Transcript for Confirmation of Death Training To be read in - - PDF document

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Transcript for Confirmation of Death Training

To be read in conjunction with NHS Lothian Clinical Education and Training Department powerpoint presentation (if no sound available on computer) SLIDE 1 – Title Slide Nurse Verification of Expected Death has now changed with the introduction of the NHS Lothian’s Confirmation of Death policy and procedure. The Confirmation of Death policy and procedure is aligned to the Scottish Government Confirmation of death circular (2017) and Framework for implementation (2018). This new policy, procedure and training enables registered healthcare professionals, identified by their line manager, to confirm death in any circumstance The information in this presentation is supported by NHS Education for Scotland Confirmation of Death resources, on Turas, and relates to Confirmation of Death in an adult patient SLIDE 2 – Learning Outcomes The aim of this training resource together with information from NHS Lothian Confirmation of Death policy and procedure is to support a safe, effective, person centred approach being taken by Registered Healthcare Professionals when confirming a death. Please take a moment to read through the learning outcomes. SLIDE 3 – Confirmation versus Certification Confirmation of death and certification of death are two separate processes. Confirmation of death is the confirmation that life has ceased, based on a physiological assessment. It can be performed by any suitably trained registered health care professional in any circumstance. Whereas Certification of Death is the issuing of the Medical Certificate of Cause of Death (MCCD) by the medical practitioner. This is required for families to be able to register the death and proceed with funeral arrangements. SLIDE 4- Confirming a death: NHS Lothian Policy/procedure Here are some of the key points from the Confirmation of Death policy & procedure, please take a moment to read them. To re-iterate, the most appropriate registered health care professional should confirm the death. It is preferable but not always necessary for the healthcare professional confirming death to have known or provided care for the person in life Staff will require sufficient information to make informed judgements when undertaking the clinical procedure of confirming death, for example

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 When do I escalate?  When are further precautions necessary?  What communications and/or notifications are required? Within the procedure you do have the right to refuse to confirm death and to request the attendance of the responsible doctor/police if there are circumstances around death that raise concerns SLIDE 5- Roles and Responsibilities of Registered Healthcare professionals Here are the Roles and Responsibilities of registered health care professionals who have been identified to undertake Confirmation of Death Please take a moment to read through this slide With regard to training and competency requirements – this will include working through this presentation and viewing the linked video You can access further information, support and resources at the end of this presentation SLIDE 6 - Accountability & Professional Practice This slide considers the accountability of registered healthcare professional in relation to the clinical procedure of confirming death In order to be accountable RHCP’s need to be able to give a rationale for any action or omission when confirming a death. When considering your vicarious liability, if you are called to account for any action or omission, for your employer to assume responsibility for your actions you need to;

• Have been acting within the course of your employed duties
• Have been trained and educated for the role
• Have been working to agreed policies and procedures

HCP’s who confirm deaths will need to

• Follow their regulatory body code of practice; for example the Nursing &

Midwifery Council for a Registered Nurse

• Have current knowledge about the confirmation of death and relevant

communication skills

• The competence for this skill is confirmed by a self assessment and

discussion with your line manager and will need to be regularly reviewed

• As an accountable practitioner you need to ask for help from a suitably

qualified and experienced healthcare professional to carry out any action or procedure that is beyond the limits of your competence (NMC code of conduct 13.3)

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SLIDE 7 – Best practice at end of life In many circumstances patients will have these key documents in place. They demonstrate that the multi-professional team are in agreement that the patient is dying and this has been discussed with them and their family The expectation is you are going to confirm a reported death, but there may be exceptional circumstances when undertaking the confirmation of death procedure there is evidence of signs of life. Therefore in the absence of a DNACPR form confirming that resuscitation should not be attempted, the healthcare professional will use professional judgement to assess whether life preserving measures such as CPR should be initiated (NHSL Confirmation of Death Procedure 2020) Slide 8 – Reference to NHS Scotland DNACPR POLICY Further information can be accessed in the policy with regards to issues around DNACPR Slide 9- Dying process versus reversible deterioration In expected and unexpected scenarios you attend, it is important to consider if there are reversible causes. Having an awareness of conditions such as these listed on this slide, can support you to distinguish between the dying process and reversible causes of deterioration. These conditions may lead to a reduction in a patient’s conscious level and/or an altered breathing pattern and may have a reversible cause. Knowledge of these conditions can support you in your professional clinical judgement as to whether to escalate and call for emergency support. Slide 10 –Person Centred approach The approach you take and how you communicate with relatives when undertaking the clinical procedure of confirming death will have a lasting impact

• n them.

I would like to emphasize the importance of the language you use, being sensitive and empathetic at this difficult time. You also need to be receptive to any questions and ideally have supporting information with you to clarify next

• steps. Examples of these are contained with the resources at the end of this

presentation The recommended timeframe for confirming a death in a hospital setting is within

• ne hour and in the community within 4 hours (RCN Confirmation or verification
• f death by registered nurses advice guide)

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Slides 11 & 12 – We are now going to play a 9 minute video resource that demonstrates the complete procedure of confirming a death and clinical signs you need to check. This has been developed by NHS Education for Scotland Please note, where the patient has suspected or confirmed COVID-19, you must adhere to the up to date infection prevention and control measures that include Personal Protective Equipment (PPE), which can be found at:

https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/

Slide 13- Clinical Signs of Confirmation of Death checks: This slide shows the 5 clinical signs checks you are required to undertake to confirm death. These were shown in the linked video, but are highlighted for you here. Slide 14- Infection Risk in Deceased Patients These resources relating to the infection risk in a deceased patient, they are referenced at the end of this presentation

• The National infection, prevention & control manual contains general

guidance on standard and transmission based infection control precautions

• Section 2.5 and Appendix 12 of the National infection, prevention and control

manual give specific guidance about application of transmission based precautions to key infections in the deceased e.g. Hepatitis

• NHS Lothian COVID base gives up to date information relating to specific

PPE requirements if the patient is suspected or confirmed COVID-19

• Health Protection Scotland website provides specific information relating to

deceased patients with suspected or confirmed COVID-19 in Primary and Secondary care settings. When you are undertaking the clinical procedure of confirming the death of a patient with suspected or confirmed COVID you need to

• ensure you are wearing the appropriate personal protective equipment
• avoid leaning towards the patient’s airway to listen or feel for absence of

breath Please access this information from the websites listed e.g. Health Protection Scotland in order to view the most up to date version Slide15 – Examples of other hazards This slide is to make you aware of the importance of highlighting if a patient has a pacemaker or implantable cardiac defibrillator device or other battery powered

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• device. These may impact on the health & safety of anyone involved in the

subsequent care of the deceased once death has been confirmed. If these devices are not removed prior to cremation they can explode. If the implantable cardiac defibrillator device has not been deactivated prior to removal they can continue to shock. It is not your responsibility to deactivate or remove these devices, but it is important to escalate & notify the doctor responsible for completing the death certificate. Slide 16- Notifying other Agencies If the circumstances or context of death give rise to immediate concern then the registered healthcare practitioner should discuss the issues with a senior colleague or a medical practitioner. Following discussions police attendance may be required to provide support and

• advice. It is the role of the police or the relevant medical practitioner to decide

whether a death is reportable to the Procurator Fiscal. An example being when you arrive to confirm a death but realise there are suspicious circumstances i.e. Where murder cannot be ruled out. The Deaths in Hospital Procedure has been referred to on this slide, this provides further information regarding unnatural causes of death Slide 17- Documentation Confirmation of Death must be recorded as soon as the physiological assessment has been completed on the appropriate template This slide provides information on documentation requirements for inpatients and community settings In patient In inpatient settings, where the healthcare professional has access to TRAK, Confirmation of Death must be recorded electronically in the progress notes using the canned text command \deathver to generate a pro forma for completion. A deceased Inpatient Notification Form must be completed by the healthcare professional who has confirmed the death in accordance with NHS Lothian

• policy. The form must be transferred and remain with the deceased person until

this is ultimately given to the funeral director who collects the deceased person Community In community Confirmation of Death should be recorded on TRAK. In community settings without access to TRAK, a paper form should be used to document

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Confirmation of Death. This should then be kept in the DN nursing notes, and the G.P or referring agency should be informed immediately after the visit. Other information requirements for inpatient & community staff: The actual time and date of death should be recorded if the healthcare professional was present when death occurred. If they were not present then information from others, such as family or carers who were present at the time of death may be taken into account and the time of death that they indicate can be recorded together with the date and time the healthcare professional completed the clinical procedure of confirming death. Slide 18- What do you need to do now? The next step for you is to read the NHS Lothian Confirmation of Death policy, procedure and relevant documentation. Please note there is a Confirmation of Death Flowchart housed with all the other resources to assist you with the procedure of Confirming Death. You must also complete the Competency Checklist. This contains guidance of how to complete the checklist and there is a requirement to have this signed off by your manager with a verbal discussion to deem that you are competent to confirm death. Slide 19- Further information & resources around death & bereavement Further information can be found on the NHS Education for Scotland ‘Support Around Death’ website. This includes;

• guidance for Registered Healthcare Professionals who will be confirming

death

• a prompt card with clinical checks related to the process of confirming a death

and considerations for your own self care

• Further resources relating to death and bereavement e.g. Religious and

cultural requirements Slide 20 – Booklets for families and carers These booklets give specific information & advice about next steps, the Scottish Government publication ‘What to do after a death in Scotland’ and the NHS Scotland booklet, ‘When Someone has died’- information for you. Please check that you have the current editions. Slide 21 – Confirmation of Death Training Resources

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This slide lists the documentation that you are required to read as part of NHS Lothian Confirmation of Death Training. Slide 22- Related References and Resources This slide contains the references and resources that have been identified in this presentation