Dealing with Death Part 2 Learning outcomes Describe

Dealing with Death Part 2

Learning outcomes • Describe how to verify death • Describe how to certify a death • Understand what bereavement services can offer • Understand the “crem form” process • Understand when to refer to coroner

Verifying death – how and what to document • Often as a junior you will be asked to confirm a death • It is therefore important to know how to confirm death and what you should document

How to confirm death • Confirm correct patient (3 x identifiers) • Stimuli • No response to voice • No response to pain • • No respiratory effort No carotid pulse (1 min) Auscultate – No heart sounds. No resp sounds (2 mins each) Pupils fixed and dilated Cold peripheries Make sure wash hands before/after N. B timings may vary – check local policy and proformas

What to document • Title – confirmation of death • Document as previous slide • Make sure you put the date, time of death • Your full name • GMC • Contact number/bleep • NB there may be a specific trust performa – fill in as appropriate

Bereavement services • All hospitals will have a bereavement office • Staff in there provide support for families and help them through the difficult time of losing a family member • Provide guidance of the next steps after death • In addition they are very helpful and supportive to doctors when it comes to making sure the relevant forms are completed

Death certificate • ADVICE – always confirm what to write on the form with consultant(or senior Sp. R). • Arrange with bereavement services (they will usually contact you) a suitable time. • Go and fill out the Medical Certificate Cause of Death form.

Death certificate 2

Line 1 • You should start with the immediate cause of death and then work backwards through the events to the root cause. • i. e the part written in 1 c should have led to 1 b which then led to 1 a • Avoid putting “failure – eg liver failure”, “Cardiac arrest” – as these are too non-specific • “Old age” over 80 is acceptable, but not on its own • Avoid abbreviations (Eg COPD) – write out in full • Try to be as accurate as possible – (eg lung cancer – write adenocarcinoma of lung)

Line 2 • In this put the other conditions that may not have directly caused the death, but may have played a role in hastening it • Eg Ischemic heart disease in a patient who died of a pneumonia. • Try and avoid listing the entire past medical history, unless relevant • (for example someone who died of pneumonia is unlikely to have their death hastened by depression or their previous appendicectomy 5 years ago)

• Mr Patel was admitted with a urinary tract Example infection that required IV Abx. He has a BG of COPD, IHD and HTN. He unfortunately passed away 3 days after admission from sepsis • What you put on the death certificate?

Medical Certificate LINE 1 • 1 a) Urosepsis • 1 b) urinary tract infection • 1 c) • LINE 2 • 2) Ischemic heart disease, Chronic Obstructive Pulmonary Disease, Hypertension

Practice • Try geeky medics for some examples • https: //geekymedics. com/certification-death-uk-osce-guide/

Referring to coroner • A government official who is empowered to conduct or order an inquest • • into the manner or cause of death Again bereavement services are your friends – they will help and guide you through your local procedure of filling out the form and sending it to the appropriate place Discuss this with consultant and run through what you are going to write. Use the notes, do not omit any information. State facts.

When to refer (you don’t need to memorise) • Unknown COD • Death occurred in under 24 hours after admission to hospital • Not seen by doctor 14 days prior to death • Suspicious death • Death due to accident or neglect • Death during operation or recovery from anaesthetic • Death in police custody • Death by possible suicide • Death occurred at work or from possible industrial poisoning

Cremation forms • These are the forms that must be filled out in order for the body to be cremated. • There are two forms • Cremation form 4 ( which you can fill out) • Cremation form 5 (senior must fill out) • NB due to coronavirus there have been some changes – government guidelines currently only require Cremation form 4. • Please check your local trust policy (again bereavement services is your friend)

The process • Form needs to be completed in full. • Make sure you have confirmed the body • NB list of implants that can cause issues with cremation and must be identified • Pacemakers Implantable Cardioverter Defibrillators (ICDs) Cardiac resynchronization therapy devices (CRTDs) Implantable loop recorders Ventricular assist devices (VADs): Left ventricular assist devices (LVADs), Right ventricular assist devices (RVADs), or Biventricular assist devices Bi. VADs) Implantable drug pumps including intrathecal pumps Neurostimulators (including for pain & Functional Electrical Stimulation) Bone growth stimulators Hydrocephalus programmable shunts Fixion nails Any other battery powered or pressurised implant Radioactive implants Radiopharmaceutical treatment (via injection) • It is not uncommon for a medical referee to give you a call if there any queries regarding the form. Make sure you have put all your details on the form.

Cremation form 4 • The most frequently occurring errors in completing these forms are: • • Failure to complete all questions in full Deletion of questions Incorrect completion of forms Illegible handwriting. • Full guidelines can be found through following link – definitely worth a read before starting • https: //assets. publishing. service. gov. uk/government/uploads/system/upload s/attachment_data/file/878093/revised-guidance-to-medical-practitionerscompleting-form-cremation-4. pdf

References • https: //geekymedics. com/death-confirmation/ • https: //geekymedics. com/certification-death-uk-osce- guide/ • https: //www. themdu. com/guidance-andadvice/guides/signing-death-certificates-and-cremationforms • https: //assets. publishing. service. gov. uk/government/uploa ds/system/uploads/attachment_data/file/878093/revisedguidance-to-medical-practitioners-completing-formcremation-4. pdf