Policy: Although some staff may be given training in emergency first aid they are not expected to be qualified first aiders. If staff are present when a Service User dies they must summon professional assistance (either the GP or the ambulance service) and take only such immediate measures as they feel competent with, or are instructed to take by the person they contact. They must report to their Line Manager as soon as possible.
Verification of death may only be carried out by a person who is appropriately qualified and deemed to be an experienced competent person. This can be a Doctor or a Registered Nurse.
It must not be assumed that a person is dead until formal verification has taken place, even if the death is expected. Where relevant, and in the absence of a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) order, resuscitation procedures may be necessary and the Care Worker should contact the Emergency Services for advice if they are unsure what action they need to take in such circumstances.
Certification of death requires a Registered Medical Practitioner.
The procedure does not apply in any other situation, e.g. sudden or unexpected death which is defined as: • Death within 24 hours of admission or service commencement • The presence of suspicious circumstances • Death following an untoward incident, e.g. drug error, accident • Death following an operation or invasive procedure • Death following equipment failure or misuse • Paediatric death
If a death does not fit the criteria for verification by a registered nurse, the procedure should be carried out by a doctor. Additionally, the following will need referral to a coroner and therefore a nurse should not verify death:
• Death of a child, under supervision, on the Child Protection register, or being in care • Deaths as a result of neglect/fault • Deaths from notifiable industrial/infectious diseases • Deaths under medical or dental care • Deaths while subject to compulsory treatment under mental health legislation • Any death not falling into any of the foregoing categories where the circumstances surrounding the death may cause public anxiety
Any of these exceptions, or any cause for concern, require referral to a coroner through immediate notification to the Police.
Deprivation of Liberty and Policing and Crime Act 2017 Compassionate Care Team Ltd understands that changes introduced through the Policing and Crime Act 2017 mean that people who die whilst deprived of their liberty under a Deprivation of Liberty Safeguard or a Court of Protection Order are no longer classed as having died in ‘state detention’. This means the deaths do not trigger an automatic requirement for an inquest. However, coroners will still investigate where there is a concern about the death, such as a concern about the care or treatment the person received before they died, or where the medical cause of death is unknown. Therefore, the death of a Service User who is subject to a DoLS authorisation should not be verified by a nurse.
Procedure: If a Care Worker discovers a Service User whom they think is dead, whatever the circumstances, the Care Worker should make a note of the time. If death was expected, the Care Worker should follow the agreed plan for who to contact. If no plan is in place, the Care Worker should contact the GP or 111. Unless cardiopulmonary resuscitation is required, the Care Worker should not move the person or touch any of their possessions unless it is to make a potential hazard safe e.g. turning off the cooker.
The Emergency Services or GP should be made aware of any cultural or religious considerations regarding death that will have been already recorded in the Service User's Care Plan.
Routinely Care Worker are not insured if they are in a Service User's home when they are not present. Furthermore, being in the home when a Service User is not present may leave both the Care Worker and Compassionate Care Team Ltd exposed to safeguarding allegations. Where a Service User is deceased and all the necessary appropriate calls and actions have been taken,if there is no -one else there, the Care Worker should lock the door behind them and wait outside for the Emergency Services/the doctor/emergency contact/manager.
The GP should attend at the earliest possible moment to certify the death. In the case of expected death, this may not be until the next morning if the call is made during the night.
Where Care is commissioned by Nottinghamshire County Council, Compassionate Care Team Ltd should contact the duty team and agree who will take responsibility for contacting the Service User's emergency contact.
The 'agreed responsible person' will phone the emergency contact, saying that they believe the individual has died but that this has not been certified by a GP.
The Care Worker should, in the interest of privacy and dignity, try to ensure that only people who have an appropriate need to approach the individual, their room and belongings have access to do so.
The Care Worker or Compassionate Care Team Ltd should not contact the emergency contact unless this has been agreed. In the event of a referral to the Police, do not move the body or make any changes to the environment or surroundings before the Police attend and authorise any movement. Before the Police state otherwise, the place of death is a potential crime scene.
In the event of an unexpected death, and/or referral to the Police, and where the death has taken place in a public space, clear and seal the space of other persons in order to preserve the scene.
Compassionate Care Team Ltd should ensure that details about the date, time and circumstances of the death are recorded. Miss Naomi Bennett should ensure that a 'Death of a Person Using the Service' notification form is submitted to the CQC without delay. Compassionate Care Team Ltd should ensure that other Care Workers involved in the Care of the Service User are informed and that any further visits are cancelled.
The Care Worker will not keep or dispose of any medicines. This is the responsibility of the next of kin/representative or the Police/Coroner.
Compassionate Care Team Ltd should ensure that Care Workers are supported and, where required, signposted to bereavement counselling services.
If a safeguarding issue becomes apparent after death, clearly documented concerns should be raised with Nottinghamshire County Council's Safeguarding Team in line with local procedures and guidance. The CQC should also be notified in line with statutory reporting requirements. Compassionate Care Team Ltd will need to consider how to support Service Users in communal settings about the death of the Service User within the boundaries of Service User confidentiality. If the Service User has died in an environment where other people may be distressed by the death, then Compassionate Care Team Ltd will, if required, need to inform them sensitively, using relevant resources as appropriate. Compassionate Care Team Ltd should consider signposting to bereavement support in these settings.