Before death confirmation Indicate you would check the resuscitation status of the patient before doing anything else: If the patient is not for resuscitation, continue to confirm the death. If there is uncertainty as to the resuscitation status, CPR should be commenced whilst this is clarified. Ask the ward staff about the circumstances surrounding the death and document this. Ask for the patient’s notes: Confirm the resuscitation status of the patient Read the patient’s notes for some background on the patient If family or friends are present: Introduce yourself Offer your condolences Explain the need to confirm the death Offer the family the opportunity to wait outside – respect their preference Death confirmation 1. Wash hands 2. Confirm the identity of the patient – check the wrist band 3. General inspection – skin colour / any obvious signs of life 4. Look for signs of respiratory effort 5. Does the patient respond to verbal stimuli? – “Hello Mr Smith, can you hear me?” 6. Does the patient respond to pain? – press on fingernail / trapezius squeeze 7. Assess pupils using pen torch – After death they become fixed and dilated 8. Feel for a central pulse – carotid artery 9. Auscultation: Listen for heart sounds for at least 1 minute Listen for respiratory sounds for at least 3 minutes (The recommended times for each of these vary, so adhere to your local hospital policy. The only official guidance on this matter can be found here , which advises a minimum of five minutes total to establish that irreversible cardiorespiratory arrest has occurred) 10. Assess for a pacemaker – not essential, but good practice, as this will need to be checked prior to cremation. 11. Wash hands & exit the room – ensuring the door is closed and curtains are drawn. Documentation Once you have completed the above, document your assessment clearly. Ensure you adhere to hospital documentation guidelines – date / time / your name & grade Document each of the examination steps you performed & the result of each step. Finally document that you are confirming the death and the time at which you did so. Sign and print your full name, grade, registration number and contact number. To complete death confirmation Inform nursing staff that you have confirmed the death: They will then inform next of kin, if not already present. They will also contact the porters to arrange transfer of the body to the morgue. Source
