This policy fully reflects the current guidance issued by NICE and the Leadership Alliance for the Care of Dying People’s Five Priorities of Care which are:

• Recognise. The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made, and actions taken in accordance with the person's needs and wishes, and these are regularly reviewed and decisions revised accordingly.
• Communicate. Sensitive communication takes place between staff and the dying person, and those identified as important to them.
• Involve. The dying person and those identified as important to them are involved in decisions about treatment and care to the extent that the dying person wants.
• Support. The needs of families and others identified as important to the dying person are actively explored, respected, and met as far as possible.
• Plan and do. An individual plan of care, which includes food and drink, symptom control, and psychological, social, and spiritual support, is agreed, coordinated and delivered with compassion.

The above guidance provides specific, concise quality statements, measures, and audience descriptors to provide the public, health and social care professionals, commissioners, and service providers with definitions of high-quality care.

As an organisation, we seek to adhere to the following statements and, through assessment and planning, provide effective and caring end-of-life care for our service users. We work closely with outside professionals. such as cancer care nurses, Macmillan nurses, and GPs to ensure the best possible outcome for the individual.

Staff must be aware of how and, perhaps more importantly when to respond to minimise distress and adhere to any cultural beliefs or preferences that the service user, their family. or representative have expressed as part of their care and support plan.

The following list of statements is taken from the NICE Quality Statement QS13 and reflects the Five Priorities of Care:

1. People approaching the end of life are identified in a timely way.
2. People approaching the end of life and their families and carers are communicated with and offered information in an accessible and sensitive way, in response to their needs and preferences.
3. People approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, with the
   opportunity to discuss, develop, and review a personalised care plan for current and future support and treatment.
4. People approaching the end of life have their physical and specific psychological needs safely, effectively, and appropriately met at any time of day or night, including access to medicines and equipment.
5. People approaching the end of life are offered timely personalised support for their social, practical, and emotional needs, which is appropriate to their preferences and maximises independence and social participation for as long as possible.
6. People approaching the end of life are offered spiritual and religious support, appropriate to their needs and preferences.
7. Families and carers of people approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, and holistic support appropriate to their current needs and preferences.
8. People approaching the end of life receive consistent care that is coordinated effectively across all relevant settings and services at any time of day or night and delivered by practitioners who are aware of the person's current medical condition, care plan, and preferences.
9. People approaching the end of life who experience a crisis at any time of day or night receive prompt, safe, and effective urgent care appropriate to their needs and preferences.
10. People approaching the end of life who may benefit from specialist palliative care are offered this care in a timely way appropriate to their needs and preferences, at any time of day or night.
11. This statement has been removed and replaced by Quality Standard 144.
12. The body of a person who has died is cared for in a culturally sensitive and dignified manner.
13. Families and carers of people who have died receive timely verification and certification of the death.
14. People closely affected by death are communicated with sensitively and are offered immediate and ongoing bereavement, emotional, and spiritual support appropriate to their needs and preferences.
15. Health and social care workers have the knowledge, skills, and attitudes necessary to be competent to provide high-quality care and support for people approaching the end of life and for their families and carers.
16. Generalist and specialist services providing care for people approaching the end of life and their families and carers have a multidisciplinary workforce sufficient in both number and in the mix of skills to provide high-quality care and support.

We ensure that systems are in place to identify people approaching the end of life in a timely way. We use these systems to identify care and support to meet their needs and preferences.

End-of-life care forms part of holistic care and, as such, it should be respected and planned.

As much information as possible is gained following admission during the initial assessment process to ensure that, when the death of an individual occurs, the relatives are aware of the individual’s preferences, e.g. the individual’s choice of burial or cremation.

It is hopefully a rare occurrence that a death of a service user takes place whilst they are receiving a service from this organisation. Nevertheless, staff must be aware of how and, perhaps more importantly, when to respond to minimise distress and adhere to any cultural beliefs or preferences that the service user, their family, or representative have expressed as part of their care and support plan.

• Staff must remember that the death of a service user does not mean that information is not to be protected and that confidentiality is still in place.
• This organisation will co-operate fully with multi-agency partners to ensure all lawful requirements are met and will assist when asked or directed by a lead agency.
• All communication will be dealt with in a sensitive professional manner that promotes the privacy and dignity of the service user their family or representative. The involvement of healthcare professionals, including nurses, does not stop once an individual has died. Caring for dying people at home requires the use of care pathways that include care after death. Nurses are the health professionals most commonly present at the time of an individual’s death. They are therefore ideally placed to verify that a person has died and provide support and information to the bereaved.

When discussion has taken place between the appropriate medical practitioner and nursing staff – and it has been agreed that further intervention would be inappropriate and death is expected to be imminent – designated nurses may confirm or verify the death. Wherever possible the relatives should be made aware of the individual’s deteriorating condition and the individual’s care plan.

Where the death is unexpected, the nurse has the responsibility to initiate resuscitative measures, as long as they are in the best interests of the individual and unless an agreed statement has been made that resuscitation is not to take place.

These principles for practice can apply in any healthcare setting. The nurse must be trained and deemed competent to confirm the death and there must be explicit details in the care plan/end-of-life plan.

Record keeping is an integral part of the process and there is an expectation that the nursing and medical records must reflect that death is expected.

Records should also show details of the confirmation of death, with the time, date, and any other observations that were recorded. The time and date the doctor was informed must also be included.

Education and training are made available and nurses and care staff should ensure they have enough confidence, competence, knowledge, and skills to equip them for undertaking this role.

Education is based on broad principles for practice, as identified in the NMC Code and NICE. Specific topics that may be included are aspects of accountability, current legislation, and the necessary skills and knowledge to determine the physiological aspects of
death.

Care staff of Sphere Specialist Healthcare receive training from our in-house registered nurses.

Under English law, the coroner is an independent judicial office holder, paid for by the relevant local authority (LA). They must be either a lawyer or a GP, sometimes both. Their role is to inquire into certain types of death(s). Where an inquest is held, they have a duty to establish the cause of death in so far as this is possible. They are not allowed to determine criminal liability nor who was responsible. The criminal court would decide this. Coroner’s officers work under the direction of the coroner and liaise with bereaved families, police, doctors, witnesses, and funeral directors. They receive reports of deaths and make inquiries at the direction and on behalf of a coroner.

Registrars of births and deaths, doctors, or the police report unexpected deaths to a coroner in specific circumstances. These include where it appears that:

• No doctor attended the deceased during their last illness.
• Although a doctor attended during the last illness, the deceased was not seen either within 14 days before death or after death.
• The cause of death appears unknown.
• The death occurred during an operation or before recovery from the effects of an anaesthetic.
• The death was due to an industrial accident disease of poisoning.
• The death was sudden or unexpected.
• The death was due to violence or neglect.
• The death was in other suspicious circumstances.
• The death occurred in prison or police custody.

In the event of a death of a service user, the following process should be adhered to and staff should be supported and assisted throughout. Regardless of the experience of staff in working with the dying, it is important to recognise the distress, shock, or trauma that can follow, especially where the death is sudden or unexpected.

• If a staff member arrives on a scheduled visit and finds the service user has died, they should follow the end of life support plan/emergency plan which will provide the actual details on how to respond. If the service user does not have an emergency plan in place or the death is unexpected then their first response should be to dial 999 and request an ambulance. It is important to remember that the death has to be medically certified, so no assumptions should be made regarding the status of the service user. The body should not be moved or handled in any way before the medical services arrive.
• The office should be informed. This includes the on-call, where the death is discovered out of hours. Full details should be recorded and an incident form completed.
• The staff member who made the discovery should remain at the address, to assist fully with any enquiries.
• The medical services will lead and liaise with the office, as required upon their arrival, e.g. they may ask that the staff stay until the undertaker or next of kin arrives or the police may request that they stay to secure the premises.
• Where staff are distressed or anxious, a member of the office-based staff may be asked to relieve them and consideration should be given to the cover arrangements necessary for the rest of their schedule.
• The office will liaise with the lead agency until all formalities are settled and the office will keep detailed records of any dialogue. The file will then be closed in the usual way.
• Consideration should be given to requests to any funeral attendees from the company. This will take into account such things as how long the service user was with us, their regular care workers etc., and the availability of cover.

This organisation will notify the Care Quality Commission (CQC) by email within 24 hours of the death of a service user during their service provision as required under the Duty of Candour: Regulation 20 of the 2014 Regulation.

Note: There is currently a closed consultation on changes to the death certification process in England and Wales. The responses from the consultation are now under review and proposals to introduce medical examiners are currently in the public domain. When the guidance is finalised and the reforms completed, this policy will be updated.

Advance Care Planning
Assessment of Need and Eligibility
Basic Life Support
Consent
Dignity and Respect
DNACPR
Notifications
Nutrition, Hydration and Food Safety
Person Centred Planning
Prevention of Pressure Ulcers

Nice Guidelines NG31, December 2015: Care of Dying Adults in the Last Days of
Life: https://www.nice.org.uk/guidance/ng31
NICE Quality Standard (QS13), March 2017: End of Life Care for Adults:
https://www.nice.org.uk/guidance/qs13
NICE Quality Standard (QS144), March 2017: Care of Dying Adults in the Last Days
of Life: https://www.nice.org.uk/guidance/qs144
Skills for Care: Common Core principles and Competencies for Social Care and
Health Workers Working with Adults at the End of Life:
http://www.skillsforcare.org.uk/
One Chance to Get it Right: Leadership Alliance for the Care of Dying People (Five
Priorities of Care):
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/323188/One_chance_to_get_it_right.pdf
Infection Control Guidelines for Care Homes:
https://www.gov.uk/government/publications/infection-prevention-and-control-in-care-homes-information-resource-published
NICE Helping to Prevent Infection: A Quick Guide for Managers and Staff in Care
Homes: https://www.nice.org.uk/Media/Default/About/NICE-Communities/Social-care/quick-guides/Infection%20prevention.pdf
Nursing and Midwifery Code: https://www.nmc.org.uk/
Guide to Coroner Services and Coroner Investigations:
https://www.gov.uk/government/publications/guide-to-coroner-services-and-coroner-investigations-a-short-guide
Notification of Death Regulations 2019:
http://www.legislation.gov.uk/uksi/2019/1112/made

All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.

Date Reviewed: May 2021
Person responsible for updating this policy: Carly Fortune
Next Review Date: May 2022