Bereavement Policy V1.0

Document reference: POL 011

Document Type: Policy

Version: V1.0

Purpose: To provide information and support to enable all staff to care appropriately for dying and deceased patients, of all faiths and none, in order to minimise the distress to the families and carers when dealing with deaths, both sudden and expected. To provide information and support for the Management of Last Offices, in line with national guidelines, to ensure inclusion whereby all deceased patients are treated in a professional and individual manner, with dignity and respect.

Responsible Directorate: Nursing

Executive Sponsor: Sam Foster, Chief Nurse

Document Author: Lead Nurse Bereavement Services & Head of Bereavement Services

Approved by: Board of Directors

Date Approved: 07/12/2016

Review Date: 07/12/2020

Related Controlled documents

Guidelines & Procedures supporting the Bereavement Policy Manual Handling Policy Infection Control procedures Patient Property Policy Management of Miscarriages Implantable Cardioverter Deactivation

Relevant External Standards/ Legislation

The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2015)

When a Person Dies (DOH 2011)

Care and respect in death (DOH 2006)

Human Tissue Act (2006)

Target Audience: All staff dealing with those experiencing bereavement

Further information: Lead Nurse Bereavement Services

Paper Copies of this Document

If you are reading a printed copy of this document you should check the Trust’s Policy website (http://sharepoint/policies) to ensure that you are using the most current version.

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Version History:

Version Status Date Reviewer Comments Action from Comment

1.0 Draft September 2014

Maria MacKenzie; Dawn Chaplin

Separate Bereavement Policy and supporting Guidelines/Procedures into two documents

Separate document: “Guidelines/Procedures supporting the Bereavement Policy” created

1.1 Draft

March 2015 – September 2015

Dawn Chaplin; Peter Cockcroft

Updated all current procedures

Relevant documents added to respective Policy and Guidelines

2.0 Draft September 2015

Maria MacKenzie

Additional items to transfer to Guidelines/Procedures documents; formatting

Suggested changes agreed and actioned

3.0 Draft July 2016

Pathology; Equality and Diversity; Medical Examiner

Details on revised procedures within the mortuary

Suggested changes agreed and actioned

4.0 Final August 2016

Chief Executive’s Advisory Group

Summary of changes from last version: Revision of previous End of Life /Bereavement Policy and introduction of a stand alone Bereavement Policy with updated procedures and guidelines.

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Table of contents 1. Introduction/Circulation 4 2. Scope 4 3. Definitions 4 4. Policy Standards 5

4.1 Management of the Deceased Adult Patient at Ward Level (Expected Death) 5

4.2 Death Certification of expected deaths 6 4.3 Unexpected Deaths; Referral to HM Coroner 6 4.4 Management of the Deceased Adult Bariatric Patients 7

4.5 Rapid Release of deceased patients. 7 4.6 Managing the property of the deceased patient 8 4.7 Hospital Funerals 8 4.8 Dignified Relocation 8

4.9 Viewing of Deceased Patients in the Mortuary 9am – 16:00 Monday to Friday 8

4.10 Viewing of Deceased Patients in the Mortuary Out of Hours 9 4.11 Burial of an amputated limb 10

5. Post Mortem Examination 10

5.1 HM Coroner post mortem 10 5.2 Hospital post mortem 10

6. Staff Support 10

7. Management of the Deceased Child / Young Person within Paediatrics 11

8. Management of the Deceased Child in the Emergency Department 11 9. Useful Contact Information 11 10 Responsibilities 12

10.1 Chief Executive 12 10.2 Executive Directors 12

10.3 Senior Sister / Charge Nurse / Department Managers / Registered Nurses 12 10.4 Medical Staff 15 10.5 Individual Responsibilities 15

10.6 Hospital Chaplaincy 15 10.7 Portering Service 16

10.8 Mortuary Department 16 10.9 Bereavement Services 17

10.10 Finance Department 18 11. Training Requirements 19 12. Monitoring Requirements 19 Appendix A Monitoring Requirements 20

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1. Introduction/Circulation HEFT has a duty of care to ensure all deceased patients, are treated with dignity and respect; and with sensitivity to their cultural and religious requirements. The Trust must adhere to all national legislation in relation to unlawful deaths and any deaths that fulfil the reportable criteria must be reported to HM Coroner before death certification may take place. The policy is applicable to the following staff groups whether employed on a substantive, temporary or honorary contract basis:

Registered Nurses, Midwives, Healthcare Assistants, Maternity support workers

Medical Staff including locums

Mortuary Staff

Bereavement Services team

Operational Site and On-Call Managers

Patient Services Team

2. Scope

The policy incorporates the management of deceased adults and children and includes:

Last Offices/Notice of Death

Verification of death

Death Certification

HM Coroner referrals

Rapid Release of deceased patients

Viewing a deceased patient

Management of property of deceased patients

Responsibilities of staff

Hospital Funerals

Dignified Relocation

Wills, marriages and baptisms in hospital

Hospital post mortem

3. Definitions

End of Life care: the psychological, emotional, spiritual, physical and social care provided to the patient and their relatives during their last few weeks, days and hours of life. This also includes care at the time of death and until the deceased patient leaves the hospital and the immediate bereavement needs of the relatives (End of Life Care Strategy 2008)

Bereavement: a time of sadness, grief and mourning after the loss of a significant person.

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Last Offices: the personal care of the deceased person and preparation before they are transferred to the mortuary (When a Person Dies – DOH 2011).

Verification of death: the act of, following external examination, pronouncing a patient has died and confirming that life is extinct

Certification of death: the process of completing the Medical Certificate of Cause of Death (MCCD). This must be completed by a medical practitioner

Notice of death: the documentation completed by ward staff providing information about the deceased person which is sent with the patient to the mortuary (When a Person Dies – DOH 2011).

Medical Examiner: a senior impartial doctor who has been registered with the General medical Council (GMC) for a minimum of five years

HM Coroner: An independent judicial officer acting on behalf of the Crown to investigate the cause and circumstances of violent, unnatural deaths, or sudden deaths those of an unknown cause. HM Coroners must be legally and/or medically qualified.

4. Policy Standards The Trust operates a centralised bereavement service with a bereavement office situated on each site. The hospital death certification process begins in the Bereavement Office, preparing the relevant documentation to enable formal registration (Guidelines No 1). Bereavement Office hours and contact numbers:

Site Hours Contact Numbers

Heartlands: 08.00hrs – 17.00hrs.

41476/43115

Good Hope: 08.30hrs – 16.30hrs 47404

Solihull: 10.00hrs – 16.00hrs*

45360

*In times of increased activity, the hours at Solihull may be increased on an ad-hoc basis 4.1 Management of the Deceased Adult Patient at Ward Level (Expected Death)

Before a deceased patient is transferred to the mortuary from the ward, verification of death must be completed by a doctor, or a Registered nurse who has achieved the appropriate competency in verification of death (Guidelines No 2).

Verification of death should take place within one hour of death and must be documented in the patient’s medical notes, noting the date and time of verification and contact details of the verifier.

The presence and details of any combustible devices, ie pacemakers, should be documented.

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In cases when the verifying doctor is also the certifying doctor, documentation in the

medical notes at the time of verification of the data required for completion of the “Standard Data Requirements for Checking Patients in the Mortuary (Cremation and Burial in and out of hours)” (Guidelines No 8) form will replace the necessity to attend the mortuary to check the deceased patient. The above form must then be completed in the Bereavement Office at the time of certification.

In cases when the carers / relatives are not present at the time of death, they should be informed by a professional with appropriate communication skills (Guidelines No 24) and offered support, including access to chaplaincy or another appropriate person.

Families should be given the Trust site-specific bereavement booklet which provides written information on the processes to be followed after death; asking families to contact, by telephone on the next working day, the relevant bereavement office.

Last offices (Guidelines No 3) should be carried out within 2-4 hours of the death in order to preserve the appearance, condition and dignity of the deceased.

When families are unable to view the deceased on a hospital ward, arrangements need to be made for the viewing (Guidelines No 16, 17,18) to take place in the mortuary.

Notes of the deceased patient must be filed and prepared for transfer to the bereavement office by the porter before 08.30hrs the following working day

4.2 Death Certification of expected deaths

Medical notes of deceased patients are taken by portering staff to the bereavement office before 9am on the following working day after the death.

Bereavement office staff co-ordinate the death certification process; contacting medical staff and liaising with bereaved families (Guidelines No 1).

4.3 Unexpected Deaths; Referral to HM Coroner Deaths which are unexpected, unexplained or have no known cause must be reported to HM Coroner (Guidelines No 9).

Whenever possible, referrals should be sent electronically (Guidelines No 9) from a safe email address (nhs.net account) to Bereavement Services from where they will be forwarded to the HM Coroner’s office

On occasions when a referral includes a proposed cause of death, the referring doctor must make him/herself available to the Bereavement Office on the following working day in order to discuss the potential completion of the MCCD.

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In all cases every effort must be undertaken by those involved in the last care of a patient to ensure that reasonable requests from families who wish to carry out particular funeral rites following the death of a relative are respected.

4.4 Management of the Deceased Adult Bariatric Patients In hours When a deceased patient weighs in excess of 180kg the mortuary must be informed and discussion must take place regarding the transfer of the patient. Hoist weight limits vary on each site. Portering staff must be advised that the concealment trolley for bariatric patients will be required for transfer to the mortuary. In cases where the patient’s weight exceeds the hoist weight limit, arrangements will be made by the mortuary staff to transfer the patient to a dignified relocation. Out of hours The first on call sister or nurse in charge of the unit/ward where the patient has died must liaise with the portering staff and designated Funeral Directors to transfer the patient directly to a dignified relocation. The family must be informed of the transfer. (Guidelines No 18)

4.5 Rapid Release of deceased patients. Deceased patients should NEVER be released from a ward or department; they MUST be transferred to the mortuary from where they will be released.

Rapid release (Guidelines No 10 and 11) should only take place between the hours of 08.00hrs and 20.00hrs. After 20.00hrs release should wait until after 08.00hrs the following morning.

Rapid release must only take place when a cause of death is offered. Where the cause is unknown or the case requires referral to the HM Coroner, the patient must remain in the Trust mortuary until the HM Coroner authorises release

When a patient is to be transferred out of England, (Guidelines No 12) the relatives must provide the patient’s passport to enable identification to take place.

All the required documentation and guidelines for out of hours certification and release are available on the Trust Intranet Bereavement page. There are also “out of hours” bereavement boxes containing all relevant paperwork are situated in the following places:

Heartlands Hospital: First on sister bleep: 2878

Maitland Unit Emergency Department ext. 40264/ 42263

New Main Entrance Help Desk ext. 40944 / 42936 / 43047

AMU (Ward 20) ext. 40220

Paediatric certificates – Heartlands Ward 16 ext. 42216 Solihull Hospital: First on sister bleep: 0188

AMU ext. 44235 / 45267

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Good Hope Hospital: First on sister bleep: 8880

Site Office 4.6 Managing the property of the deceased patient

4.6.1 Patient’s Jewellery

The patient’s jewellery should be removed unless otherwise requested by NoK. This should then be documented accordingly on Last Offices Checklist and in the ward/unit property book

Any jewellery removed should be placed in a sealed envelope and either given to the NoK or taken to the bereavement office

4.6.2 Other property

If NoK present, offer the property to them and ensure a signature is obtained.

If no NoK present, take the property to the bereavement office the next working day.

Dentures must be put into the patient’s mouth if possible during last offices; if not, they must be placed in a dry, labelled denture pot which will accompany the patient to the mortuary

DO NOT dispose of any property/valuables unless verbal consent has been given by the NoK and if possible the NoK should be asked sensitively to sign the property form For further information refer to Trust Patient Property Policy: 4.7 Hospital Funerals In cases where deceased patients have no apparent next of kin or the next of kin is unable to fund the funeral, a hospital funeral may be arranged. In these circumstances, the MCCD will not be given to the next of kin, but retained in the Bereavement Office until a referral to the Funerals and Protection of Property Department (Birmingham City Council) has been made. No property or valuable items should be given to family or friends. 4.8 Dignified Relocation During times of increased capacity, it may be necessary to transfer deceased patients to another hospital mortuary within the Trust or an off-site mortuary provided by Co-Operative Funeral Care. Staff arranging viewings must check that the deceased is still in the hospital mortuary prior to confirming the viewing. (Guidelines No 19) 4.9 Viewing of Deceased Patients in the Mortuary 9am – 16:00 Monday to Friday Bereaved relatives may request to see a patient in the mortuary/chapel of rest. Every effort should be made to facilitate the viewing and arrangements should follow the relevant procedure. If the death is suspected to be suspicious and has been referred to HM Coroner for that reason, then permission must be sought from the Coroner’s Office as viewing restrictions may be in place.

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In hours the viewing must be arranged by the ward/unit staff from where the patient died. Staff must liaise with the mortuary staff and arrange a mutually convenient time for staff and relatives. 4.10 Viewing of Deceased Patients in the Mortuary Out of Hours A request to view the deceased patient is made by relatives to ward or unit staff. This should be noted but not agreed upon until the procedures below have been followed. (Guidelines No 17, 18) The nurse in charge of the ward / department should inform the Senior Nurse on site (1st on) for the hospital or Night Sister of the request for a viewing. She / he will then co-ordinate the procedure. The nurse attending the viewing should be accompanied by the Night Sister / Night Practitioner / 1st on call to provide assistance in preparing the patient and support as required. If the situation is thought to be exceptional, e.g. sudden death, visitors arriving from abroad, then advice should be sought from the most Senior on-call nurse/midwife on duty who will contact the portering team leader to facilitate a viewing. Otherwise they should be advised sensitively to contact the ward the next working day to arrange a viewing. NB: out of hours week-end viewing requests at Good Hope Hospital (with the exception of the Emergency Department and child deaths) should whenever possible take place between the 11.00hrs and 15.00hrs (Guidelines No 18) In all cases wherever possible the relatives should be accompanied to the mortuary by a registered nurse; however, it may be delegated to a Health Care Assistant who is confident and deemed competent (including CPR training) by the nurse in charge of the ward. The registered nurse should be available to answer/action any questions or concerns the relatives may have. Role of the Nurse Accompanying Relatives to the Mortuary to View a Deceased Patient

To facilitate whenever possible, including for wheelchair users, for a viewing to take place, ideally accompanied by a nurse known to the relatives or from the same ward or unit where the patient died.

To ensure the patient is suitably presentable for viewing, and relatives are made aware of any anomalies prior to the viewing taking place

To remain in attendance whilst the viewing takes place, until the relatives/visitors leave the mortuary.

To ensure any issues or concerns voiced by the relatives are addressed and resolved as required

Under no circumstances should a pre-registration student be sent unaccompanied to undertake a viewing.

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4.11 Burial of an amputated limb When a request is made for the release of an amputated limb for burial, consent must be obtained from the patient/family. The limb must be transferred to the mortuary and released from there to the appointed funeral director using the appropriate paperwork. (Guidelines No 21) 5. Post Mortem Examination

5.1 HM Coroner post mortem

A post mortem may be requested by the HM Coroner following referral regarding an unknown or unexpected death. Consent is not required for this procedure; however the Coroner’s office staff will liaise with the next of kin to explain the process and update progress. Arrangements for registration of the death will be made directly with the relevant Registry Office. 5.2 Hospital post mortem A hospital post mortem may be carried out at the request of the medical staff for research purposes or further investigation of a known cause of death. Informed consent must be obtained in the following manner:

Discuss with relatives, where necessary, the possibility and options relating to a hospital post-mortem. Any concerns should be identified and discussed and consent obtained

The Clinical Consultants will obtain consent for a hospital post-mortem, supported by a Consultant Histopathologist. The consultant responsible for the patient’s care should take full responsibility for ensuring that the cause of death is accurately recorded in the notes and on the MCCD.

The Consultant in charge or General Practitioner will ensure that the next of kin is advised of the results of the Post-Mortem.

In the cases where consent for a hospital post mortem has been obtained, medical

staff must complete an "Autopsy Request and Clinical Summary” form (available from the Bereavement Offices on each site) and attach to the notes with the consent form.

In the case of a limited post mortem, once consent has been obtained from the relatives, the specific site should be clearly indicated on the hospital post mortem consent form. (Guidelines No 27, 28, 29) 6. Staff Support

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New staff, or those unfamiliar with the hospital layout should ensure that they familiarise themselves with the location of the hospital Bereavement Office and mortuary. Junior staff should be accompanied by an experienced colleague during their first few experiences of escorting bereaved relatives to view a deceased patient. Dealing with bereaved relatives can be distressing for staff. Senior staff should ensure that appropriate support is available if required for all staff following the death of a patient. (Refer to Occupational Health webpage on Trust Intranet for staff support contact details) 7. Management of the Deceased Child / Young Person within Paediatrics

In the event of the death of a child or young person, carry out last offices, having

communicated with the family and ascertained their wishes to participate in the

procedure.

Unless the death is expected (chronic/long term illness), all child deaths must be

reported to HM Coroner and appropriate legal documents completed (Sudden

Unexpected Death of an Infant (SUDI) papers)

The Trust Safeguarding Children department must be informed

Families must be offered and consent obtained to begin to build the child’s memory

box and book (hand and foot prints, lock of hair, photos etc)

8 Management of the Deceased Child in the Emergency Department What to do after a child dies in the Emergency Department

Ensure the checklist (Guidelines No 25, 26) is printed, completed and placed in the patient’s medical notes.

For further information and guidance, refer to Trust Safeguarding Children Policy ((http://sharepoint/policies). 9 Useful Contact Information Relatives of patients who die at Heartlands and Good Hope hospitals must register deaths at Birmingham Registry Office: Registrar of Births and Deaths Holliday Wharf Holliday Street Birmingham B1 1TJ Families are required to phone for an appointment. Telephone: 0121 675 1004/2902/2904 9.00am – 4.00pm (Mon-Fri)

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Email:Hregisteroffice@birmingham.gov.uk Website: Hhttp://www.birmingham.gov.uk/registeroffice Relatives of patients who die at Solihull Hospital must register at Solihull Registry Office: Registrar of Births and Deaths Solihull Connect Library Square Solihull (Families are required to phone for appointment) Telephone: 0121 704 8002 9.00am – 4.00pm (Mon-Fri) Website: Hhttp://www.solihull.gov.uk HM Coroner Her Majesty’s HM Coroner for the City of Birmingham and the Borough of Solihull HM Coroner’s Court 50 Newton Street, Birmingham B4 6NE Telephone.: 0121 303 3228, option 1 10 Responsibilities 10.1 Chief Executive The Chief Executive retains overall responsibility to the Trust Board for overseeing an appropriate infrastructure to support the implementation of this policy and supporting procedures. This Executive lead maybe delegated to an appropriate appointed Executive. 10.2 Executive Directors The Chief Nurse has overall responsibility for the development, review and monitoring of this Policy. He/she will delegate the implementation of this policy through the divisional structure and provide reports, as required. 10.3 Senior Sister / Charge Nurse / Department Managers / Registered Nurses

To ensure all staff are aware of the policy and its contents.

To ensure patient medical records have correct records of patients’ addresses, telephone numbers, next of kin, named relative, and religion.

To ensure that the police have been contacted where patient's identity or next of kin are unknown, or in the event of informing with regard to sudden death, or where safeguarding issues have been identified. Informing the Nurse In charge /Senior Nurse/Matron/Manager on Duty (or On Call - Out of hours) that this has been actioned.

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To ensure the patient and the named relative, in liaison with medical staff and with the patient’s consent, are informed sensitively of the patient’s clinical condition, including the possibility of death.

To ensure that religious and cultural practices of individuals are observed in dying

and death (Guidelines No 20).

To fulfil the requests of a dying patient who wishes to make a will, ensuring the correct procedure is followed (Guidelines No 22).

To ensure the correct procedure is followed in the event of a dying patient wishing to

marry (Guidelines No 23).

To ensure the next of kin and named relative, or persons with parental responsibility, if different, are informed of the patient’s death immediately or in accordance with previously agreed arrangements. Bereaved relatives must be offered privacy, information and support in quiet surroundings.

In the event of a sudden / unexpected death and where a referral to the HM Coroner

may be required (Guidelines No 9) required, particular attention must be given to ensure that the reasons for the referral are explained to relatives, the process is discussed and the telephone numbers for the Bereavement Office and HM Coroner’s Office are provided in the Bereavement booklet which is given to all bereaved (available from the Bereavement Office). If relatives are not present, telephone numbers for bereavement office and HM Coroner’s office may be given.

Particular care should be taken when informing relatives over the telephone

(Guidelines No 24) of a patient’s deterioration or death. Prior communication regarding the imminence of the death should have taken place and will therefore determine the nature of the call and by whom. A police visit should be carefully considered in such circumstances, especially if the next of kin is known to be elderly, alone, or infirm.

The nurse in charge will contact medical staff immediately to request verification of

death. This is to ensure that the death is verified in accordance with the Protocol for the Verification of Expected Death (Guidelines No 2). This should be performed within one hour of the death occurring.

To ensure bereaved relatives are, where possible, fully conversant with the cause of

death and are given the correct information regarding procedures following death.

To ensure relatives are given the site specific Bereavement Booklet. Staff must familiarise themselves with the information in the booklet to ensure relatives receive consistent advice

To ensure Last Offices are carried out and relevant paperwork completed. This also

includes the A&E Department (Guidelines No 3).

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To ensure that Last Offices for an infectious patient are carried out according to Infection Control Guidelines (see Guidelines No 5, 6).

To ensure, wherever possible, relatives wishing to view the deceased person are

enabled to do so on the ward or department and are given appropriate support.

To ensure that relatives wishing to view the deceased person in the mortuary in or out of office hours, may do so at a time convenient to them and the department (Guidelines No 16, 17, 18).

To ensure that the Portering service and Mortuary Department is notified prior to the

transfer when a deceased patient with an infection is being sent to the department. This must also be done where the results of microbiology tests are still awaited.

To ensure all bodies with excessive leakage are placed in body bags (Guidelines No

5).

To ensure the Mortuary is informed, and procedures are followed for patients with pacemakers or radioactive implants.

To ensure all deceased patients are verified and transported to the mortuary,

including patients who are dead on arrival in the Accident & Emergency Department.

To ensure the property and valuables of deceased patients are handled in accordance with the Trust’s Patient Property Policy

For paediatrics – ensure that the parents of the deceased are aware that personal

belongings (e.g. favourite teddy/ comfort blanket / dummy) may be transported with the infant / child to the mortuary. Inform mortuary staff when this occurs.

To ensure the medical notes with the “Last Offices Checklist/Notice of Death” forms

on the front are delivered to the Bereavement Office by 09.30 am on the next working day following the death of a patient.

When the MCCD is issued out of hours, ensure that the checklist following the death

of a patient is completed and this is included in the patients’ notes (Guidelines No 15).

To ensure that, following the death of a baby or young child under the age of 18,

advice, support and guidance are offered to parents / families / siblings.

To ensure that, where a child aged 0 - 18 years of age dies in the A&E Department, the correct procedure is followed (Guidelines No 25, 26).

To arrange appointments, where necessary or requested, for bereaved relatives to

discuss the death and its implications with medical staff involved.

Prepare the deceased patient (including infants and children under the age of 18) for

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transfer to the mortuary respecting the cultural wishes of the patient and family (Guidelines No 20).

10.4 Medical Staff

Using open, honest, advanced communication skills with appropriate and sensitive language, keep patient and patient’s named relative or those with parental responsibility, (with their consent) informed, of his/her clinical condition and the possibility of death, where foreseen.

Ensure that relatives are informed of the death in accordance with their wishes, and

are fully conversant with the cause of death. Further appointments to be made with relevant medical staff if required

Complete the MCCD within one working day of death occurring, and, if required cremation papers within 48 hours of death occurring. Abbreviations must not be used. The certifying doctor’s full name, signature and GMC number must be written on the MCCD.

Junior doctors must discuss and agree, where possible, the cause of death with SpR

or Consultant before completing the MCCD and/or confirm the need for referral to HM Coroner (Guidelines No 7).

Establish any requests for Rapid and/or Out of England release (Guidelines No

10,11)

Ensure the subject of tissue / organ donation for transplant is managed and handled appropriately by the senior doctor and Transplant Donation Team caring for the patient.

Where necessary, to discuss with relatives the need for the death to be reported to

the HM Coroner and the implications of this. It is the doctor’s responsibility to report to the HM Coroner as soon as possible on the next working day.

Following external examination of the deceased patient, notify the mortuary staff of the presence of a combustible device.

10.5 Individual Responsibilities All individuals involved in the care of patients for Last Offices / bereavement are responsible for complying with the policy. 10.6 Hospital Chaplaincy

Provide support to patients, relatives, carers and staff in sickness, death and bereavement, including the conduction of funerals

Offer a 24-hour on-call emergency service. The Chaplains will endeavour to respond to a call at any time of the day or night within a one-hour period.

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Conduct memorial services for relatives of adult deaths.

10.7 Portering Service

To ensure deceased patients are transported to the mortuary within one hour of

receiving the request.

To facilitate the transfer of deceased patients from the Accident & Emergency

Department to the mortuary.

To place the deceased person in the viewing room for out-of-hours viewing.

To complete the mortuary book, ensuring completion with full name. To assist in the

rapid release of deceased patients from the mortuary (Guidelines No 10,11)

10.8 Mortuary Department

To provide a safe, respectful and dignified environment for the storage of deceased persons prior to collection by a nominated family funeral director, according to the mortuary standard operational procedures.

To safeguard any valuables/property left with the deceased person, according to Trust patient property policy

To provide access to the deceased person for bereaved relatives to pay their respects, following mortuary standard operational procedures for the viewing of the deceased.

To facilitate the checking of deceased patients by all medical staff, ensuring completion of the “Standard Data Requirements for Checking All Patients in in the Mortuary” form.

To maintain robust record keeping on all aspects of the management of deceased patients

Present the deceased for identification at the request of the HM Coroner with the HM Coroner following the standard operational procedure for Police Identification.

To release the deceased person into the care of the family’s funeral director on production of the necessary documentation issued by the Registry Office, HM Coroner or presentation of a rapid release form.

To ensure the correct deceased patient is released by following stringent policies relating to the identification of the deceased as detailed in the mortuary standard operational procedure for the release of bodies.

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Once notified, to remove and dispose of defibrillator and heart pacemaker instruments/combustible devices from the deceased following the mortuary standard operational procedures.

To provide advice and training to portering staff on the management of the deceased patient in the mortuary.

To maintain a high standard of hygiene in the mortuary

To comply with the requirements of the Human Tissue Authority (HTA).

To support rapid release of deceased patients within working hours.

To manage the seasonal fluctuations in mortuary occupancy ensuring the integrity, dignity and safety of the deceased at all times.

Assist the Lead Nurse Bereavement Services to carry out quality and Health & Safety audits as a means of monitoring the application of the Last Offices as they apply to the Trust.

10.9 Bereavement Services

To inform, by telephone, the relevant GP of the death of the patient and, on completion of the MCCD, complete and post a letter to the same GP practice.

To ascertain from relatives all contact details for communication regarding progress of the respective death certification process and determine, their intentions regarding burial or cremation.

To ensure that the relevant paperwork is completed as soon as possible in line with availability of the certifying doctor.

To ensure co-ordination of the death certification process to facilitate a seamless process for relatives.

To ensure all referrals are sent to the HM Coroner in a timely manner, confirming receipt of referral, electronically or by fax

To ensure that any property and valuables are handled in accordance with the Patient’s Property Policy, including the completion of an indemnity form.

To arrange a mutually convenient meeting with the relatives to issue and discuss the MCCD and to advise regarding the next steps of death certification, registration and funeral arrangements. In addition, to discuss any concerns or issues the relatives may have and if necessary, arrange a meeting with the medical examiner or a member of the patient’s medical team

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To refer to Birmingham City Council Social Care and Health (Funerals and Protection of Property Department) cases where no relatives or friends are known or available. To monitor progress of the necessary funeral arrangements including registering the death.

To liaise with relatives in those cases where the deceased is subject to a hospital post mortem and issue a relatives’ information leaflet - Post Mortem Examination.

To advise the Mortuary of the details of patients who have been referred to the HM Coroner and prepare the relevant paperwork for collection by HM Coroner’s staff.

To check weekly to ensure that all patients’ funeral arrangements are being dealt with. No deceased person should be in the mortuary for longer than two weeks without plans being made.

To ensure the bereavement database is kept up to date with the required details.

To ensure all funeral directors’ invoices are processed in a timely manner

To ensure medical staff receive cremation/medical examiner fees in a timely manner

To ensure medical notes are prepared for ongoing requirements, for example, Medical Records dept, medical secretaries, Investigations dept, HMC, Trust divisional Mortality and Morbidity meetings.

10.10 Finance Department

Trust Financial Arrangements

In order to receive the appropriate income/payments for the preparation of cremation forms, invoices are raised within Bereavement Services to be forwarded by the Trust’s Finance Operations Team to the respective funeral directors for repayment into the relevant Trust budget

Under the Public Health (Control of Disease) Act 1984, if someone dies in hospital and there is no one willing or able to arrange and pay for the funeral, the Trust has an obligation to ensure that the deceased is buried or cremated according to the HSG (97)43 guidelines “Patients who die in hospital”. The Trust has a contractual arrangement with Birmingham City Council to ensure compliance with this policy and is billed on an individual basis for each funeral that takes place.

To ensure the correct procedures are followed regarding the property of deceased patients. Please refer to the Patient's Property Policy

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11. Training Requirements Education around key elements of the policy will be undertaken at local induction. Further End of Life and Bereavement training is incorporated into

Trust Nurse Clinical Induction programme

Trust Preceptorship Programme

HCA Induction Programme

Junior Medical Staff Induction In conjunction with the Education Department, additional End of Life training courses will be provided for all staff involved in End of Life Care. 12. Monitoring Requirements See Appendix A

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Appendix A Monitoring Requirements

MONITORING OF IMPLEMENTATION

MONITORING LEAD REPORTED TO PERSON/GROUP

MONITORING PROCESS MONITORING FREQUENCY

Duties and local arrangements for management through:

Staff knowledge of bereavement policy and procedures

Policy compliance

Lead Nurse for Bereavement

Chief Nurse CEO Advisory Group

A high level audit based quality report summarising reports below

Annual

Lead Nurse for Bereavement

Chief Nurse Divisions Mortality and Morbidity through CQMG

A quality report utilising:

Audit

Reports (including exception report from Divisions)

Datix Incident reports analysed by trends and themes

Lessons learned

Quarterly

Staff training requirements

Lead Nurse for Bereavement with Education Department. Individual heads of departments

Chief Nurse Divisions

Training Needs Analysis. Training need identified by individual groups of staff

Twice yearly