The aim of this policy and guidance is to support Registered Health Care Professionals to undertake confirmation of death. It is envisaged that more people will choose to die at home as health and social care collaboration and integration provides greater multi-professional working and increasing local care provision. NHSH needs to ensure that there is a timely response to providing care to our population at this difficult and sensitive time for both the deceased and bereaved. Care delivered with compassion and empathy can reduce anxiety and stress for all involved and this is particularly important if, when death occurs confirmation can take place timeously. It is recognised that if a competent Registered Nurse, Advanced Paramedic or Allied Healthcare Professional (AHP) can confirm death, improved quality of care can be offered to the patient, relatives, carers and other staff. Confirmation of death is required to facilitate removal of the body (should this be the family’s wishes) to a suitable environment. Confirmation of death is defined as deciding whether a person is actually deceased. Confirmation of death does not require the presence of a doctor and is not the same as certification of death, which is solely a medical responsibility.
Funeral directors and mortuary staff are unable to remove the deceased person from their place of death until confirmation by a registered health care professional (RHCP) is received.
Any Registered Health Care Professional is able to undertake confirmation of death whether expected or unexpected, if this is identified within their role. This policy enables confirmation of the death of an adult, child or neonate by a competent and confident RHCP. Typically in NHSH this role will be undertaken by Registered Nurses, Advanced Paramedics with future development of Allied Health Professionals to be undertaken.
There are a variety of terms used to describe the process by which the absence of life is formally acknowledged, such as ‘Pronouncing Life Extinct’ (or PLE), ‘Verification of Death’ (or VoD) or ‘cessation of life’. This policy confirms the change in terminology to use the phrase ‘confirmation of death’ (instead of ‘Verification of Death’, ‘Pronouncement of Life Extinct’ or ‘cessation of life’).
Confirmation of Death relates to confirming that the individual has no signs of life and completing a confirmation of death form. This can be carried out by a registered health care professional.
Certification of death is the process of completing the Medical Certificate of Cause of Death (MCCD). This remains the sole domain of a Registered Medical Practitioner. Consideration of referral to Procurator Fiscal is also the responsibility of the Medical Practitioner.
NHSH and Highland Council recognise and accept that they have a responsibility to ensure that high standards of evidence based practice are carried out at all times and that the roles and responsibilities of staff are clearly defined in order to minimise the risk of error and potential adverse events.
This Policy outlines clear definitions and the procedures, which the Registered Healthcare Professional will follow to undertake confirmation of death.
Policy and Guidance for Confirmation of Death by Registered Health Care Professionals
This Policy will outline the appropriate training, management and supervision to achieve the safe and effective implementation of the confirmation of death by RHCPs
The Policy will identify the knowledge and clinical skills required to demonstrate competence for undertaking this role. The RHCP will be required to undertake self-directed learning activities, demonstration of practice, and assessment of competence to undertake confirmation of death.
The publication of the Scottish Government DL (2017) 9, allowed for changes to NHS Highland’s previous policy- ‘Verification of Expected Death by Registered Nurses’. It supersedes & revokes the previous 1995 verification of death communication from the Chief Medical Officer & Chief Nursing Officer (SOHHD/CMO(95)6) which limited the involvement of registered nurses in the confirmation of death in expected circumstances. This letter clarified the professional and legal aspects of undertaking this role and rescinded any previous guidance on the subject issued in Scotland.
The CNO letter (DL (2017) 9) aligns with the guidance published jointly by the CMO, Procurator Fiscal Service and Police Scotland entitled ‘Management of Deaths in the Community (in and out of hours)’ (SGHD/CMO (2016) 2).