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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 (see box below)

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, old age, natural causes

Your details

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