The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [70]
10 Stomas should be covered with a clean bag.
11 Remove drainage tubes, unless otherwise stated. Record the tubes and devices that have been removed and those that have been left in situ. Open drainage sites need to be sealed with an occlusive dressing (e.g. Tegaderm). Open drainage sites pose a health hazard to staff coming into contact with the patient’s body (RCN 2005, C).
When a death is being referred to the coroner or ME or for postmortem, devices and tubes should be left in place (Green and Green 2006, C).
12 Wash the patient, unless requested not to do so for religious/cultural reasons or carer’s preference. Male patients should be shaved unless they chose to wear a beard in life. For hygienic and aesthetic reasons. As a mark of respect and point of closure in the relationship between nurse and patient (Cooke 2000, C).
If shaving a man, apply water-based emollient cream to the face. To prevent brown streaks on the skin.
13 It may be important to family and carers to assist with washing, thereby continuing to provide the care given in the period before death. It is an expression of respect and affection, part of the process of adjusting to loss and expressing grief (Berry and Griffie 2001, E).
14 Mouth and teeth should be cleaned with foam sticks or a toothbrush. Insert clean dentures if the patient normally used them. Apply petroleum jelly to the lips and perioral area. Teeth and mouth are cleaned for hygienic and aesthetic reasons (Cooke 2000, C) and to remove debris. Petroleum jelly can prevent skin excoriation or corrosion if stomach contents aspirate.
15 Remove all jewellery (in the presence of another nurse) unless requested by the patient’s family to do otherwise. Jewellery remaining on the patient should be documented on the ‘Notification of Death’ form. Record the jewellery and other valuables in the patient’s property book and store the items according to local policy. Avoid the use of the names of precious metals or gems when describing jewellery to prevent potential later confusion. Instead, use terms such as ‘yellow metal’ or ‘red stone’. Rings left on the patient’s body should be secured with tape, if loose. To meet with legal requirements, cultural practices and relatives’ wishes (Green and Green 2006, C).
16 Dress the patient in personal clothing or white garment, traditionally called a shroud (depending on organizational policy or the family’s wishes). For aesthetic reasons for family and carers viewing the patient’s body or religious or cultural reasons and to meet the family’s or carers’ wishes (Green and Green 2006, C).
17 Ensure the correct hospital or organizational irremovable patient identification label is attached to the patient’s wrist and attach a further identification label to one ankle. Complete any documents such as Notification of Death cards. Copies of such cards are usually required (refer to hospital policy for details). Tape one securely to clothing or shroud. To ensure correct and easy identification of the patient’s body in the mortuary (Green and Green 2006, C).
18 Wrap the patient’s body in a sheet, ensuring that the face and feet are covered and that all limbs are held securely in position. To avoid possible damage to the patient’s body during transfer and to prevent distress to colleagues, for example portering staff (Green and Green 2006, E).
19 Secure the sheet with tape. Pins must not be used as they are a health and safety hazard to staff. E
20 Place the patient’s body in a body bag as leakage of body fluids may be anticipated. The patient may also have a known infectious disease. To avoid actual or potential leakage of fluid, whether infection is present or not, as this poses a health hazard to all those who come into contact with the deceased patient. The sheet will absorb excess fluid (HSAC 2003, C).
Postprocedure
21 Tape the second Notification of