Before death confirmation
Prior to death confirmation, you should check the patient’s resuscitation status:
If the patient is not for resuscitation, death confirmation can proceed. If there is uncertainty as to the patient’s resuscitation status, CPR should be commenced whilst this is clarified. Review the patient’s notes to gain further details about their medical history.
Clarify the circumstances surrounding the death with the relevant staff and family members. This information will need to be documented in the patient’s notes.
If family or friends of the patient are present, introduce yourself and offer your condolences.
Explain the need to confirm death and offer the family the opportunity to leave or stay whilst you do this. Check if the family have any questions or concerns.
Death confirmation
To perform death confirmation:
1. Wash your hands.
2. Confirm the identity of the patient by checking their wrist band.
3. Inspect for obvious signs of life such as movement and respiratory effort.
4. Assess the patient’s response to verbal stimuli (e.g. “Hello, Mr Smith, can you hear me?”).
5. Assess the patient’s response to pain using one of the following methods:
Apply pressure to the patient’s fingernail.Perform a trapezius squeeze.Apply supraorbital pres sure.
6. Assess the patient’s pupillary reflexes using a pen torch: after death, the pupils become fixed and dilated.
7. Palpate the carotid artery for a pulse: after death, this will be absent.
8. Perform auscultation in an attempt to identify any heart or respiratory sounds:
Listen for heart sounds for at least 2 minutes.Listen for respiratory sounds for at least 3 minutes.The recommended amount of time to listen for heart and respiratory sounds can vary, but it is generally accepted that a minimum of five minutes of auscultation is required to establish that irreversible cardiorespiratory arrest has occurred.
9. Wash your hands and exit the room, making sure the relevant doors and/or curtains are closed/drawn behind you.
Confirm the patient's identify
Inspect for signs of life
Assess response to a painful stimulus
Assess pupillary reflexes
Palpate carotid pulse
Auscultate for heart sounds
Auscultate for respiratory sounds
Document death confirmation
To complete death confirmation
Inform the relevant nursing staff that you have confirmed the death. Either yourself or the nursing staff should inform the next of kin if not already present and contact the porters to arrange transfer of the body to the morgue.
Consider if the death may need referring to the coroner. If this is the case, a death certificate should not be issued and you should discuss the situation with the consultant responsible for the patient.
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Documentation basics
Before we discuss how to document the death confirmation, we need to
cover the basics that apply to all documentation in a patient’s notes.
What should I use to write with?
You need to use a pen with black ink, as this is the most legible if notes are photocopied.
Patient details
For every new sheet of paper your first task should be to document at least three key identifiers for the relevant patient:
- Full name
- Date of birth
- Unique patient identifier
- Home address
If a patient label containing at least 3 identifiers is available,
then this can be used instead of writing out the information manually.
Location details
You should indicate the patient’s current location on the continuation sheet:
- Hospital
- Ward
Patient details
Beginning your entry in the notes
At this point, you should already be holding a pen with black ink and you should have ensured the continuation sheet has at least three key
patient identifiers at the top.
The next documentation steps include:
1. Adding the date and time (in 24-hour format) of your entry.
2. Writing your name and role as an underlined heading.
3. Adding your entry in the notes below this heading (see the next section for details).
Beginning an entry in the notes
Documenting death confirmation in the notes
1. Document your reason for attending and if
relevant, who asked you to attend (e.g. asked to confirm the death of Mr Smith by staff nurse Amanda Miles).
2. Document who was present whilst you were
confirming the death (e.g. staff members and/or the deceased patient’s
family and friends).
3. Document the circumstances of the death:
- Location of the patient
- The individual who first noted the patient to be dead
- Any individual present at the moment of death
4. Document confirmation of death assessment:
- Identity confirmed by wrist band
- General inspection
- No signs of respiratory effort
- No response to verbal stimuli
- No response to painful stimuli
- No pupillary response to light
- No central pulse
- No heart sounds after 3 minutes of auscultation
- No respiratory sounds after 3 minutes of auscultation
The recommended time for auscultation varies, but typically at least 5 minutes of auscultation of heart and respiratory sounds are advised to
establish that irreversible cardiorespiratory arrest has occurred.Âą
5. Document the outcome of the assessment, including the time of death (which should be documented as the time at which you
completed your assessment).
6. Document any discussions you had with staff members or relatives of the deceased in relation to the death.
7. Document any concerns of staff members or the patient’s relatives.
Death confirmation documentation
Completing the entry in the notes
At the end of your entry to need to include the following:
- Your full name
- Your grade/role (e.g. F2/Medical Registrar)
- Your signature
- Your professional registration number (e.g. GMC number)
- Your contact number (e.g. phone/bleep)
