Pre‐procedure

ActionRationale

1. 1.Show
   Check for completed DNaCPR documentation.
   To ensure cardiopulmonary resuscitation should not be commenced (Hospice UK [64], C).
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   Correctly identify the patient by cross‐referencing the details on the patient's wristband with clinical records.
   To correctly identify the deceased (Hospice UK [64], C).
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   Identify from the clinical notes any infectious diseases, radioactive implants or implantable medical devices.
   To ensure the safety of any staff involved in care after death (Hospice UK [64], C).
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   Instigate the process for deactivation of any implanted cardiac defibrillator (ICD) if not already deactivated.
   To ensure the timely deactivation of the ICD and to avoid it delivering defibrillation to the deceased patient (Beattie [9], C).
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   Apply personal protective equipment.
   To ensure the protection of the caregiver and to comply with infection control procedures (NHS Improvement [105], C).

Procedure

1. 6.Show
   Lie the patient flat. Leave all tubes, lines, drains, medication patches and infusions in situ. Switch off pumps.
   To ensure the patient is flat ahead of rigor mortis and that all treatments are in situ ahead of verifying death (Hospice UK [64], C).
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   Assess for cessation of the circulatory system; feel for a carotid (or central) pulse for at least 1 full minute.
   To ensure there are no signs of cardiac output (Hospice UK [64], C; WHO [164], C).
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   Listen to heart sounds with a stethoscope for at least 1 full minute.
   To ensure there are no signs of cardiac output (Hospice UK [64], C; WHO [164], C).
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   Assess for cessation of the respiratory system; auscultate the lungs with a stethoscope for at least 1 full minute to verify there are no breath sounds or respiratory effort.
   To ensure there are no visible respirations (Hospice UK [64], C; WHO [164], C).
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   Assess for cessation of cerebral function; using a pen torch, assess the pupils for reactivity to light. Both pupils should be fixed (not reacting to light or to any other stimulus) and dilated.
   To ensure there is no cerebral activity (Hospice UK [64], C; WHO [164], C).
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   Apply painful stimuli by performing a trapezius squeeze; there should be no response to this.
   To ensure no cerebral activity (Hospice UK [64], C; WHO [164], C).
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   Wait with the patient for at least 5 minutes.
   To ensure no spontaneous return of cardiac or respiratory function (WHO [164], C).
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   If the patient has an unexpected response to the tests above or there are any signs of life, repeat the procedure and assess the patient for a further 5 minutes.
   To ensure or confirm that death has occurred (WHO [164], C).

Post‐procedure

1. 14.Show
   Once verification has been made, this should be documented according to local trust guidance. Time of death is recorded when verification of death is completed (i.e. not when the death is first reported).
   To ensure legible documentation and legal requirements are met (Hospice UK [64], C; NMC [112], C).
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   Follow trust guidance on who to inform of the death (this will usually include the patient's family or next of kin, the consultant, the GP, the community nursing teams and patient liaison).
   To ensure consistent communication. E