g., stethoscope, watch with a second hand, documentation) is available
• Prepare family members and carers, offering support and ensuring they understand the process

8.2 Clinical Examination

The registered nurse must confirm all five irreversible signs of death, assessed over a minimum period of five minutes:

1. Absence of Respiratory Effort – No visible chest movement or air exchange through the nose/mouth
2. Absence of Carotid Pulse – No palpable pulse for a minimum of one minute
3. Fixed and Dilated Pupils – Pupils remain non-responsive to light stimulus
4. Absence of Heart Sounds – No audible heart activity upon auscultation with a stethoscope
5. Absence of Response to Verbal or Physical Stimuli – No reflexes or response to pain stimulus

A second examination may be conducted after five minutes if required to confirm findings.

8.3 Documentation of Verification

Once death has been verified, the following must be recorded:

• Full name, date of birth, and address of the deceased
• Date and exact time of verification of death
• The five criteria confirmed during examination
• Details of individuals present at the time of verification
• Confirmation that there were no signs of unexpected circumstances
• Any additional observations, including the condition of the body
• Name, signature, and professional registration number of the verifying nurse

This documentation must be submitted to the individual’s GP, care provider records, and relevant authorities as required.

9. Supporting Family and Carers

Following the verification of death, the registered nurse must:

• Provide compassionate support to family members, explaining the verification process in a sensitive and clear manner
• Advise families on next steps, including the issuing of the Medical Certificate of Cause of Death by a doctor and funeral arrangements
• Allow families to spend time with their loved one, respecting their cultural and religious beliefs
• Contact the GP or out-of-hours service to notify them of the death and arrange for the completion of MCCD
• Liaise with care teams, social services, or funeral directors to ensure proper post-death procedures are followed

10. Managing Unexpected Situations

10.1 Unexpected or Suspicious Deaths

If a registered nurse finds any signs suggesting an unexpected or suspicious death, they must:

• Not proceed with verification
• Immediately contact emergency services and the GP or coroner’s office
• Preserve the scene, ensuring no alterations to the deceased’s position or environment
• Document all observations in detail, reporting the incident via the Incident Reporting and Management Policy

10.2 Death in a Lone Working Situation

Where a nurse is working alone, they must follow lone working safety protocols, including:

• Notifying their line manager before and after verification
• Ensuring a second healthcare professional or family member is present where possible
• Reporting any safety concerns or incidents immediately

11. Training and Competency Requirements

All Registered Nurses conducting VoED must:

• Complete formal VoED training and demonstrate competency through assessment
• Undertake annual refresher training to maintain their verification skills
• Ensure compliance with NMC revalidation requirements, incorporating VoED training as part of continuing professional development

12. Compliance and Monitoring

To ensure adherence to this policy:

• Regular audits will be conducted to review VoED documentation and practice
• Incident reports will be analysed to identify trends and improve training
• Family and staff feedback will be gathered to enhance compassionate care practices
• Annual policy reviews will be conducted to incorporate regulatory updates and best practices

13. Policy Review

This policy will be reviewed annually or sooner if regulatory changes occur. Updates will be communicated to all registered nurses and incorporated into training sessions.

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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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