Verification of expected death policy

1 Policy summary

This policy provides the expectations for verification of expected death within Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) Doncaster. The policy covers the procedure for deceased patients that were known to the community nursing service (including trust inpatient settings or their usual place of residence) or St John’s Hospice or the Children’s Community Nursing team. The policy outlines in detail the process for wider services who may not perform the procedure but need guidance for who to contact after a patient has died. The policy is important due to the strict laws and processes for the deceased patient.

2 Introduction

Laverty et al. (2025) define an expected and unexpected death as:

Expected death:

“An expected death is the result of an acute or gradual deterioration in a patient’s health status, usually due to advanced progressive incurable disease. The death is anticipated, expected and predicted. It is anticipated in these circumstances that advance care planning and the consideration of a do not attempt cardiopulmonary resuscitation (DNACPR) will have taken place.”

A sudden or unexpected death:

“An unexpected death is not anticipated or related to a period of illness that has been identified as terminal. Where the death is completely unexpected, and the healthcare professional is present, then there is an expectation that resuscitation will commence (Resuscitation Council 2021).

“However, for circumstances where a patient is discovered dead and there are obvious signs of irreversible death, for example, mortal injury or rigor mortis, the healthcare professional may make an informed clinical decision to withhold cardiopulmonary resuscitation (CPR). The healthcare professionals must articulate and document clearly their actions and reasoning (Resuscitation Council 2021).”

Verification of expected death is the procedure of determining whether a patient is deceased (Royal College of Nursing, 2020). A registered nurse (RN) can verify that an expected death has occurred if there is a local policy to support the registered nurse. It is important to note that the law dictates that a medical certificate of cause of death (MCCD) is written by a registered medical practitioner in accordance with the Births and Deaths Registration Act (1953) (Laverty, et al. 2025, Royal College of Nursing, 2020). As part of the death certificate reforms that were introduced in September 2024, a medical practitioner will be eligible to be the attending practitioner and complete a medical certificate of cause of death if they have attended the deceased in their lifetime (Department of Health and Social Care, 2024).

Verification of expected death by a competently trained registered nurse allows for timely provision of appropriate care for the deceased and their family, thus minimising distress caused by unnecessary delays at such an emotional and vulnerable time.

Following the verification process, the registered nurse can instruct the timely removal of the deceased to the appropriate onward location, for example, funeral directors.

In addition, if a situation is identified during the verification procedure that requires a referral to the coroner (section 5.2), the registered nurse can explain the rationale and offer ongoing support.

It is important to advise the family that there may be a delay between time of last breath (often reported by the family or carer) and time of verification of death, which is the official time of death. It is at this time that it should be documented in the patient’s records. Please note: if a patient takes their last breath before midnight and verification takes place after midnight, the official date of death remains as the date and time of verification.

A registered nurse can only verify an expected death (see definition above).

3 Purpose

The purpose of this policy is to provide guidance and set out the organisational arrangements for implementing best practice in relation to the verification of expected death procedure for the adult Unplanned Community Nursing team, the hospice inpatient nursing team and the Children’s Community Nursing team.

To provide legislative guidance for situations requiring a referral to the coroner and local arrangements for referrals to the coroner within the Borough of Doncaster.

To provide guidance for nursing and medical colleagues supporting patients whose death, in the near future, is inevitable, enabling them to explain to patient, relatives, or carers the procedures that take place following an expected death and the services that may be involved.

The abbreviation registered nurse (RN) throughout the policy will refer to both adult and children’s registered nurses unless otherwise stated.

4 Scope

This policy applies to:

registered nurses employed by the trust, working in adult community nursing (Unplanned) or St John’s Hospice (Physical Health and Neurodiversity Care Group only), who have been appropriately trained and have been assessed as competent in this procedure
registered nurses employed by the trust working in the Children’s Community Nursing (CCN) team who have been assessed as competent in this procedure.
all general practitioners (GP’s), and doctors working in the trust, who request a trust employed registered nurse to undertake the verification of expected death procedure

Registered nurses in other clinical settings, for example, inpatient wards, are not included in this policy because they do not routinely care for patients at the end of life.

When a patient is nearing the end of life in a trust inpatient setting, other than the hospice, for example, Hawthorn, Hazel, Magnolia or Windemere, see section 5.5.8.

This policy has a limited scope regarding the wider processes of an expected death of a child (person under 18) and therefore only covers the verification of expected death procedure. For more information around the death of a child, please refer to the transfer of deceased into the care of another service provider (expected and unexpected deaths) policy

For further information about responsibilities, accountabilities and duties of all employees, please see appendix A.

This policy will support the referring healthcare professional, GP and, or doctor in their decision-making when deciding when it is and is not appropriate to request a registered nurse to verify that an expected death has occurred

5 Procedure

5.1 Medical examiner

The independent medical examiner (ME) role was recommended in the Shipman inquiry in 2008. Medical examiners are senior doctors, usually with experience in pathology, general practice or hospital medicine. In Doncaster, the medical examiner team has been scrutinising all deaths since 2023.

The role of the medical examiner is to:

improve the quality and accuracy of medical certification of cause of death (MCCD)
ensure referrals to the coroner are appropriate
provide bereaved families with greater transparency and opportunities to raise concerns

There are circumstances whereby an expected death is already known to be reportable to the coroner, for example, industrial related disease, such deaths are reported direct to the coroner rather than going via the medical examiner process.

5.2 Registering a death

Once the medical examiner team have completed their scrutiny and have had discussions with the next of kin, they will send the medical certification of cause of death to the Doncaster Register Office electronically. Once received, the register office will contact the next of kin to arrange a face-to-face appointment to register the death. The aim is to register the death within 5 days from the register office contact. For further details see register a death.

The GP practice no longer gives relatives, or other the person who is registering the death, the death certificate to register the death. The registered nurse should not request the family to contact the GP practice for the death certificate; the registered nurse should explain the ‘Register a Death’ process above.

5.3 Deaths that require a referral to the coroner

The death was due to:
- poisoning including by an otherwise benign substance
- exposure to, or contact with a toxic substance
- use of a medicinal product, the use of a controlled drug, or psychoactive substance
- violence, trauma or injury
- self-harm
- neglect, including self-neglect
- to a person undergoing any treatment or procedure of a medical or similar nature
- to an injury or disease attributable to any employment held by the person during the person’s lifetime
The death was unnatural but does not fall within any of the above circumstances.
The cause of the death is unknown.
The registered medical practitioner suspects that the person died while in custody or otherwise in state detention.
There was no attending registered medical practitioner, and there is no other registered medical practitioner to sign a medical certificate for cause of death in relation to the deceased person.
Neither the attending medication practitioner, nor any other registered medical practitioner able to sign the medical certificate for cause of death, is available within a reasonable time of the person’s death to sign the certificate for cause of death.
The identity of the deceased is unknown.

The above list is from the Notification of Deaths Regulations (2019), updated from the 2024 death reforms. Throughout this policy the coroner referral processes relate to referrals for the coroner within the Borough of Doncaster only.

Coroner processes may be different outside the Borough of Doncaster, therefore for patients who live in the community but reside outside the Borough of Doncaster, even if they are registered with a Doncaster GP, will be the responsibility of the patient’s GP or doctor for the out of hours services that covers that area.

Trust employed registered nurses are unable to verify expected deaths reportable to coroner for deceased patients who reside out of area.

5.3.1 Expected death reportable to coroner

The registered nurse may verify a death that is reportable to the coroner, if the deceased was expected to die and was being treated for end-of-life care prior to death (see 5.5.3 for acceptance criteria).

Ideally, for an expected death clinicians should have an understanding before the person dies whether the diagnosis or clinical circumstances mandate a coroner referral. The registered nurse should understand the requirements for coroner referral, refer to the relevant documentation in the patient’s electronic records about the diagnosis and have discussions with the patient’s GP or the patient to clarify. This proactive approach ensures clarity, reduces delays and supports the family through a smoother bereavement process.

If a patient has a do not attempt cardiopulmonary resuscitation (DNACPR) order in place this does not automatically mean that the death is expected. Therefore, if a contraindication is identified, a referral to the coroner will be required.

5.3.2 Deprivation of liberty safeguards

Since April 2017 coroners no longer have a duty to undertake an inquest into the death of every person who was subject to an authorisation under the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act (2005).

Any person subject to a deprivation of liberty safeguards authorisation who dies, their death should only be referred to the coroner if their circumstances meet the coroner referral criteria.

5.4 Doncaster’s coroner’s referral process (adult community nursing only)

If at the time of referral for verification of an expected death the GP or registered nurse identify situation that the death requires a referral to the coroner (section 5.3), the registered nurse may attend to undertake the verification procedure. However, the registered nurse is not competent in the coronial process, or the circumstances are unclear, they have the right to decline.

If the registered nurse attends, then they must complete letter 2 (appendix H) and sent to the GP following verification. This should be the same day if verification of expected death occurred within GP normal working hours, or the following morning if verification of expected death was out of hours.

The GP surgery should also be contacted by phone to ensure they are aware of the letter and for timely processing.

The coroner requires the name of the healthcare professional who verified the death; it is essential that this section of the letter is completed.

5.4.1 Formal identification

All coroner reportable deaths require a strict formal identification of the deceased. This formal process was normally carried out by South Yorkshire police on behalf of the coroner. In August 2025, following agreement by the Doncaster Senior Coroner, the process was changed for “expected deaths” reportable to coroner for trust unplanned community nursing only.

The registered nurse must follow the strict procedure instructed by the coroner which includes the completion of 3 identification witness statement forms:

form 1: nurse identification witness statement
form 2: relative or carer identification witness statement
form 3: coroner appointed funeral director identification witness statement

For the full procedure see appendix F (contact details for the coroner appointed funeral director is in appendix F).

For coroner reportable expected deaths, the police are no longer required.

It is responsibility of the deceased patient’s GP to complete the clinical referral to the coroner and send it to the coroner’s office.

If at the time of the verification of expected death procedure the registered nurse identifies information that requires the expected death to be reported to the coroner, for example, industrial related disease, that was not known at the time of the reification of expected death referral (see 5.3), the registered nurse is required to contact the patient’s GP to:

discuss or clarify the new identified information
discuss if the death requires a referral to the coroner:
- if so, complete the formal identification process (appendix F)
- if there are conflicting opinions for a referral to the coroner for expected death, the registered nurse will escalate to their line manager for further advice; out of hours; the registered nurse should escalate via the on-call management system for advice
authorise the removal of the deceased to the coroner appointed funeral director, if no concerns

5.4.2 Suspicious circumstances

If it is suspected that suspicious circumstances may be a cause, or contributed to the death, for example, trauma or injury (see section 5.3), the death should be treated as an unexpected death (see transfer of deceased patients policy). The deceased should not be touched. Furthermore, it is an offence to remove or otherwise interfere with a body or surrounding evidence without leave of the coroner where death has occurred in circumstances which may lead them to hold an inquest (Earland 2006).

A phone call must be made to the patient’s GP practice to notify of the possible unexpected death and highlighting that a letter 2 has been sent. The police must be contacted as per the unexpected death procedure; they will refer to the coroner.

5.4.3 For hospice inpatient unit service only

For coroner referral process, see transfer of deceased patients policy.

5.5 Verification of expected death procedure (community services and children service)

5.5.1 For adults

When an expected death occurs outside normal GP working hours the GP out of hours service, family or carers can contact a registered nurse via the single point of access (SPA) and request that a registered nurse visit to verify that an expected death (see 5.5.3 for acceptance criteria).

5.5.2 For children (person under 18 years)

The Children’s Community Nursing team’s normal working hours are 8am to 6pm, on weekdays, outside these hours will be by prior arrangement by the Children’s Community Nursing team with the family and their contact number being left with the GP out of hours service.

5.5.3 Acceptance criteria

The deceased adult must have been known to the trust community nursing service (planned or unplanned) for end-of-life care prior to death (community and inpatient wards only) or in the case of children, they will have been known to the Children’s Community Nursing team.
A valid do not attempt cardiopulmonary resuscitation (DNACPR): ReSPECT with DNACPR decision must be in place (Laverty et al. 2025).
Death is expected and not accompanied by any suspicious circumstances.
It includes where the patient dies under the Mental Health Act, or Mental Capacity Act, including Deprivation of Liberty Safeguards (DoLS) for example patient on Windermere Lodge.
There is written documentation in the patient’s records. Preferably in the electronic palliative care coordinating system (EPaCCS) indicating that the patient is deteriorating, unlikely to recover and or nearing the end of life.
The deceased must have a Doncaster GP.
For coroner reportable expected deaths, the deceased must reside within the Borough of Doncaster.

5.5.4 Exclusion criteria

Patients not known to the adult or children’s community nursing teams.
Unexpected deaths.
Any expected adult death believed to have occurred due to suspicious circumstances, this must be treated as an unexpected death.

5.5.5 Timely verification

Best practice dictates that verification should be carried out in a timely manner as it is key to the grieving process, causes minimal distress and allows time to offer support to the family:

in the community setting within 4 hours
in the hospice setting within 1 hour

The registered nurse will:

in a sensitive and supporting manner support the relatives or carers and offer full rationale for their contact and procedures that they are required to undertake
confirm the identity of the patient (see appendix F for identification procedure) with the relative or carer or designated person
clarify any faith or cultural requirements that may affect the verification procedures, resources can be found in the practical resources page of the Association of Hospice and Palliative Care Chaplains website

5.5.6 Verification procedure (no contraindications)

The registered nurse must not remove any parenteral or life prolonging equipment until after death has been verified and confirming that no suspicious circumstances are identified (Laverty et al. 2025).

The registered nurse must verify that death has occurred following agreed procedures (appendix F, G and H).

Following the procedure the registered nurse will:

authorise the removal of the deceased to a funeral director identified by the relatives or carers
explain to the family or carers the procedure for registering the death (see section 5.2)
complete letter 1 (appendix G) and send to the deceased’s GP practice on the same day via email
as a courtesy it is important to phone the GP practice to inform them the patient has died (same day if the death occurred in normal working hours, or the following day if out of hours) to give them the opportunity to visit the family if they wish, the GP or doctor will send the medical certificate of cause of death (MCCD) electronically to the medical examiner for scrutiny (see section 5.2)

The registered nurse will provide information for relatives or carers regarding what to do after death and can signpost to the government after a death. Explain that their GP will complete the death certificate and this will be sent to the medical examiner (see section 5.2).

The registered nurse must notify the funeral directors of any suspected infections, implantable devices (implantable cardioverter defibrillator (ICD), pacemaker). Deactivation should be explored or arranged by the GP, specialist nurse or registered nurse prior to death. This is through the Cardiac Devices team based in Rotherham. Whilst Doncaster patients with an implantable cardioverter defibrillator may come under Rotherham or Sheffield, the Rotherham team should be contacted for advice and signposting.

Contact:

Phone: 01709 424 794
Email: rgh-tr.cardiacdevices@nhs.net

So see regional recommended summary plan for emergency care and treatment (ReSPECT) procedure in the resuscitation manual.

5.5.7 Verification procedure (if contraindications identified)

Refer to section 5.3 (deaths reportable to the coroner) and 5.4.2 (suspicious circumstances).

5.5.8 If an expected death occurs within a Doncaster inpatient unit (not hospice)

5.5.8.1 Prior to death

When the patient has been assessed as last days to short weeks of life and is to remain on the inpatient unit:

the patient should be referred to community nurses via the single point of access (SPA), this is to provide support for the patient and ward nurses who do not regularly care for patients at the end of life.
this referral is also required to meet the criteria for unplanned nursing to perform verification of expected death
the patient should also be referred to the Community End of Life team via the single point of access, who can provide guidance on prescribing and additional advice and support to the ward nurses, patient, and family

5.5.8.2 After expected death

Follow the process above for section 5.5.

5.5.9 Verification of expected death procedure (hospice inpatient unit)

When an expected death occurs, the registered nurse will follow the verification of expected death principles outlined in section 5.5 (except for the information aimed specifically community nursing) with the addition of following the hospice coroner referral process in the Care After Death Local Working Instruction, if coroner referral is required.

If a medical certificate of cause of death (MCCD) can be written, the doctor will notify the medical examiner via the formal process.

5.6 Record keeping

The registered nurse is required to complete the electronic record in line with the trust healthcare record keeping policy and records management policy and the Nursing and Midwifery Council “The Code”.

Verification of expected death, and associated conversations and care should be completed in the electronic palliative care coordinating systems (EPaCCs) template or the designated template for children’s services.

6 Training implications

6.1 Registered nurses undertaking verification of expected death procedures

Frequency: 3 yearly.
Length of training: 1 hours.
Delivery method: face to face.
Training delivered by whom:
- unplanned clinical leads
- palliative care nurse consultant
- hospice ward sisters: hospice services
- for the Children’s Community Nursing team training is delivered at Sheffield Children’s Hospital
Where are the records of attendance held: electronic staff record system (ESR).

7 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

7.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.

Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all patients with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

7.1.1 How this will be met

No issues have been identified in relation to this policy.

7.2 Mental Capacity Act (2005)

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

7.2.1 How this will be met

No impact as patients are deceased.

8 Links to any other associated documents

Care of the adult patient following death (last offices) procedure
Clinical risk assessment and management policy
Mental Capacity Act (2005) Deprivation of Liberty (DoL) policy
Healthcare record keeping policy
Health and safety policy
Infection prevention and control
Learning from deaths policy the right thing to do
Records management policy
Safe and secure handling of medicines manual
Safer manual handling operations policy
Transfer of deceased patients policy

9 References

Chief Coroner (2017) Guidance No.16 A Deprivation of Liberty Safeguards (DoLS)
GOV.UK What to do after death: step by step
Department of Health The Mental Capacity Act (2005)
Earland, E (2006) H M Coroner for Exeter and Greater Devon
NMC The Code (2020)
Royal College of Nursing. Confirmation of Verification of Death by registered nurses
Wilson, J, Laverty, D, Cooper, M (2016) Care after Death: Registered Nurse Verification of Expected Adult Death guidance. London, Hospice UK
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 ed. London. Hospice UK

10 Appendices

10.1 Appendix A responsibilities, accountabilities and duties

10.1.1 Chief executive

The chief executive is responsible for making arrangements to support the safe and effective implementation, monitoring and review of this policy.

10.1.2 Medical director

The medical director is responsible for the implementation and monitoring of the policy

10.1.3 Medical colleagues and consultants

Consultants are responsible for the safe and effective implementation and monitoring of this policy.

10.1.4 Area clinical managers, modern matrons, team leader or ward managers

The area clinical managers or modern matrons or team leaders or ward managers are responsible for the safe and effective implementation of this policy.

In addition:

monitoring compliance relating to registered nurse training and competency outlined in this policy
ensure appropriately trained registered nurses are available within their areas to undertake the verification of death procedure
monitor inappropriate referrals and actions taken

10.1.5 Registered nurses

All registered nurses who have undertaken the required training, who are assessed as competent (appendix C and D) and have been assessed using trust clinical skills assessment tool (appendix E) to verify that an expected death has occurred are responsible for:

ensuring their knowledge and skills are kept up to date
ensuring they follow the verification of death procedures
ensuring documentation is accurate and up to date
ensuring referral to coroner’s office is requested in line with legislative guidance
ensuring escalation to senior colleagues if issues arise

10.2 Appendix B monitoring arrangements

10.2.1 Standard IR1 reporting incidents regarding issues relating to the verification of expected deaths

How: number if IR1 reports.
Who by:
- service managers
- team leaders
- unit managers
- matrons
- lead for verification of expected death
Reported to: Physical Health and Neurodiversity Care Group or Children’s Care Group appropriately.
Frequency: quarterly.

10.3 Appendix C assessment specification (performance)

10.3.1 Aim

The registered nurse can competently and confidently verify that an expected death has occurred.

10.3.2 Competency performance and competence expectation

The registered nurse competently and confidently undertakes verification of expected death, and ensures that related documentation is completed.

Equipment needed:

pen torch
clock with second hand
stethoscope

If infectious or bodily fluids:

fluid resistant surgical mask (FRSM)
eye protection (if required)
personal protective equipment
sterile sheet or trolley
community: 2 small waste bags

Evidence type:

direct observation
questioning
simulation
reflective

10.3.3 Practice record

Evidence of performance:
Type of evidence:
Date achieved:
Assessor:

Checks relevant patient records to ensure that death was expected and that the deceased had a do not attempt cardiopulmonary resuscitation (DNACPR) order in place (recommended summary plan for emergency care and treatment (ReSPECT) with DNACPR decision)
Did the deceased require deactivation of an implantable cardioverter defibrillator (ICD)?
Checks that all necessary equipment is available and in working order.
Confirms correct identity of the patient, following formal process.
Informs relatives or carers of verification process in a professional manner.
Performs hand decontamination pre-procedure and post-procedure.
Maintains infection prevention and control standard precautions, in line with local policy.
Respects privacy, dignity, cultural and religious beliefs at all times.
Lies deceased patient flat, leaves all tubes, lines, drains, medication patches and pumps in place (turning off pumps and fluids).

Stages 10, 11 and 12 should take place over a minimum of 5 minutes.

Confirms with stethoscope the absence of heart sounds for 1 minute.
Observes for any signs of respiratory effort over 5 minutes.
Test both eyes for the absence of pupillary response to light (cerebral function) using a pen torch.
Confirms the absence of carotid pulse for 1 minute.
No reaction to a Trapezius muscle squeeze (cerebral function or motor response). Carried out through patient’s clothing.
Repeats the above procedure over 5 minutes if any spontaneous return of cardiac or respiratory activity during the procedure.
Decontaminate equipment used in the process according to local policy.
Removes personal protective equipment (PPE) according to policy if wearing.
Safely disposes of medication, if required.
Records physiological findings on the electronic palliative care coordinating systems (EPaCCs).
Records date, time that the expected death was verified (official time of death) on the electronic palliative care coordinating systems.
Authorise removal of the deceased to appointed funeral directors, if appropriate
Hospice, complete checklist, notify doctor, notify medical secretary who will instigate e-notification of death.
Community and children, inform the GP using letter 1 (appendix G) or letter 2 (appendix H).

10.4 Appendix D Assessment specification (knowledge)

10.4.1 Aim