The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [69]
2 If the patient is on a pressure-relieving mattress or device, consult the manufacturer’s instructions before switching off. If the mattress deflates too quickly, it may cause a manual handling challenge to the nurses carrying out Last Offices. E
Procedure
3 Lay the patient on their back with the assistance of additional nurses and straighten any limbs as far as possible (adhering to your own organization’s manual handling policy). To maintain the patient’s privacy and dignity (NMC 2008, C) and for future nursing care of the body. Stiff, flexed limbs can be difficult to fit easily into a mortuary trolley, mortuary fridge or coffin and can cause additional distress to any carers who wish to view the body. However, if the patient’s body cannot be straightened, force should not be used as this can be corrected by the funeral director (Green and Green 2006, E).
4 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.
5 Remove any mechanical aids such as syringe drivers, heel pads, and so on. Apply gauze and tape to syringe driver/IV sites and document disposal of medication (adhering to your own organization’s disposal of medication policy). Consider leaving prosthetics in situ as appropriate (e.g. limb, dental or breast prosthetics). To prepare the body for burial or cremation. E
6 Close the patient’s eyes by applying light pressure to the eyelids for 30 seconds. If this is unsuccessful then a little sticky tape such as Micropore can be used, and leaves no mark. Alternatively, moistened cotton wool may be used to hold the eyelids in place. To maintain the patient’s dignity (NMC 2008, C) and for aesthetic reasons. Closure of the eyelids will also provide tissue protection in case of corneal donation (Green and Green 2006, E).
7 Drain the bladder by applying firm pressure over the lower abdomen. Have a disposable or washable receptacle at the ready to collect urine. Because the patient’s body can continue to excrete fluids after death (Green and Green 2006, E).
8 Leakages from the oral cavity, vagina and bowel can be contained by the use of suctioning, drainage and incontinence pads respectively. Patients who do continue to have leakages from their orifices after death should be placed in a body bag following Last Offices. The packing of orifices can cause damage to the patient’s body and should only be done by professionals who have received specialist training. It might be helpful to manage self-limiting leakages with absorbent pads and gently rolling the patient who has died to aid drainage of potential leakages. Leaking orifices pose a health hazard to staff coming into contact with the patient’s body (Green and Green 2006, E; HSAC 2003, C). Ensuring that the patient’s body is clean will demonstrate continued respect for the patient’s dignity (NMC 2008, C).
The packing of orifices is considered unnecessary, as it increases the rate of bacterial growth that can occur when these areas of the patient’s body are not allowed to drain naturally (Berry and Griffie 2001, E). However, there are certain situations where it is necessary (in severe leakage or where repatriation is required). A body bag is also necessary in these cases.
9 Exuding wounds or unhealed surgical scars should be covered with a clean absorbent dressing and secured with an occlusive dressing (e.g. Tegaderm). 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. The dressing will absorb any leakage from the wound site (Naylor et al. 2001,