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Good evening, everyone. Welcome to this evening was kind of big webinar today, Doctor Wendy Tanners and F two is going to be covering verification and certification of death, which is something that has funded nephews will be doing a little off. But before we had over to Wendy, we're just gonna have a quick word from down from the BMA. You're just gonna run us through some of the things that they could do for us. Steering are foundation years. Yeah, so we just kind of it's it down now, So just, um a screen, like a deck of together is Ah, there's a secure code on the screen. Um, and there will be a couple of links shared in the chat as well. Sorry of you. Like you heard me out of this chart before, but yeah. Anyway, it's zero. Good stuff. It's just about the b m a. How we consult support you and just sort of a refresher already. I'm sure you know you remember. You remember support s Oh, yeah. Ah, Couple of, uh Well, there's a couple things on the screen. Said one is about joining. Um, They have ones about employment guidance. Pull pack. So? So basically, Yeah, well, we've We've great an employment guide, and we made some of even ah support pack for for students. It doesn't matter if you remember or no, you could You could Everyone can have it because also means it's just a way of us stay in touch with you. So yeah, including that you get to your doctor. Employment guys is off under our minds. All the terms of conditions that we often see, um, negotiate contracts. Eso. Weeks ago, she had to do the contracts. So So talks about inside out, um, I think stalk. It's in there as well, as well as our original. It's and trip tricks. There's looking at yourself section and it's a cute name with Doctor Alex. George is there. Some of it's on there, but yeah, skin, like your code. Leave a few details, and then and then we'll get it sent out to you. Um, again, Doesn't matter if you remember. No, that's just the way of us will give you think. Brings on that. 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So being a baby library by my house is it's closed, sealed with cabbage, but we're we're we've got we've got, like, e books and the gels that you can you can access instantly on your phone or laptop. So So that's sort of fruit. That would be a very light breeze taking at the moment. Um, there's a new tour school clinical case. It's essentially Ah ah ah search engine. A medical search engine you may need. A lot of people have come across kind of cookie before, but now it's about B M A membership. So it's another member benefit. I'm really, really good, really good to use. Ah, point of care. And it's got lots of step by step procedure videos and just lots of breakdown of of everything you need to Really. Um, if you think about your middle, your your specially options already you can use our special export. Also, that one gives you a ah, a good picture of what we see you best. So it's an online psychometric take test, which takes about 20 minutes to complete. Ask you all sorts of work life balance questions and then I will give you a detailed report listing the top. So especially, is according to the answers that you've given, I'm really, really easy to use and covers all specialties. And there are possible reason Really interesting that there, uh, of lots of, like graphs and charts to break things down. Um, if any time you feel you know, it speaks something about your well being, we have services. The repertory. Seven total students on the Actos and drop the choice to speak to a counselor or appears smaller doctor. So this one's a telephone based service, and we do a vehicle's well, if you if you like that, Um, and yet, if it's more than single a quarter service will make sure that you speak to the same person. Things cause a confidential free of charge on dopa is everybody says, regardless of what you remember, no. So if you're not currently member, there's there's off color. Come on today. If you join, you get 10 lbs about show. 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Thanks so much done. I thought those links in the chart so the fentanyl wasn't able to get the urethra. You can also get the neck from that. All right, so now I'm not gonna hand over to Wendy who's just going to give us a really short of verification certification of death. Uh, all right, everyone mornings. Wendy, I'm, uh, I have to work in Manchester at the moment on. Did a a be talking about verifications certification of that with me? I have a d who sorting out the zoom and past name. Who's going to be reading out, and he's off questions that you guys have an Any servants is that you can pop on the chat box. We'll try and make this s in directive this possible S o. If you have any self questions or anything for you to put them on the check box and Tasneem can read them out to me because I can't really see them. Yeah, let's go ahead. So things that we're going to go through today, I'm just basically going to talk about the introduction on Be a move. Why we're doing this teaching a little bit on the verification, the assessment itself, what to do before, during and after and little bit on different certification as well. What difference between that is's and what's the difference between that and a cremation for ms and then within that will give you some tips when being on call a swell and on how to speak to family members And then, Actually, I have some questions in some cases for you guys to do a swell. So we'll try and make this super interactive. And so definitely if occassion and certification is a common tests. When you're on the war zone call, it can be very daunting at first. If you're unsure of the process, remember first time being asked to go and verify a patient's death on the ward. I just wasn't sure what to do, so I had to grab an asset. Children could watch me do it on day. He gave me feedback at the end and basically watch me document as well. And so what? I what city? So what? I did and said, whether it was appropriate or not. So it's quite useful to have someone so feet back to you. You know when when you're doing it for the first time. But hopefully this talk will help prepare you if you have any sort of questions or anything. Um, then you know it's a safe space. You can always ask anything. And in medical school, you might have been thought about different occasion and certification. Um, you might have been not a theory of it or might have some assimilation that really life is a little bit different. Eso the names of today's topic is going to be the basics of death certification certification. Take some what to do on call and how to speak to family members and then basically where and how to seek for help if you're unsure. So what is the verification of death? If you guys know of any sort of definition, only solve simple terms. Um, feel free to please put that on the track. I'll give you a couple of seconds, and then we can move on anything on the box. Yeah, All right. That's why, um so in simple terms, verification, that just means confirming death. You're not certifying it per say you're not feeling in the phone. You're confirming that as opposed to anything else. What that means is you you're ruling out if there is has been hypoglycemic event, if the patient has had a vasal Vago, for example, passed out, Um, so you confirming that the patient has definitely have passed away and they have been a loss of life, and it is an important house to do because you're legally establishing it. The patients not pronounced that that until you've established the time until you finish your assessment document the time Then the illegally establish just said, um, in clinical settings in hospitals. Um, most of time, you you'll be the ones. If your junior doctors on the Ward's, you'll be asked to do it. So medical professionals, registered nurses and paramedics who have been trained, um, can verify patient's death. Um, it's just good in none Couldn't go satings. Most of you will not be involved in that. If your junior doctors, it would be mostly G p score paramedics. But it's just good knowledge to know. In light of Kobe Pandemic, apparently none. Medical professionals a swell are allowed to verify death with remote clinical support. Um, but that's completely rather than it's just, um, you know something to know about. So you'll be asked, is a lot on the words whether you're on call or working around on awards, you can get a bleep on the stuff Nurse will say, Hi, Doctor, please. Can you come and verify misses a Steph? So the couple of things that you need to ask this stuffiness when you're on the phone, for example, um, what would you want to ask him? If you want to pop that on the chat and we'll wait a couple minutes and and see and see You know what I'm saying? You come up with These are descriptions that you want to ask that stuff messes before you actually go and verify the patients that, um So what could I details? What you want to know? So Jamie Lee have lost where the patient is any of them? Is this back Has asked. Um, sorry. Only has asked, Could there be any reversible causes? And current has asked, Is it an expected death? Uh huh. Yeah, Mr. For is ask doing. Does the patient have any comorbidity ease on T A. Dora is asking about what the disease is. Patient. May. We may not have had. Mm. Yeah. So perfect. So those are the main questions you want to know? You should ideally try to get this much information as you can when you're on the phone. Um, things like the things that you guys you guys have mention perfectly correct. So things like dcp Ah, you want to find out a little bit about, um, you know, the patient's background. Why, at the been, um, it's It's a hospital. What was the date? You know, the date Eames plan. Have they been pallative? Um, and any issues and expected death or sudden that, um um especially d any CPR, whether that's in place or not, That's the main important thing Before you go and verify the patients that also I think someone mentioned about where the patient iss That is obviously a very key detail to get. If you're trying to go to a war, do you want to know? You know where exactly this patient is? Um, and yet and other teachers as well as the patient's name, um, and the ages well, could be relevant. Just so when you go in the war, you can ask, um, who is this patient s? So I've written a set of things that you should be asking before very final patients That so, like I mentioned earlier that live the in a CPR should be in place. Check the resuscitation status. If they are not for resuscitation, then you can continue to wear if I patients death. Um, if the any x e p. R is not in place, that the CPR should be commenced into resuscitation status. Is this foam? I don't call on the ward. Before, when I was on call like a bleep from the nurses to say to ask me to go very fire patients, that and I remember asking for a D and C CPR and and I remember hearing them say that they did not. But they do not know whether the NSC pale was in place. Still not and me and marriage, which is looking each other, will be like Does this need to be a crash cold? Because if the patient stop breathing and they don't have a D and C P r n play CPR have to be commenced and crushed call has to be put out. So that's an important thing to think about and next. Just need to make sure that there's no obvious need to refer to the corner or police. Um, just rule out that that the death is not suspicious or requires any sort of investigation before you go to verify them. And then once you've gotten all the information ready, just need to get all your stuff ready because you don't want be fumbling around when you go in. Very five patients. Death. Um, you want to get several items such as a pen torch? Um, stethoscope. Take a listen to your chest clock so you can verify the time of death. Um, pans we can document and pee pee. When you go and see the patient in community, I believe it's there is a four hour time in it before, um, a patient read maximum limit where the patient has be verified. But in the hospital, it's important thing to go and verify patients that probably I know when you're on coal special in your medical cold cold. You can be really, really busy with a lot of different important job. Seem, really, really sick patients. I'm obviously going prioritizes sick patients, but you need to think about doing this a soon as possible is well, especially if you're doing it around like 10 11 PM before midnight. Um, so let's say if they passed away on the 15 of September and 11 PM and you going to verify them? Um, like around one ham, the date would change. It was kind of lately, the 16 of September, and that's the date that will be written on there. Destitute. Fickett and some family members would not be very happy with that. So just just think about that. Um, if you've been asked for a patient that so before verification deficit I mentioned earlier, it's important. Speak to stuff members looking after the patients stick to a nursing staff to find out what happened. Look at their notes themselves. You must confirm that they have that purple form. The any CPM place confirmed that details read up on them. If you're not sure, Um, and then if the family members around sometimes stuff messes. And it's not that the stuff in a ward would bring the family members to ask him to come in. They know it's an expected that, and they might already be, you know, by the patient's bedside when they have passed away. So if they're around you, go and speak to them, not forget your condolences and explain why you're there on That's really quite important bit and a little bit daunting when you're starting up. So I've written on the page basically on top tips on what to do when you're speaking to family members. So, um, you don't want to, you know, when the family members in the room you don't want to just barge in and just verify this patient that you want to go in festival offer condolences. Explain why that so? Explaining none. Technical terms, especially what you need to do what you're about to to some family members can get quite touchy and confused, like why you examining? You know, the patient when they've obviously passed away. Um, and so that's why you need to explain fully what you're about. Still like China, my like, light in the eyes. Listen to their tax. And this is important because I need to legally established time. We need to do it in the certain amount of time. Um, you should also offer options because it might be quite distressing for them to what you do this. You can offer them the option of either seeing the room or waiting outside. And things that you should not do is you should manage expectations. You should not overdo liver on promises. For example, if you tell them like the death certificate would definitely be completed tomorrow by the warty mean with your nights. And that's something you shouldn't you should try not to do because the family members already quite the stressed and you don't want to you know, the stress them in further by telling them information that you're not sure off so that I have himself raised everything on there on the left side of the page. Just something simple that you can say it's family members went there around. So you should say Hi. My name's Wendy on one of the doctors in the cold tonight. I'm sorry for your loss. I've been asked to verify, um, Mr A staff by the stuff members in the ward. Um What? This involves ISS Cymbalta me tracking for any soft signs of life. I need to listen to the chest. I need to shine a torch into their eyes with a pen torch just to see if there's any self reactivity. And I need to do other tests. Well, some relatives confined this quite uncomfortable and distressing when I'm doing this. So you're welcome to either stay in the room when I do this or wait outside, quit for a few minutes, and I'll come in that you know what I'm done. Um, I understand it's quite distressing period of time. And you said you have any questions? Please feel free to ask me. Um, and I can try it off. Answer them a spastic that I can. If not, I will try some and, you know, hand you over to hand this hand the questions over to the people who might know about sir. So, yeah, that's the show off. Short phrases back usually use when I'm speaking to coming on this. Um, yeah. So that's all the stuff that you do before. So now we'll go into the assessment that, um So there's, uh, some, but is really quite It's quite simple, really. Most of the examination is done mostly in the chest when you're listening. But what's the main things that you need to do when you you know, when you go into a room you've got you've prepared all your stuff, you read the information and you've seen that there's there is the any CPR in place. It's spoken to family members. Um, what is what she would be doing when you answer the room, you pop the absolute it down on the on the check. Uh, I seem to be enough. No, wait a few minutes. Yeah. Any any answers yet? You know, know that I can see anything you guys would do when you enter the room. Um, you spoken to the family member And what do you think? You should You should check full first of all, what's the consensus on that? So Mister has said signs of breathing and heart rate. Karen has said to confirm patient's identity. Uh, yeah, that is perfect. That is the main thing you need to, um you know, obviously you don't want to verify the Roman patients that how you should do this is you should check the risk than that they have, um, and then verify against, you know, the notes that you have. That's the 1st 1st thing that you should do, first of all. And then you can go ahead with the other examinations. It was He can be surprised. The amount of people have gets checked. The identity went into the room. That's very important. Um, next thing to check is to do a general inspection of the patient and the bedside area. Don't around them a swell. You would do this with almost every examination that you're doing. So stand at the end of the bed. Look for any so obvious site. Sign off life. What? The patient. What does the patient look like of the general appearance, this skin color? And if they have any soft monitoring or easy jillions attached to them, um, and have a look around the room, a swell to see if they have any self cannulas on them. And it's a capsule to the touch. Any soft pacemakers from the end of the bed. If you can see any, that's just something important to do before you dive into the examination. Um, and then even though you know the patient's obviously unresponsive, really can't see it to you that, um, if the family members in the room I like to verbalize everything I'm doing Just so the family members know, you know, exactly what I'm doing is just so they're not just sitting there watching May on I like to sew it just introduced myself a swell just with every other patient. Hi, my name's Wendy. I'm going to listen to this. Do this eso festival. I would tract if the patient is unresponsive to valuables. Do my So you would just shut their name and see this Any sort of reaction on Ben. Check for painful stimuli. A swell ast two things that you can do you conducive to prop. It'll pressure trapezius squeeze. And then if there is no sort of response than you can move on. And like I say earlier, most of your examination and assessment would be focused on mainly the chest. It can seem like you you are spending a lot of time just using your stethoscope. Been listening to the chest and you were menstruating for 3 to 5 minutes on different sections in this area, which we'll talk about later. But it's important to just do that just to confirm that there's definitely no breath sounds, definitely no heart Selves. So when you're on the chest, auscultate and observe for the absence of respiratory effort for 3 to 5 minutes, that can seem like a long time. But you can listen to each section of your chest for 30 seconds. Minimal ones 30 seconds. And then, while you're doing this, you can always just, you know, have a look. Do a more close inspection. The A test. You can check for any salt devices that they're pacemaker. Um, it's the chest wall or rising and falling, they breathing yet, So that's why you need to spend quite a long time in this, and then the next check for the continual absence of heart sounds or a C study of East she monitoring. So once you listen to a chest, listen to the lungs, listen to the heart sounds swell. So just a foot 30 40 seconds in each area on the four seconds of the heart sounds as a man like, just like the chest sounds just so it doesn't seem like a very long time. Um, And then after that, after you spend majority of the time of the chest, check for central pulses, check that accepts, um, for about one minute and and then once that's all done Tech the I, um, be checked for the absence of Irish Texas. So I've written here pupils or corneal reflexes, but corneal reflexes ready, performed most of time. You just use a pen torch to go and look at the patient's I Nothing that I forgot to mention this and try and find a pen torch. There will be one somewhere in the ward. Still be one. Definitely somewhere in the hospital. Do not use the light on your phone. Um, that's just, you know, not great practice, and family members will not be happy with that. Um, so yet, use the pen torch. Look at their eyes make sure it's fixing dilated on Ben have written last See check for any sort devices such a pacemaker because that needs to be removed. The patients We made it. But you can do this really early on when you're on the chest listening to a chest, listen for heart sounds or respiratory efforts. You can then do focus. It's inspection and looks with things like that, so that will make your life a little bit easier. So once you're done with that, it's really quite a simple, you know, assessment. It's really not very long. Most of the time it's been on the chest. And to be honest, most of the time it's spent, you know, gathering or the information beforehand and then documenting it very clearly afterwards. And so, yeah, after the verification of death is done, um, three top things that you should like to do. So, um, you need to show us back to the patient in the family members. If you know you open their eyes to shine a pen torch in there, make sure you know you close your eyes again on diffuse. Remove a blanket to listen to your chest with the steps to go, make sure that they're covered after what the no dignity is maintained, Um, and then afterwards document your assessment very clearly. A swell. I have a page after this with you talking more about documentation. But the timing, especially, is important because it's dimensionally they're not. Legally, they're very fight us that until you you know, you you've done your assessment and document the timing. So it's important. Select clock. And once you've finished your whole a Saxon, look at the clock and see what time it is. And that will be the specific timing right on your documentation. And then the time that you write your documentation will be the one that's transferred over to and the information that will be written a cream form or the best difficult. And so it's just important to know. And then, lastly, obviously, the family members still around skipped to them and tell them what the next process is. If you know, if you're not sure after stuff, members in the war or aspirin movement team or senior doctors call with us, well, if they're not around, then it's important to bring them up to form them of the relatives death most of time. This will be done before hopefully the stuff. Nurses if it's an expected that family members would already have been told about it. But it is. But yeah, if you did verify that that that it's important to, you know, let them know. So I have a page on an example of documentation here. Um, there some things that are missing on it. Um, if you guys want to have a read and then, you know, pop your answers on the check on Facebook on let me know what you think is missing is not very good documentation. Um, there's some key things that are not on there. Um, yeah, I'll give you a couple minutes to do that. And then, um, custody convict them out when you guys have done so, There's certain key things that are really missing from this. Um, the good thing is, some hospitals have a fail safe saw system. Um, where they have, like, an online system where all all this assessment populated and you just have to say yes. No. Yes. No, that's the case in the hospital. Anyway. Um, but it is now online. And you asked to write it up or type it up. Um, Then there's some stuff. No, on this page. So most people have said time and time and date off verification. Yeah, Onda, uh, Martin has said absence off a DNA CPR. Okay. Chin book. Who has said that there's no patient identity? Yeah. And watching is also said that, um, the doctors details or the healthcare professionals details are absent. Yeah, definitely. Yeah. So is that the general consensus, then? Um so, yeah. As you can see, there's no patient details on on the on this documentation whose verification of that is it. If there's no sort of patient details, who is it written for? There is also no documentation off the doctor who's very fights death. Um, ideally, you should be writing your full name. GMC number in them? Um, yes. At the bottom of the page. Once you have done this well, and maybe a bleep or a contact number. Um, so that's, um, the nurses can contact you if they need you, or the bereavement team can contact you to meet you. Um, other things that the missing that that were mentioned as well, things the most important one with just, um, the time and date of that. So, as I mentioned earlier, that's a specific one that will be, you know, transferred over from your documentation to their medical stuff. It costs death to the Kremlin form, so you need to write the specific time of that on on the bottom of the page. Hop off the page. As you can see here, it says that you stopped breathing around 11 30 PM but that's not really that's not very five s t actually girl time that until you've done all your assessment um, assessing twice all the information on that, um, other things you could write a short summary of flights, you know, the background of what happens of the patient, why they were in the hospital and what has happened while they were inpatient. On def. There were any self concerns or anything from NASA and stuff that would be a good thing to document as well. But one of the things that have not been documented here is also the presence off pacemaker. So, as I mentioned earlier, any soft, um really well, like so any soft like pacemakers that needs to be documented very clearly because when you're feeling a cremation form out, there is obstruction. Where you need to say is whether pacemakers, present or not on do need to know that before the body is being cremated. Um, and if you if that is not very clear on your documentation, then the doctor who would be doing the cream form with that then have to probably go to the mortuary to confirm that there has not been a peacemaker present. So there would be double work involved then. So you don't want to, you know, add extra work for the other person. Yeah, and tea things I mentioned earlier patient details ever little bit on the background with the patient on Ben. Full assessment. That's what we've mentioned earlier. So check your density, voice, pain, stimuli, pulse, heart sounds especially sounds, people reflex and then presence of pacemakers or not, any concerns from the nursing stuff on Do. Another thing that, forgot to mention is if the family members are around to write them, do you write that down on the on your documentation as well? Now, last see your name, um, your GMC number and your bleak or your extension of breath, so I'll leave that on. All of that is documented everything. These are the key thing to just know. So you can mention to the family members this might be different in some hospitals. But, um, once you verify and you've documented, the body would then be taken to the mortuary and then the proven team with them being contact with the family members regarding next process, um, left that kind of a death because it's different in different hospitals. On be in order to find out more, you just need to, you know, get in contact with the brief one team. Um, but as I mentioned earlier, if you don't know, you're not really sure about anything. Always just asking you a member of your team, um, and always, you know, ask for help from the stuff members in the ward. And they might know about the process of a bit past in you on, Ben, get another provement you miss? Well, could stay. There are experts in this, um, Selassie tips on speaking family members again after you've done your verification. Um, as I mentioned earlier, only off the information that you know about. So if the family members have any further questions about what happens after verification. And if you're not sure that direct them to the direction of people who know better, try not to over promises. Far as I mentioned earlier, Um, and these are the people you can get help from. Stuff messes the reef, been teams in adults and consultants has always help if you have to ask for it. Um, before I move on to you guys have any sort of questions or anything, I'll give you guys a couple of seconds. Just pop that on the check box. If not, we can move on to question to answer. So I'll put that on the next page anyway. So you can read that in the you know, Pop the correct answer on the check box. If you have any self questions as well regarding what I've just mentioned, do you feel free to pop and I'll try to on my best one, sir? So the general consensus is number four. Any any questions regarding what mensch like in the previous size? No. Okay. Noise? Yes. Oh, sorry. Yeah, the court unsafe Number four. So you have to be appropriately trading to do this. Unfortunately, this weapon I don't think is, um, a training session. And so, if you, um yeah, you know, work in the hospital and have enough to verify a patient death. Please do not refer to my slides. You have to be appropriately trade, I guess, by the trust itself. Um, next question. So what is important document on your notes? Other than the options of vital size, it's quite, um, an important thing. When did just after seeing a question, Um, so someone has lost what would be appropriate PP for, um death. Very complication. On a second question, where is status verification normally done? Is it normally on the world's in rooms or in the march tree? Okay, first question, ppd wise in the hospital that I work is basic kidneys. The plastic thing that you tire on the pennies and gloves and mass. Do you wear the mask everywhere in the hospital anyway? But those are the key things that we use before we go in is the same thing as we used before. We're going to examine any soft patients anyway, So we do that with defecate in the tens. Obviously, the patient is called it positive or not, they might be different rules in different hospitals. Um, but yet that's a general pinky that I I have to wear my hospital in terms of location of where you would be verifying that. It's mostly around the woods, and I have not personally verify patient there in the mortgage early before most of the time it's done. It's then directly on the ward itself because the staff nurses will bring up the on call doctors to go into it as soon as possible. So, yeah, so that's that would be the main location. Any self consensus on this answer question. Sorry. So most people have said number two. Yeah, that's easy. And mentioned a pacemaker thing like million times because it is really important. Um, and it's important to definitely document that down, so it's somebody else. Doesn't have to do this. You know the work again. Yeah. Um, next we'll move on to death. Certification? Um, so I've written a little bit on, um, the VESIcare in process what to fill in for the cost of death section. And I'm also written all the information for so medical the medical stuff. Icka of course of death is the form that you be. Acid pill information forms if the patients are to be cremated, are very common forms that you be active pill as junior doctors on day are very important documents. They have legal documents, so you have to be honest and trustworthy when completing it. You're not shown how to do it. Always see for help from his union doctor. Um, and if you're enough, one always just, you know, get your senior consultants to have a look at it before you go and, you know, fill in one a one B and 20 which we'll talk about later. Um, it's an important for modesty because family members use this to register that, and it is required by law in the UK for death to be registered within five days of occurrence unless preferred coroner morning quest is made. And so yeah, so that's why it's important to get it done promptly. Um, other things. We can do it so it can only be complete it in by the doctor who's looking after the patient in the last 14 days. Um, and it's 28 days in Northern Ireland. Um, I believe in Corbett Times. They might have also changed this in England 28 days. But let's just stick to 14 days. The person who has looked after the patient in last 14 days would be the person who would be after feeling the best of difficult. Um, before you completely dust to figure it. Couple of things that you should do if you're if you're If you're very junior, it's neph one. Speak to your senior. Your consultants determine the course of the F If you're unsure, Um, and make sure you still read the notes as well. No, the second stances behind it. That and you might notice patient any Well, because, um, you will be asked, you know, complete his thumb if you've looked at the patient in the last 14 days, so you really sort of know the information about them. But just to find out more information about what happened in the last few days before they passed away, just read the notes, probably in order circumstances and then get familiar with the brueckmann stuff members. A swell. They're often very friendly, very nice, and they are experts, and necessarily they're seen so many junior dot So is F one F two struggling with filling up the form so they know what needs and what does not need to be on the form. Um, so just ask them for help if you're unsure, but definitely clinically wise. If you're not sure what should be the cost death. Definitely stick to a consultant area of senior members of your team. Um, a few things that needs to be referred to the corner. And these thesis causes quite, um, um, the quite would you say that, um, it's quite obvious. So if the cause of death is unknown so sudden, unexpected, suspicious of violent on natural death and that should be referred to the corner that resulting from injury poisoning um, alcohol or drugs which are not chronic use um doubtful, Still. But, um surgery, anesthetic. Um, if they have been admitted within the last 24 hours, any death in prisons if they're unknown, um, any death of industrial disease like a spastic OSIs and that from the glad want or exposures well, that all of these tribute fits of corner. It's quite a long list of stuff to remember, but just so that you know that if you're filling up the medical stick certificate, of course death. There is a section of this at the back on the back page, so you can always just refer to that as well. And like I said, if you're not sure. Asa Bereavement team Um but yeah, he said, uh, the stuff that you should refer to the corner. This is what the medical certificate, because stuff looks like it's normally a F know after it. So in every page, piece of paper, quite a long, big pieces just to fix it with an in lace off section and the on the left side. Eso It's essentially like a piece of a difficult that you tear out and gives the family members on the in. The section is literally just a summary of what you've written on the cysts certificate itself. It's just for, um, bracket keep keeping on, but this is difficult with you. Then we scan himself. The reels get with them beginning to the family members. Um, there is a couple sections that you need to fill on this the most confusing section if the cost that. But we'll go through that later. Um, but here is just like patient details, which I'll talk about here. So main things to fill on the top. It's the patient information. So the main details, their name, um, your age and the date of death estates it to you. So, like I said earlier, it's important to document if you're the person verifying death the specific, you know, the date of that, Um, as clearly as possible. Um, it's written in the format off. Um, next day, off months. And yeah, So, for example, if it's not, um, like here, so day off, blah blah. So it can be a little bit confusing. I remember feeling this up in forming, like, where do I write the month and where do I write the year? Um best. This is just the formats of 19 day of April 2019, for example, and then place of death would usually be the hospital that you're working in, or the hospital the patient's passed away on been lasting a life by me. It is also the same format that's the date of that. So might be a couple days before, So the 17 day off April 2 of 19, for example, and then this section you just have to solve circled it. So it just say is if post more multiple be taken will be taking place at all. Um, so if postmodern not being held, most commonly will be number three and then this section issue have seen the patient after death. So if you were the one who's verify the patients that, um, that would be a or if you've seen the body after death and it's a, um if if it seems somebody else, then it's be, um, unlike the you'll be see, not seen the death of my, um, medical practitioner. Um, but I just sent in the answers this correctly, as you know it to be through, Um and then next will be because of that. So this is the section as I mentioned that little which just people, you know the most confusion if you have any. So I doubt so. Any questions regarding this? Um, always, like I said, going to be to, um, senior members of your team or your consultants on bail be able to point in the right direction. In some hospitals, they're also medical examiners and the president's well that you can discuss what you've written. A section one B and one a one b um, on the see with some on day will. You know they'll do the same thing They will read through the patient's notes. And then, based on that, they will data confirm if what you've written is accurate on that. And but, yeah, let's say you're just doing this section on your own, Um one A is basically the disease or the condition that directly let let the patient their one. B is the the thing that led to one A and then similarly one c let to one B so and then Section two is just the other significant conditions contributing to that, but not related to the disease itself. So this is not a section that you should be feeling. You don't feel to. The section that's the full patient's past. Medical history, just significant things, that tough haste in the death. So topics of completing Section one, um, consider me sequences. I mentioned that left to death. So think of the main things that they're only left stuff in one a and then think of think of other things that the half left toe one a. So write that down one B and then one. C. What has lots wouldn't be happening on be really specific about the cost of death. So if they passed away from, um, lung cancer, for example, do not right lung cancer. There's a specific information like long medical carcinoma. Um, so be specific. And then more than that, an old age ideally, should not be reading on Section one. But I'll talk about that in my next light on section on stuff that should not be recent on Section one, um, and then some cases only have one condition that not to death. So in that case, only one a section would be completed, and that's completely acceptable. So things that's up a recognized hemorrhage. If you just write down one day with nothing else in one being on stage, that's completely fine on Ben. In some circumstances, two separate conditions could lead to have left is the death directly? So in that case, you should enter them both on the same line on 18, and then in brackets sit that there are joined courses and then lastly, you do not use abbreviations, so things like type two diabetes COPD. I've written that so many times out of habit on the foams and be nice to change them. So do not right COPD, right? You know the full name of what it is you know, right t two pm When it's tough to diabetes. Um, yeah, those are the top stuff. Things that you need to remember. So things that cannot be reaching one a and it's all failures. Like we know failure, respiratory failure, everything. All of these should not be written on there except for congestive cardiac failure. Um, old age and feel seizure ideally not be used as a sole cause of death. Unless you can't find any sort of reasons, Um, for the cause of death and they're over 80 years old, then that might be an acceptable course. Death in one. A more of dying like cardiac arrested respiratory arrest as well should not be resettled. One a and then other things. And they allow a spec c s denia coma, um, exhaustion or coke Axio. So these are things that you just need to remember that should not be on money. Um, like I say section to ifs things that did not need to death, but so I've played a role in hastening the process. This is, like I said, not a section to write the patient's past medical history, fully need to pick and choose whichever have might have hastening. And, he said, the process is that overall, but not directly elected. That can be a little bit confusing to know which is which. And but we'll do some example cases later, and you guys can let me know and then now just a little bit on Formacion form. So in England, Um Scotland Orwell's If a patient is to be cremated and separate forms need to be completed and and again this needs to be accurate, alleged a swell. So cremation from four and the medical certificate call step at both separate forms in England. Anyway, where I look, um and um, that is just that just applies to patients who have to be cremated. So the commission from four is usually the one that you be completing. It's completed by the medical practitioner know who saw increase to the patient in the last 14 days before they before the death. This's normally the same person is completing best ficus well, and there's also noticed from From which come from five and that will be completed by senior doctor who is fully registered for at least five years on day will be completely independent of the doctor who sent from from four. And then you should know involving the capitation, um, come from Forest of Main one that would focus on because that's the one junior dots will be asked to complete. It is, um, essentially, you have to fill in the same stuff. Information estimate icals difficult costs of death assuage. Well, you got the patient details in the front. Um, I think there's a section on it like a some way off in, like the tummy of details. So what happened to the patient? You know, from the beginning to you, then off, like why they came to the hospital, what they were being treated for on. Then there's also a section on, you know, one the 11 a one b in one C, just like in the medical stuff cost death. And then there's also a section on whether the patients had surgery or not, and and then last see important thing that I mentioned earlier that was on the cream form was the presence of a pacemaker or not. And so, yeah, that's why it's really important documents that when you first when you're the one. Very fine the patient's death. So now we have a few examples cases for you guys to do. Um, I have two cases here. Um uh, this is basically just the patient's past, you know, past medical history on the history of when they were seen on the ward round, Um, this which in any type of over here pleasing going up. But if you guys could think about what you want to write one a one B one c number two, and then we can go through the right answers after this. So I give you just a couple of, um I mean, it's the complete best. And we'll just get, you know, gather the general consensus on what is the right answer. Um, and yeah, we can go through that later. Hi, Wendy. Um, store eating for the comments to come through hours. So just think of the basic main thing that half course this patient, uh, have caused this patient death. Um, and then walk away, you know, backwards. And number two, as I mentioned, that is thing that paste in the patient. That but not directly causing it. And CIA. If you're not sure, we can go through the answers as well. But just have a try. Pop on the check box if you have any sort of idea. So two door has set on option for you. What could be written in one day could be bleeding. Yeah, Anything else on one? A. Other people have said also visual varicies on perception to a liver Cirrhosis? Uh huh. Okay, we go to the answers, then, Um yeah. So that's what Everything on one A one b in one c. So, like I said, just think of the things that the main thing, that course, you know, the loss of life and that is the bleeding itself. So if it's a massive him, a temp assists and the thing that have caused that Westie various assists. But the thing that have caused the viruses was the liver cirrhosis and had the significant conditions contributing to that wedding really feel that, and because I don't didn't think that that was relevant frequent for COPD um I didn't think that was relevant to be written on there. Um, but yeah, that's the young staff left. Um, yeah. So we have another case after this. Um, this is a second case, and I read that out for you guys as well. Um, just while I'm reading out, you guys think of what you need to fill in one a one b in one, seek again. And number two, Remember, one a is D main thing that have directly let the patient death one be the thing that that's one a one C's the thing that left one B. Um, and then the two is just basic condition. Any self condition that tasted death. Um, so in this is a 60 year old male with past medical history of ischemic heart disease. Basically seen on the war brown yesterday with your consults and has been admitted. Um, it is a girl with a fractured enough of his right leg, not his neck or femur fracture. Sorry, if you don't know that, um um, office right leg had an operation a week ago. Um, and he has been complaining of cough pain three days ago. Seen by a doctor in a ward and started on low molecular weight happen. Unfortunately, he did. He was really unwell. Couple days they complain of chest pain on breathlessness. And then very fact passed away on the 11th. Timber 2021 at three PM Um, so think about what goes on one a one b in one C and number two is Well, any consensus sofa one A. So lot of people have said pulmonary embolus for wondering. Yeah, buttons have said Others have said, um, Claudia caressed on blood clot, um, or P in one A. Yeah. Hold me. What? What would be any consensus from that one? Be the most common on so that I can see husband deep vein thrombosis or ischemic heart failure. Yeah, And then anything a one c in one c I've seen neck off, right neck, the femur fracture or femur fracture or heart failure. Okay. And anything on number two. So for number two, people have mentioned ischemic heart disease on this chemo called failure. Okay. Yeah. So, as I mentioned earlier, one a should not be them more off. Um, that so cardiac arrests, respiratory arrest should not be written on there all. Um, but this is whatever. It's a s one a one b in one c. So, um, the patient is unfortunately, if you think about it, that's the sequence. So they had a fracture of theme of their right late that was operated on that have led to, um, high risk of DVT. I'm happening. And that was that was what That was suspicious off. When the, you know, the June the doctor on the ward started the patient on, um, low molecular weight happen. And the, you know, deep vein thrombosis could have, like, two and P e forming, which then the patient then present the next day with shortness of breath, chest pain, difficulty breathing. Um, so that's the whole sequence is that I was trying to get you just think about, um, number two ischemic heart disease. Could be an import. Could be. Could be something that could have haste in the death itself. So that's something I popped on there. And what was I going to say? Anything, um, anyone want to mention about fracture femur? Right late. So remember, it was operated on. Um, So anything that has, you know, has had a non operation, as I mentioned on, Yeah, um, should be reflects the coroner A swell, Um, even even if you think the operation itself may not need to death, um, isn't. And on the list of the, you know, the things that should be referred to a corner, um, safe here. And he saw definitely to surgery and aesthetic. So they had enough. It was operated on, which could have left. So, you know, the DVT, um just don't reflect sleepy. So that's something. Think about as well, if you're unsure. Like I said speaks to the bereavement. You speak to the staff members, senior members on the ward. Yes. Well, then, you guys general in Texas, Um, a couple questions, and then we'll we'll be done. So if you guys want to fill in on the chat as well What you think the most accurate answer is in here? When is that certificate not required? So it's four ounces on there. And if you pop what you think is the right answer on the on the check box, um and then we can You can have a discussion. So one is before 24 weeks of gestation features delivered with no signs of life. Number two is after in four weeks of gestation features. Is the liver with no signs fly after 24 weeks, Deliver it with science, life before it dies And enough 24 weeks we're in abortion is perform them. So which one of these is a deficit but not required to remember? It's not required. Um, rather than required because I always get that wrong. When I'm answering antique use, I always reef. Always forget to eat not you need this. So the general consensus coming through your husband number four Although a few people have said number one So, um, the unsaid a pop on that issue Number one And so I don't know if you remember in the, um the river to Cornel Bit section of written Um really a sorry. Now that's not relevant. Sorry. Um, I believe it's number one before before 24 weeks of gestation. If he's is not delivered with no signs of life, I I think that is considered a miscarriage for then a stillborn. So if that's the case, then best good is then not required. And but I can see why you would think after 24 weeks when abortion is performed. Um, would be the case is, Well, it, um, I guess when abortion is the form after in four weeks, that is, it is considered. And after 24 weeks, you need to do a testicle it for any soft Peter's. So, um, that is just to get you thinking after 24 weeks, you do need to fill in any sort desk to get for someone who's passed away before 24 weeks. I guess it's counter as a miscarriage, and that's not you don't really need a best of cooked For that extent and few more questions. What is the name of document given to relatives to register that this is quite a simple one? Um, like I said, only a pop that on their check box for the correct answer. So this is the one that you know, the one I showed you guys really a, um, that you have to fill them when they won't be a one C um, and then two on a swell. And that's the one that you know the relatives will take to register the patients that, um and that's the one that I was to mention it has to be done. Um, within mm five days after the person you know, after death has occurred unless, um, referral has to be made to the corner or an inquest be done. And no consensus is too. Uh huh. Yeah, it's quite a simple one. It's, um yeah, number two. Oh, really? Got the, um, so in this. Sorry. Um, but which ones of these are correct about the M C CD? This just to get you thinking as well. Hot one is Theo Mediate cause death things that directly Let's stuff itself in part to, um it's the condition that contributed to death. Um, remember, it's just think. Think of the thing that have direct me. Let's def itself in one a, um and then think about the sequence. Is that, um, you know, perhaps proceeded it before in the number two is just things that contributed to it, but not directly lead to death itself. Yeah, So that's the end of my talk a little bit on the summary and take home points. So keep points to remember is if you're unsure of anything, always speak to your senior members of your team. um, And to, um, you know, to your consultants is Well, if you don't know what's up with money would be a one c and number two, Um, if you have any sort of trouble speaking family members as well, you know, just always meet them in the like in the direction of person who can, um, other things, the desk difficult and the cream form can be quite confusing. You're failing it up for the first time. Um, we have, you know, a section on and on mind a bleep. They are articles on defecate in and death certification as well. You just want to, you know, have a read before you go and do this. And before you go to verify someone's definitely before you go and do the system quick itself just to refresh your memory, that might be helpful. Um, and yeah, that's the end of the presentation. If you have any salt questions, please feel free to put them on the chat. Um, and I can try my best to one to them. Um, and if you don't if you You know, if you think of any other questions at some other time, um, always just feel free to message. Mind a bleep, and we can try to help you as best as we can. And this also a, um, certificate at the end. Um, not sorry. A cure code that popped on right the end. Um, if you wouldn't mind, just, you know, filling it up and doing me feedback. That would be amazing. Um, yeah. Thank you so much for interacting with me as well during this. You know, teaching session is really different. A little bit difficult because I can't see you face to face. Um, but yeah, thank you very much. And I feel free to ask me further questions and put your feet back on the phone with Well, you'll get us to forget once you've finished this feedback on metal, Um, if that if you've done this before, it's just a really simple short form to fill on. Do you get the system to get at the end? Yes. Thank you. Thanks so much. Ready? That was a really useful section. Um, we've I pushed the feedback link in the chat, everything it in, and it's unable to scan me fewer. Puts a PT to feel that I was really useful for us and for usual, for you with the certificate as well. We have just one question that's just been posted in the shop by Martin. Why it's about patients who are under dolls on if they possibly if they need to be referred to corners. Um, no. So let's go back to that slide and places like pasta, pasta. And so, as far as I remember, that is not one of the causes that needs to be referred to the corner. A lot of patients, you know, other lead patients on the ward with the men should have dolls in place. So that is not a criteria. Unless, obviously it is sudden, unexpected or suspicious, violent, then that needs to be done them that it doesn't in place. It's not necessary. Are there any other questions? Um, that's really questions come through. But I'm still on the web. Know with us. If there are any further questions you have, you do drop us a message on. We will. We'll pass it on to our team to get back to you. Um, yeah. I think that we're all ready to wrap up, so thanks for sending it back so much ready for such a usual session is well on. But we'll see everyone who be on the next level. Que just be two seconds. Uh huh.