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New guidance emphasises need for training in 'care after death'

  • 29 Comments

Updated guidance has been published for the wide range of health professionals who care for people just before and after death.

The guidelines – titled Care After Death – aim to help ensure a person who has died is cared for and there is well co-ordinated support that respects the wishes of the deceased and their families. 

As well as nurses and doctors, the document covers mortuary staff, pathologists and funeral directors.

“We particularly welcome the guidance’s emphasis on training for staff”

Ros Taylor

The first edition, published in 2011, focused mainly on care for adults in acute hospitals, at home or in a care home. The updated version also covers post-death care in mental health services and prisons.

In addition, it incorporates detailed elements of care provision in the immediate aftermath of someone’s death. One particular aspect of care that has been identified as needing attention is the verification of expected death, particularly in a community setting – care home or patient’s home.

Families can experience distress when verification is not completed in a timely manner and the guidance recommends minimum timelines for this to take place.  

The updated guidance also places emphasis on the need for training for staff involved in providing care after death, particularly support for bereaved families. It highlights the need for empathetic, clear communication by professionals, which is adapted to the needs of different families.

“The importance of the care of a person who has died cannot be overestimated”

Jo Wilson

Among others, it has been endorsed by the Royal College of Nursing, Hospice UK and the National Council for Palliative Care. 

Lead guideline author Jo Wilson, a member of the National Nurse Consultant group for Palliative Care, said: “The importance of the care of a person who has died cannot be overestimated for those providing the care for the deceased, or their families.”

Dr Ros Taylor, national director for hospice care at Hospice UK, added: “This guidance will address some significant gaps, in terms of both practical measures and also emotional support – which is a crucial aspect of hospice and palliative care – to help improve the provision of care after death.

“We particularly welcome the guidance’s emphasis on training for staff,” she said. “There is only one opportunity to get things for right individuals and their loved ones after death, and it is very important they feel fully supported by all the professionals they encounter.”

 

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  • 29 Comments

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Readers' comments (29)

  • michael stone

    The piece above tells us that:

    'In addition, it incorporates detailed elements of care provision in the immediate aftermath of someone’s death. One particular aspect of care that has been identified as needing attention is the verification of expected death, particularly in a community setting – care home or patient’s home.'

    I have not yet read through the guidance, but I have searched to see 'how it defines' the term 'expected death'. It does not use the only logically-correct definition of 'expected death' - which, incidentally, is a term I think should not be used in guidance or protocols {you can just require that a 'marker' is present for the situation, in notes: then, by adding a second 'marker', you could resolve a serious issue around the uncertainty about 'the point when a death becomes 'expected'’} - although 'the clues are there'. The correct definition of 'expected death' is IMPLIED by the wording on page 11: '... in order that a Medical Certificate of Cause of Death (MCCD) can be appropriately issued without involving the coroner.'.

    A community EoL death is 'expected' if the GP has formally indicated that 'I will certify a future death which does not appear to be obviously unnatural, even if I (the GP) CANNOT ATTEND post-mortem'.

    I have been writing about this for ages - most recently, on the Marie Curie website (see the comments to this piece):

    http://blog.mariecurie.org.uk/2015/04/20/end-of-life-care-challenge-for-government/


    My comment at 22 April 2015 at 12:08 pm (my second comment - with a typo correction immediately afterwards) explains the problem, and the link goes to another of my online pieces where I explain the solution.

    So this guidance does not, in fact, resolve the problems with 'expected death' as an operational concept: if you search the PDF for 'expected' these are the references you come up with:

    All people die – some deaths are expected, for example, due to ill health. Some deaths are unexpected, either due to a sudden event, or to an accident / violent event. (page 5)

    Unambiguous and documented communication on all of the above decisions ensures there is clarity about whether the death is expected or not and allows for appropriate preparation of the dying person and their family/carers. (page 10 - and it is also wrong)

    In care home and home settings where death is expected, it is crucial that the GP reviews the person regularly and at least every 14 days, both from a care perspective and in order that a Medical Certificate of Cause of Death (MCCD) can be appropriately issued without involving the coroner. (page 11)

    I have explained why that is crucial on the BMJ website:

    http://www.bmj.com/content/347/bmj.f4085/rr/654490


    Where there is a rapid, same day discharge home (to a private home, social care or mental health care setting) from hospital for expected end of life care, and this occurs on a Friday, it is essential that there is a GP visit that day or the hospital consultant is happy to issue the MCCD, should the death occur at the weekend. Alongside the care planning – including equipment, care of the person’s hygiene and nursing needs, and family support – the practicalities of who will verify the death and issue a MCCD, including the paperwork for cremation (cremation part 4 and part 536), should be considered. For rapid discharge from hospital to prison it is essential that the prison has 24 hour healthcare provision and the lead nurse is contacted to ensure the health needs of the dying prisoner is met. (page 11)

    It is recommended that all care settings – including care homes - ensure adequately trained staff to verify expected deaths of patients in and out of hours. The role of GPs in verification of death for residents of care homes has been specifically addressed (page 13)

    Section 23 on page 13 also mentions 'expected death' but it is 'a mere aside' so I'm not reproducing it here.

    It isn’t either logically correct, or satisfactory, for flawed ‘proxy markers’ to be used for ‘expected death’: a DNACPR decision is not necessarily an indicator of ‘expected death’ [because a patient has the legal right to refuse attempted CPR irrespective of whether or not the death could be certified], and ‘palliative-only treatment’ is also not necessarily inevitably an indicator of ‘expected death’.

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  • michael stone | 24-Apr-2015 1:26 pm

    hope it meets with your most high and mighty noble approval and you participated in writing it on stone so that if anything goes wrong you only have yourself to blame!

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  • michael stone

    Anonymous | 25-Apr-2015 10:41 am

    I am not 'high and mighty' ('opinionated' yes - strongly-developed views, yes), but I am however 'seeing things from the lay perspective' - and an awful lot of the behaviour 'around dying and death' which is not 'the care itself', does not 'meet with my approval'. In particular, the muddle and 'biased behaviour' around 'early EoL community deaths'.

    It is 'complicated' - but the present 'balance' is also wrong.

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  • michael stone | 25-Apr-2015 3:05 pm


    does anything ever meet with "your approval"? why you consider yourself so exclusive?

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  • Anonymous | 25-Apr-2015 5:59 pm

    I think you're the 'exclusive' one, thinking you, as a' health professional??' are the only one entitled to an opinion. Time you opened your mind and listened to what other people, from all walks of life, have to say. It then may improve your attitude to other human beings. It doesn't mean you have to always agree, but you could have a civilised debate.

    michael stone | 25-Apr-2015 3:05 pm

    ..."muddle and 'biased behaviour' around 'early EoL community deaths'."

    I would be very interested to hear more on this, if you wish to elaborate.

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  • B R | 25-Apr-2015 10:15 pm

    help yourself and don't forget to follow the history right back to the earliest comments, forums and e-mails sent to individuals and kindly think before trying to make assumptions about and lecture other readers on what are most probably your own projections!


    https://www.nursingtimes.net/michael-stone/1509869.publicprofile

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  • BR

    It took me about 18 months before I got tired of Mike ' inverted comma's' Stones daily output of 'EoL' related stories, which aren't themselves out of place on the 'relevant topics', but when they ivade 'other aspects' of ' nursing' they become 'a' pain in 'the arsenal'.
    As a result I stopped coming to this site for nearly two years, and 'lo' and ' behold' come back on only ' to find him' incessantly 'going on about' the ' same sh!t' different 'day'. Soon it'll only be Mike on here...

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  • Anonymous | 26-Apr-2015 1:54 pm
    redpaddys12 | 26-Apr-2015 11:18 pm

    Then why not just comment on the article and ignore Michael Stone's comments. You may get fed up of him, but the constant 'tete a tete' between you totally retracts from others contributing anything, judging on the few comments on here. That's all I have to say, I am finding it tiring.

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  • B R | 27-Apr-2015 0:12 am


    trolling activity disrupts the thread and the subject has been bought up with the editors. I would suggest you read the comments properly and do not interfere with those not addressed to you, as is the case above, as there is more to it than you think and which obviously cannot be described here. it is not up to you to control the site or make your own false assumptions about other readers. trolling is also a reason why many do not wish to enter into any meaningful discussion in the comments which includes a considerable number of senior and experienced front line clinicians.

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  • redpaddys12 | 26-Apr-2015 11:18 pm


    ...and on nearly every page which I find totally off putting and tend to avoid. like you I stopped reading NT for a considerable time and my heart sank when I returned to see the same old habits from MS.

    There is a lot of criticism from on the poor level of much of the commentary in general although it doesn't seem as bad as it was a few years ago which puts readers off.


    the problem is when one tries to place a well informed comment or try to share experience on the subject with other professions it is invariably receives an irrelevant or inappropriate response from MS and often the discussions stop there making it a waste of time and effort to write any well thought out commentary.


    shame some like BR haven't followed the history from the beginning and understand what underlies this pattern of behaviour and are ignorant of its consequences where individuals have been contacted personally by him!

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