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9.1.2 Death and Dying

AMENDMENT

This chapter was significantly updated in June 2014 as a result of local review and should be re-read throughout.


Contents

  1. Introduction
  2. Background
  3. Legal Position
  4. Procedures
  5. Incident Report and Communications
  6. Support for Staff and Other Users
  7. Reporting to the Care Quality Commission
  8. Preparing the Room for another Resident


1. Introduction

The purpose of this procedure is to provide advice to residential staff in relation to procedures following the death of a service user.

Although written primarily for residential settings, there may be circumstances where this procedure also applies to Day Services and Independence At Home.


2. Background

In January 1999, the Local Medical Council (LMC) issued guidance to GP's regarding their obligations following the death of one of their patients.

This guidance clarified the law for GP's and made it clear that where their patients die outside hospital, the individual discovering the body can confirm that the person is dead and arrange for the body to be removed by the funeral directors. The LMC stated that there is no 'legal requirement' for a doctor to attend, unless there is any doubt as to the person's death.

This has left residential staff in a difficult position, as prior to LMC advice, GP's generally responded to requests from staff of our residential homes to attend and certify a death. The legal position is set out below.


3. Legal Position

According to the LMC, the current position in English law is as follows:

  • There is not a requirement that a registered medical practitioner confirms that death has occurred or that "life is extinct", or to view the body of a deceased person;
  • There is not a requirement that a registered medical practitioner reports the fact that death has occurred;
  • There is a requirement that the registered medical practitioner who attended the deceased during the last illness issues a certificate detailing the CAUSE of death.

In summary, therefore, there is no legal requirement for death to be confirmed by a doctor. A GP is required to issue a certificate detailing the cause of death, but the LMC make the point that this can be done at a later date and at the premises of the funeral directors.


4. Procedures

  1. In the event that the service user appears to have died, call the GP and request a visit to certify that death has occurred/cause of death. If the doctor is reluctant to visit, make it clear that you would prefer a visit to take place especially if you feel there is uncertainty (and explain this);
  2. If the death was expected and you feel there is a reasonable degree of certainty that the person has died, establish whether a visit would be possible within the next four hours. If so, make it clear that you would prefer to wait for a doctor's visit, but ask that the doctor says whether in his/her view it would be safe to tell relatives that the person has died;
  3. If the doctor is adamant that they will not visit, ask if he/she is giving permission for removal of the body;
  4. Inform relatives/next of kin as appropriate that their relative has died, and when, or if, the doctor is going to visit. Explain, if this is the case, that doctors do not always visit immediately to certify the cause of death, but will visit at the undertakers. Give the relative the opportunity to visit the body at the home;
  5. After the relatives have viewed the body if they wish, arrange for removal by an undertaker unless the relatives wish to do so themselves. It may well be necessary to indicate to the undertaker that the GP has granted verbal permission for the body to be removed if the GP has refused to visit. In the event that a relative was unhappy about removal of the body, it may be that they would wish to talk to the GP themselves;
  6. In the event of an unexpected death you should be insistent that the GP visits. If there are suspicious circumstances surrounding the death, the police may well need to be involved. Seek G.P guidance regarding this and consult your manager;
  7. If you feel unhappy about any situation contact your line manager for further advice, i.e. Lead Support Worker, Senior Care Officer, Operations Manager, Service Manager or General Manager. Their contact details can be found in the lead worker file or the orange 'Grab 'n' Go' file in the main reception area;
  8. It may be appropriate to call an ambulance only if you are unclear that a death has occurred and the G.P. will not be able to visit. Ambulance staff may confirm that a person has died, but they are likely to be concerned if this starts to happen as a matter of routine;
  9. Please let your Operations Manager know of incidences when a GP does not agree to visit to certify the cause of death, in order that the frequency of such instances can be collated and the impact of these interim procedures can be fully evaluated;
  10. Record all conversations (and times of conversations) with the GP on the service user's diary sheets e.g. response to your request for a visit, and at what point a doctor has agreed for you to arrange for removal of the body. All notes relating to conversations are to be signed and dated and must be kept in a safe place for 12 years.


5. Incident Report and Communications

When it is appropriate (in every case which is not an expected death) and while the incident is still fresh in the minds of the workers involved, the worker(s) who discovered the death must write an HS2 Incident Report. This report must detail the following:

  • Events prior to the discovery of the death;
  • The circumstances in which the death was discovered;
  • The actions taken immediately after the discovery of the death and the names of all who were informed as per the procedure above.

All incident reports must be passed to the management team. If the incident occurs out of normal office hours, the Duty General Manager On-Call must be notified.

Please see the corporate 'Incident Reporting' policy and procedure for future guidance in this area.

Management must consider the following communications in every case of a service user death:

  • A phone call at the earliest opportunity to senior management and the Health and Safety Team to report the death;
  • The timely completion of an HS2 report via the Council’s online Incident Reporting System;
  • A decision on whether a Safeguarding Alert might need to be raised and the recording of any decisions or referrals under this procedure;
  • In the case of an unexpected death, any communication with the Coroner’s Office and / or the police.


6. Support for Staff and Other Users

Some practical ways of supporting the staff team / service users during this potentially stressful time are set out in the following points and should be put into practice:

  • Ensure that members of staff are given some time away from dealing with the reactive tasks in order to take stock of how they are feeling. This may include changing people’s allocated tasks or requesting additional support to cover shifts;
  • Ensure that the Council’s confidential counselling service phone number is available to staff and consider whether group counselling for staff might be appropriate. This can be arranged in some situations;
  • Ensure that communication between the team is effective and that each member of staff is kept informed and updated of relevant information. Management should consider holding individual and team de-briefs to support staff and also ensure any relevant details are fed into the incident reporting process;
  • Ensure that Lead Support Workers and Senior Care Officers offer their staff support during supervision as required and also allocate time in the morning / handovers for staff to share their thoughts and feelings about the death;
  • Enable staff who wish to attend the funeral, to do so;
  • Encourage staff to attend the council's loss and Bereavement and / or End of Life Care training courses as part of the non-mandatory training programme;
  • It may be helpful to arrange a space in which to discuss service users concerns - there may be some of the service users who may have become friendly with the deceased and may wish to talk about what has happened. However staff will need to be mindful of confidentiality at all times;
  • If appropriate staff could arrange to purchase a card or flowers to the deceased's family that service users could sign.


7. Reporting to the Care Quality Commission

It is the responsibility of the Senior Care Officer on duty at the time (or nearest the time) to complete a Regulation 16 Notification for the Care Quality Commission - copies of which must also be forwarded to the Service Manager and Care Standards Officer. Please also retain a copy for the file.


8. Preparing the Room for another Resident

Action to clear / clean a vacant room after a death must only be taken once clearance has been given by the Police and / or a manager to do so. The decision to clear the room should be taken as a team with the nature of the death and feelings of everyone in mind. For example, it may be that the Next of Kin wishes to come and visit the room and pack the service user's belongings.

If the Next of Kin do not wish to pack up the belongings themselves, staff will need to do so - remembering to do this in conjunction with the inventory list - and ensure that all items are in labelled bags / suitcases and are locked away in a suitable place ready for collection by Next of Kin.

Following the packing up of the service user's belongings, the domestics will then need to do a deep clean before the room can be made available for another service user.

End