Expert advice

Verification and certification of death: what is a nurse’s role?

The legal obligations and processes related to a patient’s death, and how to ensure distress for bereaved relatives is considered and minimised
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The legal obligations and processes related to a patient’s death, and how to ensure distress for bereaved relatives is considered and minimised

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When a patient dies, it is important that nurses understand their role in the verification and certification of death, and the legal implications of this.

At the same time, the nurse’s role also involves maintaining sensitivity towards the bereaved.

What is verification of death?

Verifying or confirming a death means carrying out certain checks to ensure the person has died, and documenting the death formally in line with national guidance.

The verification process includes checking that the patient’s cardiac and respiratory functions are non-existent for five minutes and that there is no cerebral activity. If the person dies at home, this verification is usually undertaken by a GP or a senior nurse, says the charity Marie Curie.

What is certification of death?

After a death is verified, a medical certificate of the cause of death (MCCD) must be completed by a medical practitioner in accordance with the Births and Deaths Registration Act 1953.

The MCCD should include a cause of death, provided by the doctor to the best of their knowledge and belief, using their clinical judgement, the patient’s medical history, and the circumstances of their death. If a doctor cannot reasonably give a cause of death, the case must be submitted to the coroner for investigation.

How should death be verified?

The dying person should be observed by the person responsible for verifying death for a minimum of five minutes, to establish that irreversible cardiorespiratory arrest has occurred, says Care After Death: Registered Nurse Verification of Expected Adult Death (RNVoEAD) Guidance, the fourth edition of which was published by Hospice UK in January 2022.

‘Any spontaneous return of cardiac or respiratory activity during this period of observation should prompt a further five minutes of observations,’ says the guidance.

The person verifying death should ensure an absence of heart sounds on auscultation, test both eyes for the absence of pupillary response to light, and be certain there is no central pulse and that there is no respiratory effort during the five minutes of observation.

Time of death is recorded when verification is complete, not when death is first reported.

Are nurses legally obliged to verify or certify someone’s death?

Verification or confirmation of death can be undertaken by a registered nurse. However, individuals must check their employer's policies to determine local agreements about the circumstances in which this can be done, says the RCN.

The RNVoEAD guidance states that a nurse has the right to refuse to verify a death and request the attendance of the responsible doctor or police if there are any unusual circumstances.

Only doctors who are registered (including temporary registration) and licensed to practise with the General Medical Council can certify death. Nurses cannot.

How can nurses support families during this process?

It is important to confirm death promptly.

‘Timely verification – within one hour in a hospital setting and within four hours in a community setting – is supportive to bereaved families, and is necessary before the deceased person is moved to either the mortuary or funeral directors,’ says the RNVoEAD guidance.

‘Verifying a patient’s expected death is an important act of care,’ says Jo Wilson, a Macmillan consultant nurse in palliative care at the Royal Free London NHS Foundation Trust and one of the contributors to the RNVoEAD guidance. ‘It’s about enabling nurses to provide good quality care to the patient as they approach the end of their life and after death, alongside support to those left bereaved.’

Responsibilities towards families include answering any questions about the next steps, including getting the MCCD.

Universal infection control precautions should always be followed.

‘The registered nurse verifying or confirming death must consider the health and safety of others to ensure they are protected, for example, from infectious illness, radioactive implants and implantable devices,’ says the RCN. It recommends individuals check their employer’s policy for details.

What training is available for nurses?

The RNVoEAD guidance includes competencies for registered nurses to verify an expected adult death, which are a mixture of practical skills, knowledge and understanding.

‘Different kinds of care happen at the point when someone moves from living to dying,’ says Dr Wilson. ‘Nurses need to be prepared and feel confident and competent.’

Simulation can be a useful learning technique, she says. ‘For example, it can help you think through issues such as how will you ask a family to wait quietly for five minutes, because you need silence to be able to listen for the absence of heart and respiratory sounds,’ Dr Wilson says.

E-learning for Healthcare has produced a module on registered nurse verification of expected adult death, while organisations such as St Joseph’s Hospice also provide training for a small fee.

Individual employers should offer training covering their specific procedures, including documentation.

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