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Surviving the F1 Bleep – Session 6Amy – FY2 Southern T rust Med School – QUB FY1 – UHD: Surgery, Medicine, Medicine FY2 – GP, General Surgery, ED FY3 Year incomingLearning objectives How to confidently manage how to verify the death of a patient on ward How to cope with your bleep How to obtain the important information Importance of communication with staff and family Importance of documentation Cremation form completionHow confident would you feel as an FY1 being called to verify a death? A – Yes would know exactly what to do B – Think I would be alright managing this C – no idea where to start, haven’t seen a patient who has passed awayDon’t panic You’re on call and have been bleeped! by SN ‘A’ on Ward ’ ’ about patient ‘A’ who has just passed away…1. THINK – * as with any bleep * • Who are you speaking to on the phone? • Who is the patient? • What is the problem? • Do I need to get there right away? • What else can I find out over the phone? • Hospital Number • What ward • Background historyWHA T ARE YOUR INITIAL THOUGHTS? Was this an Did the patient Are the family expected/unex have a DNAR in in the room pected death? situ Have the family Have the family had any been informed? thoughts about cremation or burial? What should you do prior to verifying the death… Check patient’s resuscitation status: do they have a DNAR in situ?? Usually kept at the front of the notes – red form. If the patient is not for resuscitation → death confirmation If any uncertainty to what the patient’s resuscitation status is → CPR should be started whilst clarified. → Review the patient’s notes → gain further details about medical history → Clarify circumstances surrounding deathwith staff and family members. This will need to be documented in patient’s notes.Are there any family members present in the room with the patient? Introduce yourself + offer condolences. →Explain the need to confirm death and offer the family the opportunity to leave or stay whilst you do this. → Check if family have any questions or concerns.STEP by STEP guide on how to verify a death 1. Wash hands and put on relevant PPE if appropriate. 2. Confirm identity →check wrist band. 3. Inspection → ?any obvious signs of life such as movement and respiratory effort. 4. Assess patient’s response to verbal stimuli (e.g. “Hello, Mr X, can you hear me?”). 5. Assess the patient’s response to pain using one of the following methods: Apply pressure to the patient’s fingernail Perform a trapezius squeeze Apply supraorbital pressure6. Assess pupillary reflexes using a pen torch: after death pupils become fixed and dilated. 7. Palpate the carotid artery for a pulse: after death, this will be absent. 8. Perform auscultation in an attempt to identify any heart or respiratory sounds: Listen for heart sounds for at least 2-3 minutes. Listen for respiratory sounds for at least 2-3 minutes. 9. Wash hands, dispose PPE appropriately 10. DOCUMENTATION Verification of life extinct - documentation Here is a structured example: A Ross F1 31/03/2020 09:00 Informed by nursing staff at 08:30 that Mr X showing no signs of life. Mr. X with BG of metastatic lung cancer was admitted to hospital on 21/03/2020 for symptom management at end of life. This was an expected death. Family present on arrival. Family left room prior to verification of death. Verification of death/life extinct: - No response to painful stimulus - No heart sounds for 5 mins - Apnoeic for 5 mins - No central pulse for 5 mins - Both pupils fixed and dilated - No pacemaker palpated Date and time of death: 31/03/2020 at 09:20 (This is the time of death is the time when you complete the verification of death). A Ross F1 Bleep #xxx GMC number xxxxxxxNow that I have verified life extinct, what do I do now..??Morbidity and Mortality pathway on NIECR MCCD certificateUsing NIECR, All Medical Certificates of Cause of Death (MCCDs) should be sent via email to: GRO-pandemic@finance-ni.gov.uk name and contact details for the next of kin in the email providing details → vital to allow the GRO to contact the informant to obtain information required to register the death If known, the name of the Funeral Director being instructed by the family should also be included. If the Funeral Director information is not known, there is no requirement on the Certifying Doctor to obtain it as the Registrar can source from the informant when finalising registration.Deaths reported to a Coroner •a doctor did not treat the person during their last illness •a doctor did not see or treat the person for the condition from which they died within 28 days of death •the cause of death was sudden, violent or unnatural such as an accident, or suicide •the cause of death was murder •the cause of death was an industrial disease of the lungs such as asbestosis •the death occurred in any other circumstances that may require investigation A death in hospital should be reported if: •there is a question of negligence or misadventure about the treatment of the person who died •they died before a provisional diagnosis was made and the general practitioner is not willing to certify the cause •the patient died as the result of the administration of an anaestheticBurial or Cremation ??F1 ESSENTIALS (not sponsored) INDUCTION THANK YOU! – this webinar will be uploaded to MedAll tonight Webinar ideas: Please scan the QR code on your phones and fill in 1. Doctor my patient has chest pain the feedback form! 2. Doctor my patient has had a fall 3. Doctor my patient has a temperature 4. Doctor my patient’s is in pain 5. Doctor my patient’s fluids are finished 6. Doctor my patienthas passedaway, can you verify the death? 7. Doctor my patient hasn’t passed urine all day 8. Doctor my patient is SOB 9. Doctor my patient has a low BP 10. Doctor my patient is having a seizure 11. Doctor something isn’t right with my patient - confused 12. Doctor my patient is drowsy?