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Confirmation or verification of death is defined as deciding whether a person is actually deceased. Confirmation or verification of death can be undertaken by a registered nurse however, you must check your employer's policies to determine local agreements about the circumstances in which this can be done.
Certification of death requires a registered medical practitioner.
When a patient dies, the nurse has a duty to inform the doctor who has been treating the patient, as the doctor is the only person authorised to certify the death.
In the event of an expected death the doctor may pre-arrange to be informed at another time. For example, when expected deaths occur at night, the doctor may be informed the following morning.
When discussion has taken place between the appropriate medical practitioner and nursing staff - and it has been agreed that further intervention would be inappropriate and death is expected to be imminent - designated registered nurses may confirm or verify the death. Providing the;
These principles for practice can apply in any health care setting, in the NHS or independent sector. The registered nurse must be trained and deemed competent to confirm/verify the death, and there must be an explicit local policy in place which the nurse must check for specific details.
It is the right of the verifying nurse to refuse to verify death and to request the attendance of the responsible doctor / police if there is any unusual situation.
Experienced designated registered nurses have the authority to confirm death, notify the relatives, and arrange for last offices and the removal of the body to the mortuary or the appropriate funeral director. However, the nurse must check their employer's own policy on this area for specific details as applicable to their workplace.Back to contents
Record keeping is an integral part of the process and there is an expectation that the nursing and medical records must reflect that the death is expected and that nurse verification/confirmation has been agreed. Records should also show details of the verification/confirmation of death, with the time, date and any other observations that were recorded in line with an identified protocol - whether in the NHS or independent sector. The time and date the doctor was informed must also be included.Back to contents
Education and training must be made available and nurses should ensure they have enough confidence, competence, knowledge and skills to equip them for undertaking this role.
Education should be based on broad principles for practice as identified in the NMC Code.
Specific topics that may be included are aspects of accountability, current legislation and the necessary skills and knowledge to determine the physiological aspects of death.Back to contents
If a patient's condition improves significantly following a decision that death is imminent, the appropriate medical practitioner should be consulted.
The registered nurse verifying/confirming death must also consider the health and safety of others to ensure they are protected, e.g. from infectious illness, radioactive implants and implantable devices.
You must check your employer's own policy on this area for specific details as applicable to your workplace.
RCN publication: Decisions relating to cardiopulmonary resuscitation
Hospice UK publication: Care After Death