The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [66]
Repatriation to another country needs further documentation, alongside the death certification and registration documents, and this varies according to which country repatriation is to. Only a coroner or medical examiner is authorized to permit the body to be moved out of England or Wales. A ‘Form of Notice to a Coroner of Intention to Remove a Body Out of England’ (Form 104) is required which can be obtained from coroners or registrars. This form needs to be given to the coroner along with any certificate for burial or cremation already issued. The coroner’s office will acknowledge receipt of notice and inform when repatriation can occur. Coroner authorization normally takes up to 4 working days so that necessary enquiries can be made. In urgent situations, this can sometimes be expedited. The coroner’s office and relevant High Commission will have further information. In terms of infection control, packing may be required by different countries and those involved with repatriation must be informed if there is a danger of infection (HSAC 2003). Funeral directors would assist with transportation issues.
Referral to a coroner
If the patient’s death is to be referred to a coroner or ME, this will affect how their body is prepared. The need for referral to a coroner or ME needs to be ascertained with the person verifying the death (DH 2008). Preparation in this situation differs according to how the patient died. Broadly, two types of death are referred to the coroner.
Those from a list of cases where the coroner must be informed (which includes deaths within 24 hours of an operation, for example).
Cases where the treating doctor is unable to certify the cause of death (Home Office 2002, HTA 2006).
The Department of Health website at www.dh.gov.uk gives more information about when to refer to the coroner or ME and when postmortems are indicated.com
Requirement for a postmortem
Postmortems can affect preparation after death, depending on whether this is a coroner’s postmortem (sometimes referred to as a legal postmortem because it cannot be refused) or a postmortem requested by the consultant doctor-in-charge to answer a specific query on the cause of death (also referred to as a hospital or non-legal postmortem). A coroner’s postmortem might require specific preparation but the coroner or ME will advise on this and should be contacted as soon as possible after death to ascertain any specific issues. Individual hospitals, institutions and NHS trusts should provide further guidance on these issues. If the patient is to be referred to the coroner, cap off catheters and ensure there is no possibility of leakage. Do not remove any invasive devices until this has been discussed with the coroner (HTA 2006).
If the patient is not to be referred to the coroner, invasive and non-invasive attachments, such as central venous access catheters, peripheral venous access cannulas, Swan–Ganz catheters, tracheal tubes (tracheostomy/endotracheal) and drains, can be removed prior to Last Offices.
Organ donation
Consider whether the patient is a candidate for organ or tissue donation. Patients who previously expressed a wish to be a donor (or carry a donor card), or whose family has expressed such a wish, might need specific preparation (see further resources at the end of the chapter and contact local or regional transplant co-ordinators).
Organ donation is an important consideration at the end of life. Current law is an opt-in system for donation, therefore express wishes must be made by families (next of kin) or patients.
Infectious patient
If the patient was infectious, it needs to be established whether it is a notifiable infection, for example, hepatitis B, C or tuberculosis, or non-notifiable (Healing et al. 1995, HPA 2010, HSAC 2003). There are additional requirements for patients with bloodborne infections, so the senior nurse on duty should be consulted and local infection control policy adhered to. In the UK,