The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [67]
Certain extra precautions are required when handling a patient who has died from an infectious disease. However, the deceased will pose no greater threat of an infectious risk than when they were alive. It is assumed that staff will have practised universal precautions when caring for all patients, and this practice must be continued when caring for the deceased patient (HSAC 2003).
Porters, mortuary staff, undertakers and those involved with Last Offices must also be informed if there is a danger of infection (HSAC 2003).
Informing the next of kin
Inform and offer support to relatives and/or next of kin to ensure that the relevant individuals are aware of the patient’s death and any specific care or practices can be carried out (Wilkinson and Mula 2003). The support of a hospital chaplain or other religious leader or other appropriate person should be offered. If the relative(s) or next of kin are not contactable by telephone or by the GP, it may be necessary to inform the police of the death.
Some families and carers may wish to assist with Last Offices, and within certain cultures it may be unacceptable for anyone but a family member or religious leader to wash the patient (Green and Green 2006). It may also be required for somebody of the same sex as the patient to undertake Last Offices (Neuberger 2004). Families and carers should be supported and encouraged to participate if possible as this may help to facilitate the grieving process (Berry and Griffie 2001).
Families and carers should also be supported in adhering to infection prevention and control procedures.
There are a few, very rare, exceptions where it is not possible for families to participate in Last Offices.
If the patient has had any of the following infections prior to death: typhus, severe acute respiratory syndrome, yellow fever, anthrax, plague, rabies and smallpox. Assistance with Last Offices or viewing is not permitted because of the high risk of transmission of these infections (Healing et al. 1995).
The patient who has died was exposed to radiation. Patients may have been treated with radioactive material as therapy or may have been exposed to it in accidental circumstances. Always seek expert radiation protection advice before beginning Last Offices in such cases.
Patient considerations
Ascertain any social, cultural, spiritual and/or religious considerations that should be observed during the procedure. Spiritual needs involved in preparation of the patient who has died can be diverse but the final sections in this chapter give up-to-date guidance about religious considerations in Last Offices. It should be noted that this is guidance only and the patient’s previous wishes should be established where possible and should always take precedence (Pattison 2008a). If not documented, try to determine the patient’s previous wishes from family or carers. The patient’s last will and testament might have instruction on this, or an Advance Directive might have information. Families, carers or members of the patient’s community or faith may wish to participate in Last Offices (with consent of the next of kin or as expressed in the patient’s wishes when they were alive). If this is the case, they must be adequately prepared for this with careful and sensitive explanation of the procedure to be undertaken.
Families may request other items to accompany the patient who has died to the mortuary and funeral home. This might be an item of sentimental value,