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Care of the adult patient following death (last offices) SOP

Contents

  1. Aim
  2. Scope
  3. Link to overarching policy or procedure
  4. Procedure
  5. For guidance regarding non-standard care after death and problems solving
  6. Associated documents
  7. References
  8. Appendices

1 Aim

The aim of this standard operating procedure (SOP) is to provide further guidance to clinical staff working within St John’s Hospice in relation to caring for a deceased patient and supporting their relatives. The physical care given to patients following death in a clinical setting has been traditionally referred to as ‘last offices’, however in this guidance we refer to it as ‘care after death’, a term more befitting of a multiple cultural society (Wilson and White, 2011).

Continued compassionate, sympathetic, dignified and quality care for a patient, once they have died, and supporting their relatives is enormously important and a privilege. We only get one chance to get it right and so we need to ensure that we all understand the steps that are required in order to provide a seamless and co-ordinated pathway of care following death (Wilson and White, 2011, Wilson, 2015).

We also need to recognise that we, as care givers and our colleagues, who are involved in the care process, may also be affected at this emotional and stressful time.

The term “relative” used throughout this policy is applicable to all family members and friends of the dying or deceased patient.

2 Scope

This standard operating procedure applies to all clinical staff working within the inpatient unit at St John’s Hospice. The qualified nurses in the hospice inpatient unit will need to have a detailed knowledge of the expected minimum standards in relation to their role in care after death. Clinical staff on other inpatient wards within the RDaSH and community services, including medical staff, will need to have an awareness so they are able to answer any queries which patients or their families may raise.

3 Link to overarching policy or procedure

This standard operating procedure is overarched by the following policy which can be found on the RDaSH trust policy website.

4 Procedure

Once a patient has died, it is imperative that a timely and sensitive process of care follows. The nurse in charge of a particular shift should oversee the care and delegate roles, as appropriate. The following should be adhered to:

The ‘fact of death’ has occurred, immediately document the time of last breath.

If the relatives are not present, inform them, as directed in the admission documentation.

Start the ‘checklist following the death of a patient’, (see appendix E)

Does the patient need referring to the coroner? See transfer of the deceased into the care of another provider (expected and unexpected deaths) for guidance.

  1. When an expected death of a known illness that requires referral to the coroner (for example, Mesothelioma) but dying was anticipated and expected, it is not necessary to involve the police. Formal arrangements have been agreed between the Coroner and St John’s Hospice. The following process must be adhered to
    (flowchart appendix A):

    • on admission for all patients ensure that the name of the nurse who has identified the patient, and the name of the nurse who has put the Identity (ID) band on the patient has been documented in notes
    • if the patient dies out of hours and the death is reportable to the coroner due to industrial related disease then the relevant persons need to complete the following forms,
      • identification statements for staff (appendix B)
      • identification statements for relatives (appendix C)
      • identification statements for funeral director (appendix D)

      a qualified nurse may perform verification of expected death as normal (if trained to do so)

    • ring the coroner agreed funeral directors. If industrial related death they will transfer body to Doncaster Royal Infirmary (DRI) mortuary (for further examination).
    • fax all 3 completed forms to the coroner at CER@doncaster.gov.uk immediately. Send hard copies (scan a copy in the patient’s notes) in post the next working day. Next working day ward doctor or senior clinician will liaise with the coroner using the coroner’s on-line form
  2. has there been a formal complaint around the care of the patient or any clinical incidents prior to death? If yes, coroner referral will be required and death should be treated as ‘not expected’
  3. if the death is ‘unexpected’ (for example, suspicious circumstances, following recent serious incident). The body cannot be touched; the room needs to be secured to preserve evidence. The police need notifying of an unexpected death immediately and the family need informing of the situation and offer of support for the family is essential. For detailed instructions see policy for the ‘Transfer of the deceased into the care of another provider (expected and unexpected deaths)

Are there any religious requirements to be adhered to? For additional guidance, see Royal Marsden clinical procedures, chapter, last offices (requirements for people of different religious faiths) (Royal Marsden, 2015).

  • Does the chaplaincy service need to be notified?

Verification of an expected death should take place within one hour (best practice in inpatient setting) (Wilson and White, 2011, Wilson,
2015). For procedure follow verification of an expected death policy and interim guidance for Covid 19.

  • Document clearly in the electronic patient record (SystmOne or TPP) the rationale for any delay.
  • If the expected death occurs out of hours and there is not a nurse on duty that is trained in verification of death (very rare), the procedure is to contact ‘unplanned care’ and document in the notes the reason for the delay.

In working hours, notify the doctor or medical cover that the person has died and to request completion of the medical certificate of the cause of death (MCCD) at the earliest opportunity.

  • If specific timeframes are required for religious requirements, ensure prior arrangement have already occurred and plan in place.

Personal care after death needs to be carried out within two to four hours of the person dying, to preserve their appearance, condition and dignity.

Document clearly in electronic patient record (SystmOne or TPP) the rationale for any delay.

Give the relatives information regarding what to do after death and inform the relatives of the procedure for the MCCD and registering the death. Usual timeframe is between 24 to 48 hours of death and during a weekday.

The body’s core temperature will take time to lower and therefore transferring the deceased to the family appointed or trust appointed funeral director for refrigeration within four to six hours of death is optimum.

  • Allow relatives to spend time with their loved one immediately after death.
  • If after 4 hours the deceased remains in the hospice, the cooling blanket must be applied (as per manufacture instructions). A sheet must be placed between the cooling blanket and the deceased to protect and preserve the skin. If a cooling blanket is not available (if both in use, or the deceased is not in the hospice), then turn on the air conditioning (if available) to its lowest setting and monitor the temperature in the room hourly. If using the air conditioning the bedroom windows must be closed. Document the above in the electronic patient record and support the family.

Notify the family appointed funeral director or trust appointed funeral director to collect the deceased.

5 For guidance regarding non-standard care after death and problems solving

  • The Royal Marsden clinical procedures, last offices, problem solving (Royal Marsden, 2015).
  • Verification of expected death policy (see section 3. above).
  • National guidance for care after death (see section 3. above).
  • Transfer of the deceased into the care of another provider (expected and unexpected deaths) policy (see section 3 above).

Staff also need to be familiar with the following procedural documents:

7 References

  • Royal Marsden Clinical Procedures (2015) (opens in new window) or via link on intranet, ask line manager for password.
  • Wilson, J. White, C. (2011) Guidance for staff responsible for care after death. National end Of life care programme and national nurse consultant group.
  • Wilson, J (2015) care after death, guidance for staff responsible for Care after death. London. Hospice UK.
  • Wilson, et al (2020) special edition of care after death, registered nurse verification of expected adult death (RNVoEAD) Guidance. 3rd edition London. Hospice UK

8 Appendices

Appendix A process of deaths related to industrial diseases that occur out of hours

  • On admission for all patients, ensure that nurse who is Identifying the patient and nurse who has put the ID band on the patient has been documented in notes.
  • If patient dies out of hours and death is either within 24 hours of admission or due to industrial related disease (commonly mesothelioma), for example, need referring to coroner, then get the relevant forms, Identification statements for staff, relative and funeral director. Verify death as normal.
  • Ring coroner appointed funeral director (number on poster in nurses office hospice), if industrial related death they will transfer body to DRI mortuary (for further examination).
  • Fill out the two forms (staff and relative) (see example). Ensure Steadman’s funeral directors also fill out their form as well. Email forms to the coroner at CER@doncaster.gov.uk immediately. Send hard copies (with copy for patient’s notes) in post the next working day.
  • Next working day ward doctor or senior clinician will liaise with the coroner using the coroner’s online form.

Document control

  • Version: 4.
  • Unique reference number: 51.
  • Date ratified: 5 April 2022.
  • Ratified by: Clinical policies review and approval group.
  • Name of originator or author: Specialist palliative care nurse consultant.
  • Date issued: 12 April 2022.
  • Review date: April 2025.
  • Target audience: All clinical staff working within St John’s Hospice inpatient unit.

Page last reviewed: April 22, 2024
Next review due: April 22, 2025

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