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;
- death is expected and not accompanied by any suspicious circumstances and it occurs in a private residence, hospice, residential home, nursing home or hospital,
- ‘Do not attempt cardio-pulmonary resuscitation’ document is signed in line with current guidance,
- death does not require reporting to the coronial service - NB. Local arrangements may be in place with the coroners in respect of Deprivation of Liberty Safeguards (DoLs). If so these must be reflected in the organisations policies and covered in both the nurse confirmer\verifiers training and competency assessment
- wherever possible the relatives should be made aware of the patient's deteriorating condition and of the patient's care plan
- verification/confirmation is timely– within one hour in a hospital setting and within four hours in a community setting. This is an important stage in the grieving process for relatives and carers and also a key time for support.
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.
Within prisons registered nurses do not currently verify death. All prison deaths in England, Wales and Northern Ireland currently are subject to an inquest (whether the deceased died of natural causes or not) and are therefore reportable to the Coroner at this time. This issue is being looked at within the NHS England Health and Justice team to potentially revise the wording within the legal requirements and will be the result of discussions with the Chief Coroner.
In Scotland deaths in legal custody must be reported to the Procurator Fiscal for a mandatory Fatal Accident Inquiry.
We hope to be able to update this position in due course.