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Care after death in an acute settingEdited by Sonia Blundell, Practice Development Sister, Brighton and Sussex University Hospitals NHS Trust

©2021 Clinical Skills Limited. All rights reserved

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always follow the policies of your employer or educational institution.

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Patient Notes ?

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General Notes

The patient identified to me as Mr Bernard Smithdied this morning at 7.50 am.

D.O.B. 10 05 1962

Address: 114 Park StreetBrintonBN2 8SJ

NHS No. 600 557 6151

Allergy Notes

Documentation

Document the time of death and the time of verification of death in the deceased’s nursing and medical notes, and in any relevant documentation. Follow local policy and/or national guidance (Hospice UK, 2020) and the Nursing and Midwifery Council’s guidance on record-keeping (NMC, 2018). Carry out personal care after death within 2 to 4 hours to preserve the deceased’s appearance (Hospice UK, 2020).

Ensure documentation is accurate and concise so the registrar can issue the death certificate promptly and reduce delays. Obtain contact details of the deceased’s family from the nursing notes to inform them of the death. Invite them to view the deceased if local policy allows. This can signify the transition to a life without the deceased (Kwan, 2002). Establish the religious or cultural beliefs and any other wishes from the deceased’s notes/family before carrying out care. If unsure, contact your local chaplaincy. Talk to patients and staff who are in the vicinity, so they are aware of what has happened.

Inform family members and relevant staff; inform other patients

Good end-of-life care does not stop at the point of death (Hospice UK, 2020). “Care after death” describes the nursing tasks involved when someone dies, including the ongoing support of the family and carers; “personal care after death” describes the physical preparation of the body (Hospice UK, 2020). Provide care in a culturally sensitive and dignified manner, respecting the deceased and their family,carers while following health and safety guidelines, and local policies.

Before a patient dies, it is important to ask them or family members if they have any specific cultural or religious requirements for their care after death. Discuss with the family/carers what their roles will be when their loved one dies (Hospice UK, 2020); two nurses will provide care after death if the family and/or carers do not wish to be involved. The COVID-19 pandemic has placed restrictions on people visiting dying relatives and viewing the deceased in hospitals; communication may have to take place with family members by telephone or by using remote technology (Hospice UK, 2020).

A doctor, or nurse with extended training in verifying death, must confirm the death. It is a legal requirement that a medical practitioner certifies the death and completes the correct documentation. All healthcare professionals caring for deceased patients must be familiar with how to refer deaths to the coroner if deemed necessary (Hospice UK, 2020) so that they can provide the correct personal care and prepare family and friends if there is a delay in the release of the death certificate.

The nurse must confirm if the deceased consented to organ donation, referring to local policy and procedures for guidance. A donor transplant coordinator will be available to support staff, family and carers to discuss the patient’s wishes. The nurse must make a record of active devices, such as pacemakers and cardiac defibrillators, and inform the mortuary and funeral home following local policy for guidance about deactivation (Hospice UK, 2020).

HOSPITAL NUMBER....................................................................

NAME....................................................................................

......................................................................................

CULTURAL BELIEFS.........................................................................

....................................................................................

NEXT OF KIN..............................................................

..............................................................................

Assemble the equipment that you will be using. It is acceptable to use the deceased’s own toiletries, or ward supplies.

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Care after death in an acute setting

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Wash the deceased fully to maintain their dignity and respect. Comb the deceased’s hair. This will assist the funeral director for final presentation (Hospice UK, 2020). Follow local policy if family members wish to participate in personal care after death. They must be aware of what they may see and need to do (Kwan, 2002).

Clean the mouth and oral cavity to remove debris. Suction to contain leakages from the oral cavity or tracheostomy sites. Follow local policy where COVID-19 is suspected or confirmed, as suctioning is an aerosol-generating process (Hospice UK, 2020). Clean dentures, if worn, and reinsert them into the deceased’s mouth. If unable to reinsert them, place the dentures in a suitable container, named and dated so that they can be sent with the deceased to the funeral home. Document this on the deceased’s property list.

Follow local manual handling policies to position the deceased onto their back and place a pillow under their head. Straighten their limbs and close their eyes (Green & Green, 2006) to maintain dignity and protect their eyes for potential corneal donation. If family and friends can visit, make sure the environment is clean, clutter free and private. Allow friends and family to spend time with the deceased following local policy.

Take out the razor

Decontaminate your hands by washing them or using alcohol-based hand sanitiser, and put on non-sterile disposable gloves and an apron to reduce the risk of cross-infection (Stevens et al., 2020). Follow national and local policy for what personal protective equipment (PPE) to wear when caring for a deceased patient with COVID-19.

Wash the patient Mouth care

Decontaminate hands, apply PPE

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pH 5.5 (approx) IsotonicOsmolarity 308 mOsm/l (approx) Sterile non pyrogenicSingle dose Solution for infusion

Formula for 250 ml mmol per 250 ml (approx)Sodium Chloride 2.25 g Sodium 38Water for injections Chloride 38

For intravenous administrationStore out of reach and sight of children. Do not use unless solutionis clear and container undamaged Check additive compatibility withboth the solution and container prior to use thorough and carefulaseptic mixing of any additive is mandatory Do not remove from)overwrap until ready for use D iscard any unused portion after firstuse Do not reconnect partially used bags for use under medicalsupervision

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Sodium Chloride0.9% w/v 250 ml

POM 07

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07K16E2N 10 2023

Position the patient

NAME.................................... DATEOFBIRTH WARD...................

.....

Protouch

Protouch

350Ambidextrous

Examination Gloves

100PCS

Ref:

Size Large

350Ambidextrous

Examination Gloves Ref:

Size Large

100PCS

Slide sheet

Gloves and apronOcclusive tape

Identification bands

Comb

Tape

Absorbent pads or incontinence pad with pants

Notification of death forms and envelope

Toothbrush

Disposable wipes

Spigot

Clean sheets and towel

NAME.................................... DATEOFBIRTH

WARD........................

Clinical and domestic waste bags

Body bag

SUPERReadiwipes

Spray cleanserProperty book and bag

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VioletPhillipsMatronOutpatients

The Royal Surrey County Hospitals NHS

SuzyCole

Senior Practice

Development Nurse


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If no post-mortem is anticipated, clean and dress wounds using a dressing and occlusive tape. Leave dried wounds exposed and sutures and clips in place. Be cautious when using tape as it can be challenging to remove at a later stage and can leave permanent marks (Hospice UK, 2020).

Spigotting/capping indwelling lines and tubes

(b)

Shaving the deceased shortly after death is not recommended as it can cause facial bruising (Hospice UK, 2020). Document if the family wishes the deceased to be shaved for cultural or spiritual reasons, or if they wish the deceased to be shaved before going to the funeral home.

Intravenous cannulae: remove infusions and giving sets, and cap the cannula. Nasogastric tubes: remove the drainage bag and spigot the tube. Subcutaneous lines: remove the infusion, and coil the giving set around the insertion site, capping it and taping it in place. Central venous catheters: follow local policy. Leave all lines, prosthestics and devices in place if referring to the coroner.

Remove the pillow. Provide a clean sheet beneath the deceased in preparation for their removal to the funeral home. Place an absorbent pad under the deceased’s buttocks to absorb any leakage of urine or faeces, if you have not already applied a pad and pants (may vary with local policy) (see clinicalskills.net procedure “Giving a bed bath”). When moving the deceased, protect your back, use equipment provided and follow local manual handling policy (Croshaw & Fray, 2019).

Drain the bladder by gently applying pressure on the lower abdomen for 30 seconds and collect the urine in a receiver (Hospice UK, 2020). If a urinary catheter is present, drain the bladder into the catheter bag, then remove the bag and spigot the port. If a stoma is present, empty or change the stoma bag as appropriate. If there is no catheter or stoma, clean intimate areas and apply pad and pants to absorb fluid leakage from the urethra, vagina or rectum.

Advise against shaving

Protect against leakage from bowel and bladder Wound care

Changing the sheet: (a) (b)

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BERNA

RD

SMITH

Continue to wrap the body in the sheet (b). Secure all limbs within the sheet (c). Ensure that the feet are also covered (d). Apply tape to secure the sheet (see inset) making sure the sheet is not pulled too tightly as this could cause abrasions or disfigurement of soft tissue. The sheet will protect the deceased and avoid damaging the body during transfer (Hospice UK, 2020).

Discuss with the family and record if jewellery is to remain with the deceased. Secure rings left in place with tape. If authorised by the deceased’s family, remove jewellery following local policy. Ensure the removal is witnessed by another member of staff. Clean jewellery with a disinfectant wipe, place in secure envelope and seal in a clear plastic bag to prevent risk of infection (Hospice UK, 2020) and store according to local policy.

Dress the deceased before they go to the funeral home. This may be in a shroud or their own personal clothing depending on local policy or the family’s wishes. Do not send the deceased to the funeral home naked as this does not promote their dignity.

Wrap the deceased in the clean sheet so that their face and limbs are held in securely.

Attach identification bands on the deceased’s opposing wrist and ankle. The bands should include the deceased’s name, date of birth and hospital number.

............................................HOSPITAL

PATIENT'S PROPERTY WARD RECORD BOOK

...................Ward Date...................20...... Time ..............am ..............pm

Cash and Valuables received for safekeeping from:

Patient's Name........................................................................................................

Home Address........................................................................................................

CASH VALUABLES

£ P

£20 X = ................................................ 1 ........................................

£10 X = ................................................ 2 ........................................

£5 X = ................................................ 3 ........................................

£2 coin X = ................................................ 4 ........................................

£1 X = ................................................ 5 ........................................

50p X = ................................................ 6 ........................................

20p X = ................................................ 7 ........................................

10p X = ................................................ 8 ........................................

5p X = ................................................ 9 ........................................

2p X = ................................................ 10 ........................................

1p X = ................................................ 11 ........................................

TOTAL ................................................ 12 ........................................

1. WARD/BED BUREAU/A & E

Received by ........................................................ Designation .....................

Witness ................................................................ Designation .....................

14472The deceased’s property

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Attach an identification band on the deceased’s opposing wrist and ankle. The band should include the deceased’s name, date of birth and hospital number. Attach a hazard label if infectionis is indicated.

(c) (d)

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Dispose of used equipment according to local policy. After removing and disposing your gloves and apron, decontaminate your hands by washing to reduce the risk of cross infection (Hospice UK, 2020).

Transfer of property

Alternatively, if there is a risk of infection, or leakage of body fluids, place the wrapped body into a body bag and secure it from head to toe. Attach the death notification form to the bag. Follow local policy and guidelines.

Tape the death notification form to the sheet. Ask the porters to remove the deceased to the funeral home without delay, as decomposition may occur quickly, depending on the environmental temperature (Stevens et al., 2020). If the family and/or carers have not yet viewed the deceased, they will be able to do so later in the home’s chapel of rest.

Having carried out the process of personal care after death, take time to look after yourself and others. Sit with colleagues or patients away from the ward environment to debrief them and bring closure to the event.

Screen off other beds Dispose of equipment

Screen off the area where the removal of the body will occur, in order to prevent unnecessary distress to other patients on the ward.

Supporting staff and patients

Finalise all documentation. Record all the actions that you carried out and place records in the envelope; transfer the deceased’s property and records to the relevant administrative departments according to local policy.

CITY HOSPITALN4

SMITHBERNARD JOHN

G421653

10.5.1962

MALE

23 CRANBOURNE

STREET

RIPLEY

YORKSHIRE

15.7.202107.50

DR PETERS

MIDDLESBOROUGH RD

RIPLEY YORKSHIRENONE

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DENTURES

Transfer the body to the mortuary

PATIENTPROPERTY

Transfer of property

Use a body bag if necessary

CITY HOSPITAL

N4

SMITHBERNARD JOHN

G421653

10.5.1962

MALE

23 CRANBOURNE

STREET

RIPLEY

YORKSHIRE

15.7.2021

07.50DR PETERS

MIDDLESBOROUGH RD

RIPLEY YORKSHIRENONE

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DENTURES

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