Canberra Hospital and Health Services
OperationalProcedure
When Death Occurs
Contents
Contents
Purpose
Scope
Section 1 – Pronouncement of Death
Assessment of the extinction of life and pronouncement of death
Deceased Person Checklist
Section 2 – Notification
DonateLife
Notifying the Coroner
Notifying the next of kin and General Practitioner (GP)
Section 3 – Documentation
Certification – Medical Certificate of Cause of Death and Certificate of Medical Attendant form
Documentation
Section 4 – Care of the deceased and their Next of Kin/Family
Section 5 – Transfer
Section 6 – Ritual Washing
Section 7 – Special Circumstances
Community setting:
Post Mortem – non-coronial:
Perinatal deaths:
Infectious diseases:
Radioactive substances
Larger (Bariatric) patients
Section 8 – Coronial Matters
Notifying the Coroner and the next of kin
Note:
Do not certify
Documentation
Care of the deceased and their family
Release of information to the Coroner’s Office or ACT Policing
Information provided verbally to ACT Policing
Release of information to the public
Special Circumstances:
Related Policies, Procedures, Guidelines and Legislation
References
Definition of Terms
Search Terms
Attachments
Attachment A: When Death Occurs Flowchart
Attachment B: Coronial Criteria –Coroner’s Act1997 Section 13 (1)
Attachment C: Sign to be printed and used for exposure to infectious diseases
Purpose
This procedure outlines the steps to follow after the death of a patient who is in the care of ACT Health. It includes information for staff on Coronial deaths and processes, and on caring for the deceased and their family through Coronial, and non-Coronial processes.
It supports ACT Health staff to:
- Ensure the appropriate processes are followed for notifying adeath to the relevant parties
- Ensure documentation is completed appropriately, and
- Provide appropriate care for the deceased and their family.
An overview of the process to follow can be found in the When Death Occurs Flowchart at Attachment A.
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This Standard Operating Procedure (Procedure) describes for staff the process
AlertsThe Coroners Act1997 imposes a responsibility on all ACT Health staff to inform the Coroner’s Office or Police of a death if they feel it meets the Coronial Criteria or if there are reasonable grounds to believe the death is one that a Coroner would have jurisdiction to hold an inquest and which has not previously been reported. Staff can contact the ACT Policing Coroner’s Team 24hours/7 days per week on 0413 009 547 or through Police Operations on 131 444.
If ACT Health staff are unsure about any part of this procedure in relation to a specific death and a possible Coroner’s notification, they should contact the Coroner’s Office to clarify before any further action is taken.
The Coroners Act1997 also states that all deaths that occur in custody must be referred to the Coroner. Death in custody refers to a person in the care of a custodial officer as defined in Section 3C Death CoronersAct1997(including Police, Corrections and Mental Health Officers). This includes all people subject to an order under the Mental Health Act 2015.
When Medical Officers (MOs) employed by ACT Health pronounce death they must complete the Deceased Person Checklist (available on the Clinical Forms Register) to assist with determining whether to make a referral. MOs must refer a death to the Police if it meets any of the criteria outlined in Section 13 of the Coroners Act1997(please see Attachment B).
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Scope
This procedure pertains to all patientswhose death occurs while in the care of ACT Health. It also outlines the criteria for a referral to the Coroner’s Office (as per the Coroners Act1997) and information to support the decision to refer.
This procedure also outlines circumstances which require consultation and alternative processes to be followed. This includes management of:
- Deaths in the community setting
- Non-coronial post mortems
- Perinatal deaths
- Patients with infectious diseases
- Radioactive substances
- Larger patients.
This procedure applies to ACT Health staff who work in the following settings:
- Canberra Hospital and Health Services
- Brian Hennessey Rehabilitation Centre (BHRC)
- Dhulwa Mental Health Unit (DMHU)
- Alexander Maconochie Centre (AMC)
- Bimberi Youth Justice Centre (BYJC)
- Periodic Detention Centre (PDC)
- Court Transport Unit (CTU).
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Section 1 –Pronouncement of Death
Assessment of the extinction of life and pronouncement of death
It is the MO’sresponsibility to confirm and pronounce death and complete the associated documentation. If a MO is not present when a patient dies, a Registered Nurse may make a clinical assessment of the extinction of life and document this in the clinical record. Staff must then contact a MO to pronounce death. It is the MO’s documentation of date and time of death that will be used when registering the death on ACTPAS. The admitting MO should also be informed.
Deceased Person Checklist
The Deceased Person Checklist (available on the Clinical Forms Register) must be completed for all deaths within the jurisdiction of ACT Health, with the exception of deaths in the community setting (refer to section 7). It is the responsibility of the MO who pronounces death to use the Deceased Person Checklist to determine whether a referral is made to the Coroner’s Office.
The MO must check the clinical notes and clinical information systems (e.g. ACTPAS, CRIS, MHAGIC, CIS and EDIS) regarding administrative alerts and warnings about patients. These alerts should be checked when deciding whether to refer to the Coroner’s Office. For example, a patient under a Mental Health Treatment Order who dies must be referred to the Coroner’s Office.
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Section 2 – Notification
DonateLife
Donation Specialist Nursing Coordinators (DSNC) must be notified of all deaths as per the DonateLife Organ and Tissue Donation – Adults, Adolescents, Children and Neonates procedure. The DSNC is to be contacted via the Canberra Hospital Switchboard,
ph: 62442222, 24 hours a day, seven days a week.The Death Certificate should be completed in a timely manner in accordance with the procedure to assist with the facilitation of organ and/or tissue donation.
Notifying the Coroner
If any of the answers to question 1 – 6 on the Deceased Person Checklist is “Yes”, the MO must notify the ACT Policing Coroner’s Team as soon as practicable after pronouncing death. Staff should then follow the process as per Section 8- Coronial Matters.
Any staff member who feels it necessary (or is not sure) may also notify a death to the Coroner’s Office. Attachment B outlines the Coronial Criteria.
Note:
For notification criteria for perinatal deaths, see section 7, Special Circumstances.
If all the answers to questions 1 – 6 on the Deceased Person Checklist are “No”, the Coroner does not require notification and staff should continue to follow sections 3-7 of this procedure.
Notifying the next of kin and General Practitioner (GP)
The next of kinmust be notified in a sensitive and timely manner by the MO or nursing staff, and the discussion documented in the deceased persons’ clinical record. Spiritual Support Services may be contacted through the Canberra Hospital switchboard to assist staff with notifying next of kin, and may also be contacted to support family members at any time post death. If the next of kin cannot be located, staff can inform the Australian Federal Police who will then locate them. When the next of kin and/or family arrive, staff will provide support and clear communication of what has happened and what will happen next.
Staff must ask the family (if not already present) whether they would like to spend time with and view the deceased person. The timing of the transfer of the deceased (see section 5) to the mortuary should be accounted for and explained to facilitate the viewing.
The patient’s GP will be notified of the death via the GP liaison unit during usual business hours however no clinical information is provided. A discharge summary is completed by the Medical Officer within 24 hours. An email notification system is currently in place to ensure that JMOs are notified of any incomplete discharge summaries for deceased patients requesting that these will be done as a priority (within 24 hours). These emails are sent by MOSCETU(see section 7 for deaths in the community setting).
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Section 3 – Documentation
Certification – Medical Certificate of Cause of Death and Certificate of Medical Attendant form
Once the MO determines the deceased person is not a coronial case they must ensure the Medical Certificate of Cause of Deathform is completed in a timely manner. This form is available on all wards and is a carbon copy form that is completed in triplicate. The white copy (original) will be sent to Births, Deaths and Marriages by administration staff, the green copy is the release form to be given to the collecting funeral director and the blue copy is retained on the patient’s clinical record. The cause of death should be noted according to the Births Deaths and Marriages Practice Manual and the Information Paper – Cause of Death Certification (Australian Bureau of Statistics – see references).
Perinatal deaths should be certified using the Perinatal Medical Certificate Cause of Death form available on the ward from >20 weeks gestation (or >400g if gestation unknown) until 28 days post-delivery. The Centre for Newborn Care - Death and Bereavement Procedure should then be followed.
The MO should give consideration to completing a Certificate of Medical Attendant form (available on wards), which allows the family to organise timely cremation of the deceased person should that be desired. This certificate requires a “Medical Referee” to also sign the Certificate of Medical Attendant, who is a doctor appointed under the Cemeteries and Crematoria Act and Regulation 2003. The medical referee sign off occurs external to ACT Health.
Documentation
Timely documentation will ensure that the process of releasing the deceased person occurs as soon as possible. Documentation of all essential information is to be completed as soon as possible. This should include the following:
- Progress notes of the events leading up to and after the death, including discussions with relatives, any valuables noted, any spiritual/cultural considerations when managing the deceased person
- Deceased Person Checklist
- Medical Certificate of Cause of Death
- Medical Certificate of Attendance (for cremation)
Note:
For deaths that are referred to the Coroner, the Medical certificate and Medical Certificate of Attendance should not be completed. Refer to section 8.
The Ward Clerk or other appropriate staff member should then deliver the Clinical Record of the deceased person to the Clinical Record Service. The details and opening hours are:
- Location: Mezzanine level, Building 12, Canberra Hospital
- Hours:Monday to Friday, 7am-10:30pm; Saturday, Sunday and Public Holidays, 8:30am - 5pm.
If outside these hours, the Ward Clerk retains the medical record on the ward and sends to the Clinical Record Service as soon as office hours resume.
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Section 4 – Care of the deceased and their Next of Kin/Family
Staff should check if there are any special circumstances as per sections 6-8 which may impact on the care of the deceased and their family. Staff should liaise with the family to sensitively discuss spiritual, personal and cultural preferences for the care of the deceased. Staff should not begin preparation of the deceased person without prior discussion with the family. All efforts should be made to uphold the preferences for the care of the deceased, unless a referral has been made to the Coroner’s Office. If a referral has been made to the Coroner’s Office, the family should be informed as to why their preferences cannot be completed by the hospital, and the Coroner’s Office should be informed of the family’s wishes so they can be carried out where possible.
Family members should be referred to Social Work services who will ensure appropriate written material is provided and make them aware of Spiritual SupportServices. Where a patient and/or family member identify themselves as Aboriginal and/or Torres Strait Islander, a referral may be made to the Aboriginal and Torres Strait Islander Liaison (ALO) Service.The ALO Service operates Monday to Friday from 8:30 to 5pm. Referrals can be made via the ALO/Social Work Department reception on ph: 6244 2316 or through the Canberra Hospital switchboard.
Family may view and spend time with the deceased person as they desire. Staff should make the necessary arrangements for this and provide access to a quiet room and/or area for the next of kin and family.
Any valuables being worn by the deceased person can remain on their person and should be noted on the deceased person’s tag and on the mortuary log at the time the person is transferred. Any other valuables and personal effects belonging to the deceased person should be handed over to family members upon completion of the steps above. The details of this process must be documented in the clinical record. If there is no next of kin or family present, the belongings should be transferred along with the deceased person to the mortuary and then to the Funeral Director as per section 5 below.
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Section 5 – Transfer
For non-Coronial deaths, transfer and escort of the deceased person to the hospital Mortuary is by a wards-person and the appropriate unit nurse. Any additional paperwork related to the transfer is completed at the Mortuary. Mortuary staff are responsible for transfer and/or release of the deceased person to the Funeral Director, family or other designated person/s, and the arrangement of post-mortem particulars where required.
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Section 6 – Ritual Washing
For some religions it is a requirement that the body of a deceased person is ritually washed and shrouded before burial, and as soon as possible after death. For deaths referred to the Coroner’s Office, the hospital is unable to perform ritual washing, and the family should be fully informed regarding this. The Coroner’s Office should be made aware of the family’s request for ritual washing.
Following ritual washing and draping,it is important that wherever possible the body is released to the family in a timely manner. If the death occurs after midday, burial can occur the following day.The process of ritual washing and draping can take up to 2 hours. If required, Spiritual Support Services should be notified to help support the family, particularly where there is a potential time delay due to the operational requirements of the Mortuary. Where required the use of interpreter services is recommended (see Language Services Interpreter Policy and Procedure for further information).
Note:
Death certificates must be completed and checked prior to ritual washing proceeding. Generally the deceased is conveyed to religious institutions (for example their Mosque) at the completion of the ritual washing, and this cannot happen without the relevant and completed paperwork.
Nursing staff or their delegate should notify the Mortuary staff of the need for ritual washing and the approximate time if known. When death occurs after hours please ensure to notify the After Hours Hospital Manager of the requirement for ritual washing. If ritual body washing is required, the Canberra Hospital Switchboard should be contacted to arrange for the body washing team to be called. The switchboard can contact the team directly or through the Manager of Spiritual Support Services. The family may contact the body washing team directly if they prefer. Mortuary staff will liaise with the nominated family member to determine a mutually agreeable time for the washing to occur.
For any deaths that occur in the afternoons or the evenings, the washing can be held over to the next day and still occur in the Canberra Hospital Mortuary.The ritual washing can occur at the hospital even if a funeral director has already been engaged. On occasion, families of the deceased person may have made arrangements to conduct ritual washing and draping at a local Funeral Home. In such instances, the body of the deceased is released to the Funeral Director and family.
Once the patient has been received in the mortuary, the nurse enters the patient’s details into the mortuary register, including the “special request details” section for ritual washing.
Ritual washing occurs in the allocated area of the Mortuary. If the room is unavailable, the mortuary theatre can be used. If this is also unavailable Tobin Brothers funeral directorsare to be contacted. Linen and towels will be available for use in a labelled box in the mortuary. Ritual Washing is performed by family members and/or by religious representatives who are appointed by their faith group and appropriately trained by the CHHS.It is the responsibility of mortuary staff to ensure all visitors to the mortuary comply with the relevant rules and policies pertaining to the Workplace Health and Safety requirements in the Mortuary
A green release form(second copy of the Medical Certificate of Cause of Deathform) must be completedprior to the release of the deceased person. Following the ritual washing and completion of the release form, the body may be released to the funeral director, family or approved religious or spiritual representative