Pre‐procedure

ActionRationale

1. 1.Show
   Apply personal protective equipment. If the patient has an infectious disease, additional equipment such as gowns, masks or goggles may be required.
   To ensure staff are protected from soiled sheets and body fluids (NHS Improvement [105], C).
   If the patient is on a pressure‐relieving mattress or device, consult the manufacturer's instructions before switching it off.
   If the mattress deflates too quickly, it may cause a manual handling challenge to the nurses carrying out care after death. E

Procedure

1. 2.Show
   Lay the patient on their back with their arms lying by their side. Straighten any limbs as far as possible (adhering to local manual handling policy and procedure). This should ideally be undertaken by two nurses.
   To maintain the patient's privacy and dignity (NMC [112], C). Stiff, flexed limbs can be difficult to fit into a mortuary trolley, mortuary fridge or coffin and can cause additional distress to any family or carers who wish to view the deceased patient. If there is a problem with straightening the limbs then the mortuary staff should be notified (Wilson [166], C).
2. 3.Show
   Remove all but one pillow. Close the mouth and support the jaw by placing a pillow or rolled‐up towel on the chest or underneath the jaw. Do not bind the patient's jaw with bandages.
   To avoid leaving pressure marks on the face, which can be difficult to remove (Wilson [166], C).
3. 4.Show
   When the death is not being referred to the coroner as per local policy

   Either:

   Remove mechanical aids such as syringe pumps, tubes, drains and venous access devices; dress any oozing sites; and document disposal of medication

   Or:

   Leave devices in situ (if this is the role of the anatomical pathology technician locally).
   To minimize the number of healthcare‐related devices with the aim of restoring the patient's usual appearance (as far as possible). E
4. 5.Show
   Spigot any urinary catheters (if not removed already). Do not tie the penis. Use pads and pants to absorb any leakage from the urethra, vagina or rectum.
   To prevent or manage any leakage (Wilson [166], C).
5. 6.Show
   Close the patient's eyes by applying light pressure to the eyelids for 30 seconds.
   To maintain the patient's dignity (NMC [112], C) and for aesthetic reasons. Closure of the eyelids will also provide tissue protection in case of corneal donation (Wilson [166], C).
6. 7.Show
   1. Remove, prepare and/or bung lines and tubes (in some clinical areas this will be completed by the anatomical pathology technician)
   2. Contain leakages from the oral cavity or tracheostomy sites by suctioning and positioning.
   3. cSuction and spigot nasogastric tubes (if not already removed). Cover exuding wounds or unhealed surgical incisions with a clean absorbent dressing and secure with an occlusive dressing.
   4. Leave stitches and clips intact.
   5. Cover stomas with a clean bag. Clamp drains (remove the bottles), pad around wounds and seal with an occlusive dressing.
   6. Avoid waterproof, strongly adhesive tape as this can be difficult to remove at the funeral home and can leave a permanent mark.
   Leaking orifices pose a health hazard to staff coming into contact with the deceased patient (HSE [65], C). Ensuring that the deceased patient is clean will demonstrate continued respect for the patient's dignity. E

   It is the role of the mortuary staff to pack orifices, not the nurse. If the deceased patient continues to leak, place them on absorbent pads in a body bag and advise the mortuary or funeral director.
7. 8.Show
   Exuding wounds and unhealed surgical scars should be covered with a clean, absorbent occlusive dressing. Stitches and clips should be left intact. Consider leaving intact recent surgical dressings for wounds that could potentially leak, for example large amputation wounds. Reinforcement of the dressing should be sufficient.
   To aid the absorption of any leakage. E
8. 9.Show
   Consider whether the family may wish to be involved in personal care of the deceased.
   It can be an expression of respect and affection, and part of the process of adjusting to loss and expressing grief (Wilson [166], C).
9. 10.Show
   Wash the patient, unless requested not to do so for religious or cultural reasons; because the patient is being referred to the coroner; or because of the preferences of the patient, their family or carer. The deceased should not be shaved when still warm; this can be undertaken by the funeral director and it may be necessary to discuss this sensitively with the family.
   To ensure dignity and respect for the deceased (NICE [109], C).

   Shaving when the deceased is still warm can cause bruising to the skin (Wilson [166], C).
10. 11.Show
    Clean the mouth to remove debris and secretions. Clean and replace dentures as soon as possible after death. If they cannot be replaced, send them with the deceased patient in a clearly identified receptacle.
    To ensure the patient's dignity and to show respect. E
11. 12.Show
    Tidy the hair as soon as possible after death and arrange it in the preferred style (if known).
    This will guide the funeral director for final presentation (Wilson [166], C).
12. 13.Show
    Remove jewellery (in the presence of another member of staff) unless specifically requested by the family to do otherwise, and document this according to local policy. Secure any jewellery left on the patient with tape, documenting this according to local policy.
    To ensure the patient's culture and wishes are respected (NICE [109], C).
13. 14.Show
    Consider any religious ornaments that need to remain with the deceased (see Table 11.2).
    To ensure the patient's culture and wishes are respected (NICE [109], C).
14. 15.Show
    Dress the deceased appropriately, whether in pyjamas, hospital gowns or something they have chosen themselves. Be aware that soiling can occur.
    For aesthetic reasons and to maintain dignity (NICE [109], C).
15. 16.Show
    Clearly identify the deceased person with a name band on their wrist and/or ankle (avoid toe tags). As a minimum this needs to identify their name, date of birth, address, ward (if a hospital inpatient) and ideally their NHS number. The person responsible for identification is the person who verifies the death. Nurses should refer to local policies for the identification of deceased patients within their organization.
    To ensure correct and easy identification of the deceased patient in the mortuary (Wilson [166], C).
16. 17.Show
    Provided no leakage is expected and there is no notifiable disease present, the deceased patient can be wrapped in a sheet and taped lightly. Do not bind the sheet or tape too tightly as this can cause disfigurement.
    To maintain dignity without causing damage or disfigurement. E
17. 18.Show
    Place the deceased patient in a body bag if leakage of body fluids may be anticipated or if the patient has a known infectious disease.
    To ensure the safe transfer of the patient to the mortuary, protecting any handlers (HSE [65], C).

Post‐procedure

1. 19.Show
   Request the assistance of the portering staff to move the deceased patient from the ward to the mortuary within 4 hours of death.
   To allow refrigeration to take place (Henry and Wilson [59], C).
2. 20.Show
   Screen off the beds and area that will be passed as the deceased patient is removed.
   To ensure the privacy and dignity of the deceased on transfer from the place of death and to avoid causing unnecessary distress to other patients, relatives and staff (King's Fund [74], E).
3. 21.Show
   Remove personal protective equipment. Dispose of equipment according to local policy and wash hands.
   To minimize the risk of cross‐infection and contamination (NHS Improvement [105], C).
4. 22.Show
   Record all aspects of care after death in the nursing and medical documentation and identify the professionals involved. Update and organize the medical and nursing records as quickly as possible so they are available to the bereavement team and other relevant professionals, such as pathologists.
   To record the time of death, the names of those present and the names of those informed (NMC [112], C).
5. 23.Show
   Transfer property and patient records to the appropriate administrative department.
   To enable the administration process of giving the medical death certificate and to enable the patient's property to be returned to their family or friends. E