POLICY FOR DEATH AND DYING
- Death and dying requires great sensitivity. Many older people are realistic in recognising that the end of life is relatively close, so this subject should be dealt with sensitively but not unduly secretively.
- At all times, attempt to respect any expressed wishes of residents in relation to death or period of dying.
- We also put into practice Advanced Care Planning which is based on the Liverpool Integrated Care Pathway for the dying patient (LCP). This provides a template of care to guide our staff and to provide communication. This would include :
An initial assessment and care of the dying patient, care of the family and care after death of the patient.
This would provide appropriate information so that discussion and review of choices between residents, their families, health and social care professionals can take place. This would result in the drawing up of a palliative care plan which would improve care (allow discussion to avert difficulties at a later date) and enable family involvement and care to be individually focused.
- Ensure the resident has got a Lasting Power of Attorney or a Living Will that they wish to follow.
- We must attempt to ascertain and record any personal wishes in relation to residents eventual death.
- We welcome the involvement of relatives and friends in the information gathering process, provided permission is sought from the resident.
CARE PRIOR TO DEATH
- We aim to provide the best physical care for a dying resident, seeking expert advice on specific needs, pain control and other disorders. We strive to assist to provide peace of mind preparing for death with residents and their relatives.
- Once a resident has been diagnosed and their care needs assessed and the decision taken that the individual needs palliative care, the palliative care plan would be put into practice. This also provides specific information e.g. care provided, name of funeral director etc. and whether cremation or burial has been requested.
- We attempt to provide a homely environment within a resident’s room, even if special equipment is required.
- If a wish has been expressed to move to hospital/hospice, all assistance will be given and advice sought.
- Recognise acute and often distressing emotions experienced at a time close to death and try to offer comfort and support.
- We would (where possible) endeavour to offer comfort and support to family members and friends during this emotional time.
- We actively encourage family and friends to visit where welcomed by a dying resident and try to make them as comfortable as possible. We encourage family to stay with the resident if they wish.
- We are also aware that hearing is one of the last senses to be lost and we are aware of talking sensitively in front of that resident and any distressing conversations would be held outside the room.
- We respect the beliefs and spiritual needs of a dying resident and will seek expert advice when dealing with residents who subscribe to religious or other groups of which we have little experience.
- When a resident is seriously ill or passes away, they are remembered in our monthly Home’s Communion Service, and residents committee meeting within each home.
- Remember that it is possible for the deceased to take a gasp of air after death, no pulse means death.
- We will ensure we communicate with the Next of Kin or whoever is the main point of contact as soon as possible after the death, providing whatever help we can.
- We will treat the deceased with the utmost respect in accordance with the wishes of the deceased’s family and friends.
- During illness and after death we will be sensitive to the needs of the other residents.
- We will make efforts to enable residents and staff to attend the funerals if they wish. Of course, permission from the relatives will be sought first.
PROCEDURE ON EXPECTED DEATH OF A RESIDENT i.e. IF THE RESIDENT HAS BEEN SEEN BY GP WITHIN LAST 14 DAYS AND GP CONFIRMS CONDITION IS TERMINAL
- Senior person on duty/on call should be contacted to confirm death.
- Record time, date and circumstances of death on MAR sheet.
- Call GP to confirm death or the registered nurse from Hill House who is qualified to do so.
- Inform relatives, proprietors and Manager of death – Record time on resident’s M.A.R.
- Call chosen undertakers, ensure time is appropriate so that deceased can be discreetly removed, taking into account other residents and relatives.
- Check on the care plan if there are any religious or cultural considerations before handling the body.
- Check the deceased is clean and tidy, and laid out as flat as possible. Open window a little.
- Make a note or remove all jewellery before resident is removed by undertakers.
- If own GP did not certify death, phone surgery at 9.00am next morning to inform residents GP.
- Ensure after deceased is removed, room is left tidy. Remove all laundry and bedding.
UNEXPECTED DEATH IF RESIDENT HAS NOT BEEN SEEN WITHIN 14 DAYS BY GP FOR TERMINAL CONDITION
- Record the time and circumstances of death accurately and do not move any possible evidence. Document jewellery and clothes on deceased.
- The deceased must remain untouched, the police should be contacted.
- GP called to certify death who will then call the Coroner/their representative.
- Advise relatives, proprietor and Manager of death.
- The Coroner/representative will arrange for undertaker to remove the body.
- If own GP did not certify, telephone surgery at 9.00am next working day to inform registered GP.
- The staff on duty must document circumstances leading to death which may be called upon by Coroner.
- Ensure after deceased is removed, room is left tidy. Remove all laundry and bedding.
- CQC must be informed of the death of a resident – a Reg. 16 – 20 form must be completed and sent.
ACTION OF RELATIVES
- To make contact with chosen undertakers.
- To telephone surgery at 9.00 am next day to confirm suitable time to collect Death Certificate.
- To inform the home of certified cause of death at earliest possible time so they may notify the Commission.
The following information must be sent to CQC within 24 hours of death:
– number, age and sex of resident
– date of admission to home
– date and time of death
– cause of death (if known)
– was death referred to the Coroner?
– date of inquest
– cause of death following inquest
Registration of death will be done within 5 days of death at the Registrar of Births, Marriages and Deaths. Where there are no relatives, the Manager or Proprietor shall be responsible for this. Documents required:
– death certificate
– resident’s NHS card
– details of resident’s date and place of birth
– marital status, occupation, maiden name and husband’s occupation if widowed.
CONFIRMATION & CERTIFICATION OF DEATH
The GPC has issued new guidance which it says aims to clarify the distinction between confirming and certifying death in relation to GP’s obligations.
- Does not require a doctor to confirm death has occurred or that ‘life is extinct’
- Does not require a doctor to view the body of a deceased person
- Does not require a doctor to report the fact that death has occurred
- Does require the doctor who attended the deceased during the last illness to issue a certificate detailing the cause of death
EXPECTED DEATHS OF PATIENTS
If the death occurs in the patient’s own home, it is wise to visit as soon as the urgent needs of living patients permit.
If the death occurs in a residential or nursing home and the GP who attended the patient during the last illness is available, it is sensible for him/her to attend when practicable and issue a death certificate.
If an ‘on-call’ doctor is on duty, whether in or out of hours, it is unlikely that any useful purpose will be served by that doctor attending. In such cases we recommend that the GP advises the home to contact the undertaker if they wish the body to be removed and ensure that the GP with whom the patient was registered is notified as soon as possible.
UNEXPECTED (‘SUDDEN’) DEATHS
If death occurs in the patient’s home, or in a residential or nursing home, we recommend a visit by the GP with whom the patient was registered, to examine the body and confirm death, although this is not a statutory requirement. The GP should then report the death to the coroner (usually through the local police).
In any other circumstances, the request to attend is likely to have come from the police or ambulance service. It is usually wise, and especially in the case of an ‘on-call’ doctor, to decline to attend and advise that the services of a retained police surgeon be obtained by the caller.
Guidance issued April 1999
Copied from HCC information sheet