Diagnosis of death

Question 1

What should you do before death confirmation?

Answer 1

Before death confirmation

• (OSCE) 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 as you will need to document this in the notes.

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
• Ask if the family have any concerns or questions

Question 2

How do you confirm death?

Answer 2

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
   
   • supraorbital pressure may not be ideal as can leave visible marks after which would be distressing for family
7. Assess pupils using pen torch – after death they become fixed and dilated e.g. no light constriciton reaction
8. Feel for a peripheral pulse then central pulse – carotid artery
9. Auscultation:

• Listen for heart sounds for at least 2 minute
• Listen for respiratory sounds for at least 3 minutes
  
  • NB: may hear fluid settling in the lungs etc
• ?bowel sounds
  
  • (The recommended times for each of these vary, so adhere to your local hospital policy. The only official guidance ~advises a minimum of five minutes total to establish that irreversible cardiorespiratory arrest has occurred)

TO FINISH: Wash hands and exit the room (ensuring the door is closed and curtains are drawn)

Question 3

How do you document and complete death confirmation?

Answer 3

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
• Consider if this death needs a referral to the coroner, as if this is the case a death certificate cannot be issued – this will require discussion with the consultant responsible for the patient.
  
  • –> complete a death certificate