Guidelines for Verifying Life Extinct (VLE) during COVID-19 Pandemic, Lecture notes of Nursing

Download Guidelines for Verifying Life Extinct (VLE) during COVID-19 Pandemic and more Lecture notes Nursing in PDF only on Docsity! COVID-19 – Guidelines for VLE – V1.0 20 April 2020 Page 1 of 7 Guidelines for Verifying Life Extinct (VLE) during COVID-19 pandemic 1. BACKGROUND - VERIFICATION OF LIFE EXTINCT (VLE)1 This guidance is intended to assist healthcare staff who are trained in the verification of life extinct (VLE) with those aspects which vary from the non-pandemic situation. The procedure and a model adult form are included as aids. This guidance is not all inclusive, it is intended to give staff additional guidance during the COVID-19 pandemic; for more detail please consult Guidance surrounding Death1. 1.1 VLE during the COVID-19 pandemic An efficient and safe VLE procedure is important for ensuring that the sequence from death to last offices and burial or cremation is timely and as seamless as possible. Once the verification of life extinct procedure has been performed, the body can be moved from the place of death to a mortuary, the premises of a funeral director or other temporary resting facility. In a pandemic, the major problems that arise do so as a result of the, i. volume of deceased patients, both in hospital and in the community; ii. reduction in numbers of staff trained in the VLE procedure; and iii. risk of infection to the staff performing the VLE procedure. i. In a pandemic, the numbers of patients dying might result in a significant delay between the actual time of death and performance of VLE. It is expected that with the addition of more nursing staff to perform this role, delays should be prevented. The date/time of VLE determines the official date of death. ii. Those professions trained in the VLE procedure include medical practitioners, nurses and ambulance clinicians. In a pandemic situation, there will be fewer numbers of trained staff. As all doctors and the appropriate grade of ambulance clinicians are already trained, it would be crucial that some of the nurses who are not trained to verify life extinct, receive the appropriate training so that they can consider themselves competent to perform this role. iii. In this COVID-19 pandemic there is a risk of transmission of the infective agent unless it is clear, from recent testing, that the deceased is coronavirus free. This risk may arise from the patient or from their environment; this guidance applies to hospital and community deaths. Otherwise, staff need to take precautions when performing the VLE procedure for COVID-19 and suspected patients. This will include the wearing of suitable PPE (disposable gloves, disposable plastic apron, fluid resistant surgical face mask, disposable eye protection). 1 Also known as Verification of Death COVID-19 – Guidelines for VLE – V1.0 20 April 2020 Page 2 of 7 2. WHO CAN VERIFY LIFE EXTINCT (VLE)? 2.1 Professional requirements Doctors All doctors registered with the General Medical Council can verify life extinct and must be professional and compassionate when confirming and pronouncing death and must follow the law, and statutory codes of practice, governing completion of death and cremation certificates. Nurses VLE can also be undertaken by an experienced registered nurse2 who has received training and is deemed competent in the procedure, in any health care setting; in the HSC or independent sector. Their employers must have policies and their associated protocols in place, detailing the local workplace agreements setting out clearly the circumstances in which nurses can undertake VLE. These should contain specific details applicable to the workplace in question (particularly in the case of unexpected deaths, although see below for pandemic situation). Education and training must be made available and nurses should ensure they have enough confidence, competence, knowledge and skills to equip them for undertaking this role. Appropriately trained and registered nurses may, during this COVID-19 pandemic, continue to verify life extinct; the process is not limited to those deaths occurring as a result of coronavirus (SARS-CoV-2). If VLE is performed by a nurse, they must contact the Doctor/GP/Healthcare centre and inform them of the end of life event and advise that they have completed a VLE. They must record on the VLE record sheet the name of the doctor informed. 2.2 VLE in pandemic circumstances Due to the possibility that medical practitioners or ambulance clinicians may not be able to respond promptly during a pandemic surge, a nurse may need to perform the VLE procedure in circumstances which, in the past, they would not have done so. These circumstances include the following, i. sudden death which is unexpected, unforeseen and not predictable2; ii. when the cause of death is uncertain; iii. the verifying nurse feels that there may be suspicious circumstances; iv. death as a result of untoward incident e.g. fall or drug error; v. if the deceased is to undergo a Coroner’s or a consented hospital post-mortem examination. 2 unexpected death can be described where death,  was not anticipated as a significant possibility for example, 24 hours before the death; or  there was a similarly unexpected collapse or incident leading to or precipitating the events which led to the death. COVID-19 – Guidelines for VLE – V1.0 20 April 2020 Page 5 of 7 4. PROCEDURE TO VERIFY LIFE EXTINCT In order to verify life extinct, a permanent cessation of circulatory and respiratory systems and cerebral function must be confirmed and documented in the patient’s notes. N.B. this applies in all cases whether it is a doctor, nurse or ambulance clinician who undertakes the task. Certain situations can make the clinical confirmation of life extinct more difficult, in particular drowning, hypothermia, drug overdose, effects of depressant drugs, certain metabolic / endocrine disturbances and pregnancy. In these situations, active resuscitation should continue until an experienced doctor has verified life extinct. There are some special circumstances, including brain-stem death in ventilated patients, where medical Consultants will be involved in verifying life extinct under more detailed protocols designed because cardiorespiratory activity is being maintained by the continued mechanical ventilation. The ‘deceased’ individual should be observed by the person responsible for verifying death for a minimum of five minutes to establish that irreversible cardiorespiratory arrest has occurred. Life extinct must always¥ be verified by examining all of the following systems: 1. Cessation of circulatory system  No central pulses on palpation.  No heart sounds (verified by listening for heart sounds or asystole on an ECG tracing). 2. Cessation of respiratory system  No respiratory effort observed.  No breath sounds (verified by listening for breath sounds). Establish that cardiorespiratory arrest has occurred for minimum of 5 minutes. 3. Cessation of cerebral function  Pupils dilated and not reacting to light.  No Corneal reflexes.  No motor response to painful central stimulus e.g. supra-orbital pressure, trapezius squeeze. ¥ excluding neonates and children less than 2 months old The time of death is recorded as the time at which these criteria are fulfilled. COVID-19 – Guidelines for VLE – V1.0 20 April 2020 Page 6 of 7 5. MODEL - VERIFICATION LIFE EXTINCT RECORD SHEET (Adult) Deceased’s name H&C number Place of Death Date of Birth Present at time of death/ Witness(es) I have checked for cessation of: CIRCULATORY  RESPIRATORY  CEREBRAL  No central pulse felt No respiratory effort Pupils dilated and not responding to light. No Corneal Reflex No audible heart sounds or asystole on ECG No breath sounds No motor response to painful central stimulus e.g. supraorbital pressure, trapezius squeeze I have verified life extinct of the patient named above. Signature Date Print name Time Position and Contact details Action to be taken after Verification of Life Extinct Either The circumstances of this death do not appear suspicious. If I am not a medical doctor, I have informed a doctor (see below) that the death has occurred and I have verified life extinct. Or I have concerns about the circumstances of this death and have contacted a Doctor the Coroner, or the Police. (see below), Name of doctor informed Date informed Time informed How have you made contact? Spoke to doctor Contacted Out of Hours Service Other COVID-19 – Guidelines for VLE – V1.0 20 April 2020 Page 7 of 7 6. HOW TO CONTACT THE CORONER? The office is staffed,  weekdays 09.00 – 16.30  weekends and public holidays 09.30am – 12.00md (except Christmas Day when the office is closed) Outside office hours, the Coroner’s Office can be notified of the death by telephone or email; they will then revert to the doctor to discuss the death. Email Notifying the Coroner’s Office of a death can be done by e-mail. A downloadable form is available which can be completed and e-mailed to the death reporting team, they will then call you back to discuss in more detail. https://www.justice-ni.gov.uk/sites/default/files/publications/justice/Death-Reporting-GPs.pdf Email: [email protected] Telephone Telephone: 0300 200 7811 (answering machine out of hours) Outside normal office hours a recorded message will provide contact details for the duty Coroner or messages may be left on the telephone answering machine.