Mortuary and Bereavement Services
Contents
1INTRODUCTION
2MORTUARY & BEREAVEMENT SERVICES LOCATION
3PATHOLOGY QUALITY POLICY
4THE HUMAN TISSUE ACT
5MORTUARY OPENING TIMES
5.1Appointments
5.2Personal Property and/or Valuables
6MEDICAL CERTIFICATE OF THE CAUSE OF DEATH (MCCD)
7POST MORTEMS
7.1When to Request a Post Mortem
7.2Hospital Post Mortems
7.3Coroners Post Mortem
7.3.1Inquestable Deaths
7.4High Risk Post Mortems
7.5Removal of Catheters, Tubes etc. before Post Mortem
8PATIENT CONSENT DISCLOSURE
8.1Pathology Policy on Protection of Personal Information
8.2Mortuary and Bereavement Services Consent
8.2.1History Sheets
8.3Medico-legal Samples
8.4Cremation Forms
9CONTACT DETAILS
10FEEDBACK ON MORTUARY AND BEREAVEMENT SERVICES AND COMPLAINTS PROCEDURE
1INTRODUCTION
The Mortuary and BereavementService is provided by the Mortuary Team at the Great Western Hospital NHS Foundation Trust, Swindon and serves the Swindon HM Coroner who covers the Wiltshire area. The mortuary is located on the lower ground floor of the Great Western Hospital.
The mortuary has an HTA license and provides secure, cold storage for all hospital deaths and community deaths reported to the Coroner, and a post-mortem service to both the HM Coroners and the hospital.
Mortuary and Bereavement Services at GWH provide advice, support and assistance to bereaved relatives and carers by helping them through the procedures following a death. The Mortuary operates Monday to Friday 08.00 to 16.00. The Bereavement Service is available for telephone calls between 10.00 and 16.00 Monday to Friday. At times, the phone line can be very busy and we apologise if you are connected to a voicemail message. Please be assured that messages are responded to as soon as possible. There is no weekend service.
We hope that this handbook contains all the information you require to use our service. However, please feel free to contact us to discuss any problems or issues you may have. Any comments or suggestions about the User Handbook should be addressed to the Mortuary Manager, by email to
2MORTUARY & BEREAVEMENT SERVICES LOCATION
The Mortuary and Bereavement Services is part of the Division of Diagnostics and Outpatients, within the Great Western Hospitals NHS Foundation Trust. The service is sited on the lower ground floor of the main hospital building (see diagram-area no. 5).
The postal address is as follows:Mortuary & Bereavement Services
Great Western Hospitals NHS Foundation Trust
The Great Western Hospital
Marlborough Road
Swindon
Wiltshire
SN36BB
3PATHOLOGY QUALITY POLICY
The Pathology Department provides Microbiology, Cellular Pathology, Blood Sciences, Blood Transfusion, Point of Care Testing and Mortuary services to the Great Western Hospitals NHS Foundation Trust, Swindon Clinical Commissioning Group (CCG), Wiltshire CCG and other users where such arrangements have been made.
The management of the Pathology Department is committed to delivering a service that is compliant with the requirements for Medical Laboratories set by the International Standard Organisation (ISO 15189:2012), Health and Safety Executive (HSE), Medicines and Healthcare Products Regulatory Agency (MHRA), Human Tissue Authority (HTA) and Clinical Pathology Accreditation (UK) Ltd (CPA).
The Pathology management team is fully committed to the on-going improvement of laboratory services through the continual assessment of the Pathology Quality Management System and the establishment and annual review of quality objectives.
The management of the Pathology Department is committed to good professional practice and the provision of examinations that are fit for intended use to ensure the delivery of a high quality service that meets the requirements of its users. This commitment is reflected in the core values of the Quality Management System:
- The development of a friendly working environment which supports training and encourages the retention and recruitment of committed, highly professional staff.
- A commitment to maintaining a laboratory environment, in compliance with relevant legislation, to ensure the health, safety and welfare of staff and visitors.
- The provision of information on the collection, transportation and handling of all specimens to ensure the validity of results of laboratory examinations.
- The review of test repertoire, in conjunction with users, to ensure it is fit for intended use.
- The procurement and maintenance of appropriate equipment, reagents and consumables to enable the provision of quality examinations of specimens.
- The reporting of high quality examination results in a timely, confidential, accurate and clinically useful manner.
- The provision of advice, in the context of clinical information, to support patient management.
- The engagement with users to ensure that the Pathology service continues to meet their needs and requirements
Dr Alex Sternberg / Robin Jones
Pathology Clinical Lead
Date: 11/05/2016 / Deputy Divisional Director, Diagnostics and Outpatients
4THE HUMAN TISSUE ACT
Great Western Hospitals NHS Foundation Trust are licensed by the Human Tissue Act (HTA) to undertake examinations of post mortem samples submitted by clinical consultants and pathologists. Under the license, the samples may be retained until the examination has been completed and in line with the sample retention policies.
It is the obligation of the requesting clinician or pathologist to ensure that examination of samples they submit have been requested by the coroner where applicable or appropriate consent has been obtained from the deceased person or their relatives.
Only the specific examinations requested by the sending clinician or pathologist may be performed. It must be assumed that the coroner has not asked for any other examinations to be performed and consent has not been obtained for any other work and so this would be outside the scope of the licence.
All relevant material is stored securely and under conditions which maintain the integrity of the sample if possible and confidentiality is maintained in compliance with Caldicott principles, as are all samples received. Following processing, relevant material is only retained for the period of time specified by the retention policy.
5MORTUARY OPENING TIMES
The Mortuary is open:
Monday to Friday:08:00 – 16.00
Saturday:Closed
Sunday:Closed
Bank Holidays:Closed
Bereavement Services are available:
Monday to Friday 10.00 – 16.00
There is no on call cover provided by the bereavement or mortuary staff outside normal working hours.
5.1Appointments
All viewings are by appointment only.
Family members who wish to pay their last respects to the deceased can arrange an appointment through the Bereavement team (see section 9). Families should be given the Bereavement Office telephone number and be asked to contact the Bereavement Officer the following day. Please note we do not have a Chapel of Rest.
Official police identifications will be carried out by similar prior arrangement.
5.2Personal Property and/or Valuables
Any property that has not been returned will be available from the ward for collection. Valuables are returned to the bereaved at the appointed time for the collection of the MCCD. No Bereavement Services are available at weekends and publicholidays.
6MEDICALCERTIFICATEOFTHECAUSEOF DEATH (MCCD)
A Medical Certificate of Cause of Death (MCCD) is a legal requirement for all deaths The MCCD is required from the hospital to enable the death to be registered. It is not always available the same day and can take up to three working days to be completed.
Doctors are requested to attend the Bereavement Office as early as possible to complete all necessary formalities.
All Doctors responsible for completion of certificates follow the Trust End of Life policies including The Care after Death Policy, Care of the Dying and Deceased Policy, and Coroner’s Inquest Guidance. All individuals responsible for MCCD completion are trained and competent to do so.
Doctors comply with the guidelines of the General Medical Council policy ‘Treatment and Care at the End of Life’.
Once completed, a member of the Bereavement team will contact relatives of the deceased and arrange a mutually convenient time for collection of the certificate from the Bereavement Services.
In cases where the Coroner has been informed, and a Coroner’s Post Mortem is required, the Coroner’s Office will issue the MCCD directly to the Registry Office. The Coroner will directly contact the next of Kin to inform of the decision.
7POST MORTEMS
Staff are encouraged to seek authority from the patient’s relatives for a post mortem examination to be made (except deaths subject to the authority of HM Coroner where no authority is required). Post Mortem examination is important in improving clinical care, maintaining clinical standards, increasing understanding of disease, identifying the spread of infectious diseases and supporting research and training.
All PM examinations must be carried out on premises licensed by the HTA and in accordance with the conditions of the licence. Bodies stored for the purpose of PM examination must be stored on licensed premises.
7.1When to Request a Post Mortem
It is a statutory obligation of a doctor who has attended a patient who dies, to issue a Death Certificate without delay, unless the death falls within the categories requiring it to be reported to Her Majesty’s Coroner. Reporting a death to the Coroner must be done without delay. This is to ensure that the funeral arrangements and/or Post Mortems can proceed as soon as possible. Reasons for referral to the Coroner can include:
• It is difficult for doctors to establish the cause of death
• The death was sudden or unexplained
• They were in hospital for less than 24 hours from admission to the hospital
• If they were involved in an accident or suicide is suspected
• They died during or following surgery
• A fall or fracture was sustained
• The death may have involved an industrial disease
7.2Hospital Post Mortems
Based on the Human Tissue Authority Guidance Code of Practices, a hospital post-mortem examination in all its forms is important for informing relatives, healthcare professionals and other interested parties about the cause of death. It may also inform individuals about possible acquired or genetic diseases that may need treatment and care.
The examination, including removal, storage and use of organs and tissue and the various purposes for which tissue might be kept, may involve tissue or whole organs may be taken. If this is requested it must be in accordance with the provisions of the Human Tissue Act. To ensure compliance with the HumanTissues Act a hospital Post Mortem examination is carried out with consent from either the deceased person prior to their death or the consent of their nominated representative/next of kin.
The Post Mortem examination is carried out sympathetically, and by consenting to this examination you are still able to collect the MCCD, register the death and make funeral arrangements.
7.3Coroners Post Mortem
In some circumstances, by law, it is necessary to report a death to the Coroner. The primary role of the Coroner is to find out the cause of the person’s death.
Usually the post mortem will be performed within 24 hours of the request by the Coroner. It is the decision of the Coroner as to where the PM is carried out. Case notes and X-rays are requested in all cases. A written report will be sent to HM Coroner, the General Practitioner and where applicable the hospital Consultant.
7.3.1Inquestable Deaths
A Coroner’s inquest provides the opportunity for all involvedin the individual’s care to examine the events leading to the person’s death. Thisprovides the family withanswers to what happened and a chance to ask questions. There may be short delay to funeral proceedings if areferral to the Coroner is made.
7.4High Risk Post Mortems
Although every post mortem examination is carried out on the assumption that there may be danger of infection, it is recognized that there is a group of “High Risk” bodies, where additional precautions and procedures are necessary.
It is the responsibility of the Pathologist to ascertain whether a body is “High Risk” or not. The pathologist will make the decision from the clinical notes, plus information received from doctors and Coroner’s Officers.
When the deceased has a known high-risk infection before the post mortem is carried out, the Pathologist must treat the case as a high risk case. If the deceased is a known drug user or relevance information indicating they may be a possibility of an infection present the Mortuary staff carry out pre- testing and await the results before the post mortem is carried out.
The procedure meets the requirements of several governance and legislative frameworks encompassing optimal practice, Health and Safety, professional guidelines from the Royal College of Pathologists, the Coroner’s and Justice Act (2009)rules and amended rules and the Human Tissue Act (2004), for which standards were developed in consultation with representatives from the sector and reinforce the intention of the HT Act that consent is paramount when engaged in activities involving the use of human tissue, that the bodies of the deceased and tissue taken from bodies should be treated with respect and that the dignity of the person should be maintained.
7.5Removal of Catheters, Tubes etc. before Post Mortem
Catheters, naso-gastric tubes, endo-tracheal tubes, drains and pacemaker wires etc. should where possible be left in-situ as the position of these objects may have a direct bearing on the cause of death.
If any doubt arises about the correct action to be taken the Mortuary staff should be contacted before removal of the deceased occurs.
8PATIENT CONSENT DISCLOSURE
8.1Pathology Policy on Protection of Personal Information
The Pathology Department regards the lawful and correct treatment of patients’ personal information as vital to successful operations and to maintaining the confidence of users of the service. Request form information may additionally be used for billing purposes, financial audit, resource management and utilisation reviews.
Our policy is that we will treat personal information lawfully and correctly in adherence to the principles of data protection described in the Data Protection Act 1998.
As part of the Great Western Hospital NHS Foundation Trust we alsowork to its governance and data protection policies which incorporate the Data Protection Act, the Department of Health Confidentiality NHS Code of Practice, and Department of Health Security Management NHS Code of Practise, as listed below:
- Information Governance Strategy and Policy
- Information Protection and Security Policy
- Information Asset Register Procedure
- Data Protection Policy
- Data Transfer Policy
- Data Quality Policy
- Code of Conduct for Employees in Respect of Confidentiality Policy
- Freedom of Information Requests Procedure
- Consent for Medical Treatment for All Patients at the Great Western Hospital Policy
8.2Mortuary and Bereavement Services Consent
The Mortuary and Bereavement Service follow Trust Consent for Medical Treatment for all Patients at the Great Western Hospital Policy. Seeking consent is a process that involves listening, discussing, and questioning so as to arrive at a shared understanding - a signed form is not necessarily an indication that such an understanding has been reached. For consent to be valid it must be given voluntarily, by an appropriately informed person who has the capacity to agree to the activity in question. If these elements have not been satisfied, a signature on a form will not make the consent valid.
Written consent is good practice and must be obtained for hospital post mortem examination procedures including the storage, retention and use of tissue and organs for a scheduled purpose.
Consent remains valid unless the person withdraws it. A competent person is entitled to withdraw consent at any time prior to the post mortem taking place. Generally this is up to 24hrs after consent has been given. Clinicians should discuss with the person concerned how the samples should be returned to them or disposed of and tell him/her about any samples that may have already been used or disposedof.
8.2.1History Sheets
History sheets are completed by the Mortuary staff when the patient is admitted into the Mortuary. It is imperativethat allpatients have an identifiable wrist band present in line with the Trust policy. Information is taken from the wrist band and transferred on the forms to ensure that correct procedures are followed. The history sheet documentsif the patient has had any implants, pacemakers or catheters fitted that the Mortuary staff needs to be aware of for health and safety reasons.
8.3Medico-legal Samples
Any specimens requested for medico – legal purposes should have documentation accompanying them to ensure an unbroken chain of evidence.
8.4Cremation Forms
Cremation forms are requested by the probable interested persons and will besigned and completed by two separate Clinicians. The Clinician who attended the patient throughout their last treatment will complete Form 4 of the Cremation forms documentation andan independent Clinician who has not had any involvement with the patient will review Form 4 and complete Form 5 once agreed. Both Cremation forms are given to the Funeral Director once the patient is released from the Mortuary. Unnecessary delays must be avoided as this can cause unacceptable difficulties with funeral arrangements.
9CONTACT DETAILS
Name / External Number / Internal NumberMortuary & Bereavement Services / 01793 604809 / 4809
Dr Lawrence John
Consultant Pathologist, Clinical Lead Mortuary / Via Office / 4282
Samantha Cunningham
Mortuary & Bereavement Services Manager / 01793 604809 / 4809
Dr Lawrence John
Consultant Pathologist, Clinical Lead Mortuary / Via Office / 4282
Dr Darko Lazic
Consultant Pathologist / Via Office / 4280
Dr Saumitra Banerjee
Consultant Pathologist / Via Office / 5432
Sarah Leigh Nicholson
Cellular Pathology Laboratory Manager / 01793 604277 / 4277
Trudi Carey
Pathology Quality and Customer Engagement Manager / 01793 605013 / 5013
Fax / 01793 604810 / 4810
Hospital switchboard / 01793 604020 / 0
10FEEDBACK ON MORTUARY AND BEREAVEMENT SERVICES AND COMPLAINTS PROCEDURE