Case study:

07 September 2007

Introducing Nurse Verification of Expected Death to community nurses in Hull and East Riding PCTs

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Key points

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Senior community nurses from PCTs in Hull and East Riding are being trained to verify expected deaths among patients who are known to have advanced disease.

To date 58 nurses (band 5, 6 and 7) in Hull PCT have successfully completed this training with a further 20 due to finish by the autumn.

A survey is to take place shortly to ascertain how many verifications they have so far conducted.

But first signs are that it is between 0 – 8.

One of the main reasons for the decision to involve nurses in verifying deaths was that changes in GP out of hours service made it increasingly unlikely that at weekends and night times a patient’s death would be verified by a doctor known to them or their family.

Moreover, there is now no requirement either legally or under the NHS contract, for a GP to confirm the fact of death. Nurses, particularly out of hours staff, had witnessed prolonged waiting times before GPs were able to visit to conduct verification of death.

At the same time the Association of Undertakers has directed its members not to remove the body of the deceased unless ‘death had been pronounced’.

Finally, nurses felt disappointed that despite caring for a patient throughout their illness and building a supportive relationship with the carers and families, they could not verify the death when the patient died.

A multi-professional steering group consisting of experts from the four PCTs drew up a new policy, which was approved in March 2006.

The police, coroner’s court and funeral directors association also supported the policy.

The nurse training, fully funded by the PCTs and built around their policy, includes:

• What is an expected death?
• What are the nursing responsibilities?
• What are the medical responsibilities?
• Legal implications of verifying death
• Signs of suspicious death
• Role of the coroner
• Professional implications
• Anatomy and physiology
• Practical skills
• Competencies

Once they have completed their training, staff attend a coroner’s court to witness an inquest procedure.

They are then supervised by an experienced health care professional until they are competent to do the procedure themselves.

The training has generated a great deal of discussion among nurses around issues associated with ‘expected’ death and resuscitation.

As a result Hull PCT has further developed its policy.

The group has also sought more clarity about what is an expected death from the Nursing and Midwifery Council, the nurses’ professional body.

The NMC has now issued updated guidance to take account of these comments.

In addition a senior nurse in the PCT was identified to co-ordinate training and take forward clinical/professional issues.

Having a local ‘lead’ is perhaps the key to sustainability.

The Nurse Verification of Death Training is now built into the PCT annual training budget.

One of the strongest themes to emerge, which surprised medical colleagues, was how anxious nurses felt about undertaking this procedure.

However, there are now some very experienced nurses who are able to mentor others and give the necessary support and reassurance.

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