The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [71]
22 Request the portering staff to remove the patient’s body from the ward and transport to the mortuary. To avoid decomposition which occurs rapidly, particularly in hot weather and in overheated rooms. Many pathogenic organisms survive for some time after death and so decomposition of the patient’s body may pose a health and safety hazard for those handling it (Cooke 2000, E). Autolysis and growth of bacteria are delayed if the patient’s body is cooled.
23 Screen off the beds/area that will be passed as the patient’s body is removed. To avoid causing unnecessary distress to other patients, relatives and staff.
24 Remove gloves and apron. Dispose of equipment according to local policy and wash hands. To minimize risk of cross-infection and contamination (Fraise and Bradley 2009, E).
25 Record all details and actions within the nursing documentation. To record the time of death, names of those present, and names of those informed (NMC 2009, C).
26 Transfer property and patient records to the appropriate administrative department. The administrative department cannot begin to process the formalities such as the death certificate or the collection of property by the next of kin until the required documents are in its possession (Green and Green 2006, C).
Problem-solving table 2.1 Prevention and resolution (Procedure guideline 2.2)
Postprocedural considerations
Immediate care
Relatives’ time with patient after death
Since there is a time limit to how long a patient should remain in the heat of a ward (there could potentially be early onset of rigor mortis), the senior nurse will have to exercise discretion over when to send the patient to the mortuary. This will vary according to family circumstances (there could be a short delay in a relative travelling to the ward/area) and the ward situation (side rooms are obviously easier for the family/other patients). As a general rule, 1–2 hours would be considered the upper limits for a patient to remain in the ward area, after Last Offices have been carried out.
Viewing the patient in the chapel of rest
Families may wish to view the patient in the chapel of rest again (Figure 2.5). It is important to ensure that the patient is in a presentable state before taking the family to see them.
Spiritual, emotional and bereavement support
The bereaved family may find it difficult to comprehend the death of their family member and it can take great sensitivity and skill to support them at this time. Explaining all procedures as fully as possible can help understanding of the practices at the end of life. Offering bereavement care services may be useful to families for that difficult period immediately after death and in the future. National services such as CRUSE (www.cruse.org.uk) can be useful if local services are not available.
Relatives may express extreme distress; this is a difficult situation to handle and other family members are likely to be of most comfort and support at this point. The family member may wish for their GP to be contacted.
Maintain a high degree of sensitivity when outlining the process after a patient has died since families frequently have to attend the hospital in the very near future in order to collect the documentation for registering the death.
Education of patient and relevant others
Helping the family to understand procedures after death is the role of many people in hospital but primarily this will fall upon those who first meet with the family after their relative has died. The Home Office leaflet What to Do After a Death (DWP 2006) can help families.
If the family states that they feel the death was unnatural or even that it was interfered with, we have a responsibility to explore these feelings and even outline their legal entitlement to a postmortem.
Prepare the family for what they might see.
Invite the family into the bed space/room.
Accompany family but respect their need for privacy