Death certification

Verifying death

  • Review the patient’s notes, resuscitation status, and recent events with the nursing team – was the death expected/unexpected?
  • Wash hands
  • Introduce yourself to the family if present, say you are sorry for their loss, and explain what you need to do
  • Ask if they want to be present or not
  • Confirm the patient’s identity on their wristband (name, hospital number, DOB)
  • All criteria below must be met and documented:

Criteria to be met and documented

  • Pupils fixed and dilated (with no response to light)
  • No ventilation observed/breath sounds on auscultation (1 minute)
  • No central pulse palpable (1 minute)
  • No heart sounds on auscultation (1 minute)
  • No response to painful stimulus (e.g. squeezing trapezius)
  • Cover the patient in a dignified manner
  • Document the above findings with the date and time at the end of the assessment in the notes (include your full name and role) 

When you can fill out the death certificate

All of the criteria below must be met:

  • You must have seen the patient in the last 14 days before death or after death
  • You must have provided care in the last illness before death
  • You must be a registered medical practitioner
  • You must have ‘knowledge and belief’ of the cause of death (this should ideally be discussed with the consultant in charge)
  • The death must not meet criteria for referral to the coroner 

Cases requiring coroner referral

  • In hospital <24 hours
  • Unknown cause/unexpected
  • In custody
  • Any suspicious circumstances
  • Any drugs involved
  • Acute alcohol
  • Industrial deaths
  • Any blame
  • Following accident/fall/violence
  • Operation <1 year
  • Unknown identity

Filling out a death certificate

Demographics

  • Name, age, DOB

Details of death

  • Place of death
  • Date of death and date you last saw the patient alive (format: ‘Third day of November 2017’)
  • Whether a post-mortem is required or you have reported the death to the coroner
  • Who saw the patient after death (you/another medical practitioner/not seen after death by a medical practitioner)

Cause

  • Format:
    • Ia: the immediate cause of death
    • Ib: condition leading to Ia
    • Ic: condition leading to Ib
    • II: other conditions contributing to death (but unrelated to condition in part I)

Example:

  • Ia: Pulmonary Thromboembolism
  • Ib: Deep Vein Thrombosis
  • II: Metastatic prostate cancer

Tips:

  • Do not use abbreviations or symbols
  • Give as much information as possible (but you don’t need to fill out all sections)
  • Avoid the terms: any organ failure without a causative condition, old age, natural causes

Your details

  • Name, role, qualifications, General Medical Council number, signature
  • Hospital address
  • Consultant in charge

Test yourself – how would you list the causes of death for these scenarios?

A 54 year old man with a history of polymyalgia rheumatica was admitted with a stroke. He had an unsafe swallow and developed an aspiration pneumonia. He became progressively more hypoxic and sustained a cardiac arrest. Resuscitation was unsuccessful.

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An 84 year old with Parkinson’s disease, hypertension, COPD and previous CABG was admitted with a community acquired pneumonia. She sustained a type 2 myocardial infarction during admission. She was also noted to be in atrial fibrillation and started on apixaban. Three days later she developed large volume haematemesis and melaena. Blood products were transfused but she lost cardiac output and CPR was unsuccessful.

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A 42 year old man was admitted with hepatic encephalopathy and liver failure. He is a known diabetic and had been under the hepatology clinic for chronic active Hepatitis B and liver cirrhosis before being lost to follow up. He was known to drink alcohol to excess. He was deemed not fit for a liver transplant and died three days after admission.

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