Post death procedure - East Cheshire NHS Trust

ADULTPOST DEATH PROCEDURES(Version 3.0 – September 2010 – August 2013)Procedures for Still Birth will be found on the trust intranetProcedure for a Suspicious Death will be found on the trust intranet

POST DEATH PROCEDURESINDEXSECTION 1SECTION 2SECTION 3SECTION 4Hospital Chaplains Contact ListProblem SolvingGuidelines for Last OfficesProcedures for Management of AdministrativeProcesses by Nursing Staff following PatientDeatho Notify General Officeo Forms/sheet tickets/Coroners Formo Propertyo Post Mortem (section7)o Viewing of Body (section 6)SECTION 5Requirements for People of different Religious FaithsSECTION 6SECTION 7(6)1: Release of Bodies out of hours(6)2: Guidelines For Death In A & E(6)3: Death in the home & brought to Mortuary via A& E(6)4: Ensuring correct ID of deceased(6)5: Out of Hours viewingMortuary Department• Hours of opening• Viewing deceased patients by relatives• Release of Bodies• Post Mortem examinations• Benefits of a Post Mortem examination• Reasons for Hospital Deaths to be reported to the• Coroner• Coroners InformationSECTION 8Infection Control - Hospital Guidelines on the precautionsto be taken with the bodies of those who have died with aknown or suspected infection2/34

Roman Catholic ChaplainsFather Peter CryanFather Francis MageeanFather Peter BurkeChurch of England ChaplainsSECTION ONE - HOSPITAL CHAPLAINS CONTACT LISTRev John BuckleyRev David HarrisonRev Ian SparksRev Malcolm ShawRev Taffy DaviesEmergency call out onlyEmergency call out onlyFree Church ChaplainsRevd Stephen CallisRevd Chris WhiteleyKnutsford District Community HospitalFather John JoyceRev Nigel AtkinsonRoman CatholicChurch of EnglandCongleton War Memorial HospitalRev Ella SharplesChurch of EnglandPLEASE ASK FOR THE FAITH PREFERRED BY THE PATIENTChaplaincy request forms are available on all wards from the ward sister and also in theback of the Patient Handbook. Alternatively forms are available from St Luke’s Chapel orthe main admissions disk. Please hand the completed form in to either the ward sister or theadmissions desk.Please bleep Chaplains first on 5101 or 5402; bleep in use from Monday to Friday 9 am to 5pm. If you require a Chaplain urgently please contact the Chaplaincy Co-ordinator onextension 1334 or 3845.If you require a Chaplain out of hours please contact Switchboard (0). If you require a faithwhich is not listed, please contact Switchboard (0).Chaplains are always available for spiritual care, quiet reflection and counselling byarrangement at the ward or in the Chapel Office; please contact Facilities (Soft FM) onextension 3816 or 1334 to arrange an appointment.The contact details of other faiths are under the appropriate heading in section five.3/34

SECTION TWO - PROBLEM SOLVING(The Royal Marsden Manual of Clinical Nursing Procedures 2004)Please refer to Section Five regarding the process for specific religions and culturesPROBLEMDeath occurring within 24 hours of anoperationUnexpected deathSUGGESTED ACTIONAll tubes and/or drains must be left in position. Spigotany cannulae or catheters. Treat stomas as openwounds. Leave any endotracheal or tracheostomytubes in place. Post-mortem examination will berequired to establish the cause of death. Any tubes,drains etc. may have been a major contributing factorto the death.As above. Post-mortem examination of the body willbe required to establish the cause of death.Unknown cause of deathAs above.Patient brought in already deceased. As above, unless patient seen by a medicalpractitioner within 14 days before death. In thisinstance the attending medical officer may completethe death certificate if he/she is clear as to the cause ofdeath.Patient with leaking wounds/orifices withor without infection present.Patient with hepatitis B, CJD, vCJD orwho is HIV positive.Patient who dies after receiving systemicradioactive iodine.Patients who die after insertion of goldgrains, colloidal radioactive solution,Caesium needles, caesium applicators,irridium wires or irridium hairpins.Relatives not present at the time of thepatient’s death.Relatives want to see the body afterRemoval from the ward(See also section of this policy -Mortuary)For further information please refer to the trustIsolation policy, which is accessible on theintranet.For further information refer to Ch.35, Radioactivetherapy: unsealed sources.Inform the physics department as well as appropriatemedical staff. Once a doctor has verified death, thesources are removed and placed in a lead container.A Geiger counter is used to check that all sourceshave been removed. This reduces the radiation riskwhen completing the last offices procedures. Recordthe time and date of removal of the sources.Inform the relatives as soon as possible of the death.Consider also that they may want to view the bodybefore last offices are completed. (see Section 5)Inform the mortuary staff in order to allow time for themto prepare the body. The body will normally be placedin the hospital’s chapel of rest. Ask relatives if theywish for a chaplain or other religious leader toaccompany them.As required, religious artefacts should be removedfrom or placed in the viewing room. The nurse shouldcheck that the body and environment are presentablebefore accompanying the relatives into the chapel.The relatives may want to be alone with the deceasedbut the nurse should wait outside the viewing room inorder that support may be provided should therelatives become distressed. After the relatives haveleft, the nurse should contact the portering service whowill return the body to the mortuary.4/34

handling policy.) Remove all put one pillow.Support the jaw by placing a pillow or rolled uptowel on the chest underneath the jaw.Remove any mechanical aids such as syringedrivers, heel pads, etc. Apply gauze and tapeto syringe driver sites and document actions innursing documentation. Straighten limbs.Close the patient’s eyes by applying lightpressure to the eyelids for 30 seconds.Drain the bladder by pressing on the lowerabdomen.Pack orifices with gauze if fluid secretioncontinues or is anticipated. If excessiveleaking of bodily fluids occurs, considersuctioning.Exuding wounds should be covered with cleanabsorbent dressing and secured with anocclusive dressing (e.g. Tegaderm)Remove drainage tubes etc., unless otherwisestated. Open drainage sites may need to besealed with an occlusive dressing. (e.g.Tegaderm)Wash the patient unless requested not to doso for religious or cultural reasons (pleaserefer to section on individual faiths in this file).If necessary shave a male patient.2 – 6 hours after death with full intensity within48 hours and then disappearing within another48 hours.To maintain patient dignity and for aestheticreasons. Closure of eyes will also provide tissueprotection in case of corneal donation.Because the body can continue to excrete fluidsafter death.Leaking orifices pose a health hazard to staffcoming into contact with the body.The dressing will absorb any leakage from thewound site. Open wounds pose a health hazardto staff coming into contact with the body. If apost mortem is required existing dressing shouldbe left insitu and covered.Open drainage sites pose a health hazard tostaff coming into contact with the body. If a postmortem is required drainage tubes etc., shouldbe left insitu.For hygienic and aesthetic reasons. As a markof respect and a point of closure in therelationship between nurse and patientIt may be important to family or carers to assistwith the washing, to continue to provide thecare given in the period before the deathClean patient’s mouth with a foam stick toremove any debris and secretions. Cleandentures and replace them in the mouth ifpossible.Remove all jewellery, in the presence ofanother nurse, unless requested by thepatient’s family to do otherwise. Jewelleryremaining on the patient should bedocumented on the ‘notification of death’ form.Record the jewellery and other valuables inthe patient’s property book and store the itemsaccording to local policy.Dress the patient in personal clothing or ashroud, depending on hospital policy orpartner / relatives wishes.Label one wrist and one ankle with anidentification label. Complete any documentssuch as notification of death cards. Copies ofsuch cards are usually required (refer tohospital policy for details). Tape one securelyto shroud.It is an expression of respect and affection, partof the process of adjusting to loss andexpressing grief.For hygienic and aesthetic reasons. To maintainprivacy and dignity.To meet with legal requirements and partner /relatives wishes.(See Section 4 - lilac section)For cultural or religious reasons and to meetwith family’s and / or carers wishes.To ensure correct and any easy identification ofthe body in the mortuary.Wrap the body in a mortuary sheet , ensuring To avoid possible damage to the body during6/34

that the face and feet are covered and that alllimbs are held securely in position,Secure the sheet with tape.Place the body in a sheet and then a body bagif leakage of body fluids is a problem or isanticipated, or if the patient has certaininfectious diseases. (See Section 8 - greensection)Tape the second notification of death card tothe outside of the sheet (or body bag)Request the portering staff remove the bodyfrom the ward and transport to the mortuary.Screen off area where removal of the body willoccur.Remove gloves and apron. Dispose ofequipment according to local policy, and washhands.Record all details and actions within thenursing documentation.Transfer property, patient records etc. to theappropriate administrative department. (SeeSection 4 - lilac section)transfer and to prevent distress to colleaguese.g. portering staff.Pins must not be used, as they are a health andsafety hazard to staff.Actual or potential leakage of fluid, whetherinfection is present or not, poses a health hazardto all those who come into contact with thedeceased patient. The sheet will absorb excessfluid.For the ease of identification of the body in themortuary.Decomposition occurs rapidly, particularly in hotweather and in overheated rooms. Manypathogenic organisms survive for some timeafter death and so decomposition of the bodymay pose a health and safety hazard for thosehandling the body. Autolysis and growth ofbacteria are delayed if the body is cooled.Avoid causing unnecessary distress to otherpatients, relatives and staff.To minimise risk of cross infection andcontamination.To record the time of death, names of thosepresent, and names of those informed.The administrative department cannot begin toprocess the formalities such as the deathcertificate or the collection of the property by thenext of kin until the required documents are in itspossession.7/34

SECTION FOUR - PROCEDURES FOR MANAGEMENT OF ADMINISTRATIVEPROCESSES BY NURSING STAFF FOLLOWING PATIENT DEATHINTRODUCTIONThis policy applies to all wards and departments in the Macclesfield District GeneralHospital. Different procedures apply in Congleton War Memorial Hospital and Knutsford &District Community Hospital (please see section 8).In order to ensure good communication between the wards and General Office, theseprocedures seek to address the issues ensuing from the paperwork needed when a patientdies. This policy does not cover procedures relating to the actual nursing management ofdeath.1 FOLLOWING THE DEATH OF A PATIENTThe nurse caring for the patient post death should inform general office on ext. 1107as soon as possible that a death has occurred (if necessary, leaving a message onthe answer phone).2 IDENTITY BAND / NOTIFICATION OF DEATH FORMS / SHEET TICKETS2.1 Wrist and ankle identity bands must be checked that they contain the correct patientidentifiers. (see Policy and Procedure for Hospital In-Patients 2007) The notificationof death form is completed in duplicate. The top copy is fastened to the front of thecasenotes. The second copy remains in the book and not sent to Mortuary via porterwith the deceased.2.2 Three sheet tickets are completed, one is specifically designated for the front of theshroud, one is designated for the front of the sheet covering the body and a copyremains in the booklet. Any jewellery must be noted on the sheet/shroud ticket. E.g 1ring/ 1 chain/ 1pr earrings. It is essential to ensure that the list is accurate andcomplete as missing items lead to allegations of theft. To avoid items being removedby the family the list should be checked and attached as the body is wrapped.2.3 In order to prevent errors in the identification of deceased patients, her Majesty’sCoroner for Cheshire requires a Confirmation of Personal Details form (availablefrom the print room CPY 639) to be completed by the nurse performing last offices. Itis an addition to the above procedures.3 PROPERTY OF DECEASEDThis is listed in the patient's personal effects record, signatures are required. (SeeValuables and Property Policy). One witness must be a trained nurse. Carefulrecords of any items removed from the deceased by the family should be recordedas it is not unknown for there to be disputes over the possession of family heirlooms.o The property must be placed in patient’s property bags. Each bag must be clearlymarked with deceased patient’s name and ward number.o The top copy of the personal effects record must be stuck with sellotape in aprominent position either on one of the bags or fastened to the front of the notes withthe notification of death form.8/34

o You must note whether the patient has had valuables/cash in safe custody either inthe ward safe or cash office. Please check the property disclaimer form for details.o Please check locker and all pockets of pyjama trousers. These may hold cash, keysetc. Do not forget teeth, hearing aid etc. (Please put clean teeth in mouth ofdeceased when possible.)o Property must not be placed in any other bag eg supermarket bags. It is aninsensitive thing to do as the property remains in the bags and handed to grievingpartner / relatives as packed.o The personal effects and case notes are collected from the ward by a porter anddelivered to General OfficeLISTING PROPERTY4.1 ExceptionsAll property, valuables and cash are listed, with the exception of opened cordial andfizzy pop bottles and perishable foods e.g. fruit. These remain on the ward fordisposal.4.2 Soiled linenIf linen/clothes are dirty/soiled, using gloves, please seal in a waterproof bag(available on wards). Do not place inside the patient's property bag, as relatives aregiven the option of taking soiled items home. If they are hidden and there is a delayin the property being collected, they start to become smelly and unpleasant for thegeneral office staff to deal with.4.3 Valuables/jewelleryValuables on the patient at time of death must be recorded.Please leave all rings on the body insitu and list on the shroud ticket. Pleaseremove neck chains, bracelets, ear rings and watches and place in a clearly marked,green patient’s property envelope, and record in the valuables section on thepatient’s personal effects record, duly witnessed and taken to the General Office.Please respect the wishes of the family as to what is removed or left on the body.4.4 Purses/walletsContents of purses/wallets must be listed in the ‘valuables’ section of patientspersonal effects record. Hospital Rules “Standing Financial Instructions” state thatamounts over £20 must go to the Cash Office, and recorded in the Valuables Bookused for the Cash Office. Therefore all cash over £20 must not be sent to GeneralOffice with the jewellery etc but to the cash office.5 POST MORTEMNurses must not inform relatives / partner that paperwork will be ready at anytime. Advise relatives / partner to ring the General Office on 01625 661107, as apost mortem may need to be held. A death certificate cannot be issued if the coronerrequests a post mortem. If a post mortem is deemed necessary for any otherreason, a death certificate may be issued with an endorsement that furtherinformation may be issued after the post mortem. General Office will advise thefamily regarding the Coroner, Death and Cremation certificates but this may notnecessarily be until the next working day. On occasions because a death issuspicious the Police may become immediately involved.9/34

PLEASE NOTE: It is the doctor’s decision, with awareness of the legal requirementsof the coroner, to decide whether or not the case should be referred or at leastdiscussed with the coroner. It is also the medical team’s decision, if it is not acoroners case to decide if a post mortem would be appropriate. The coroners officeis open 7.30 am – 3.00 pm weekdays (please see page 19 for contact numbers).6 VIEWING OF THE BODY - SEE ALSO SECTIONS 6(3) & 6(4)Only the partner or relatives are allowed to visit to view the body. Please do not givetimes for relatives to visit the mortuary, or advise them that ad hoc visiting bepermitted. An appointment MUST be made in advance during office hours with themortuary staff on 01625 661847 or through the General Office. General Office(ext.1107) may advise if restrictions have been placed on the viewing. The partner orrelatives may be required to formally identify the body to a police officer.Outside office hours the bed managers/night sisters may be contacted. All otherarrangements for viewing by friends must be arranged with the undertaker.Mortuary staff are available ‘on call’ via the switchboard.10/34

SECTION FIVE – GUIDELINES - REQUIREMENTS FOR PEOPLE OF DIFFERENTRELIGIOUS FAITHSThe United Kingdom today is a multicultural, multi-racial and multi-religious society. Thisoffers a great challenge to all areas of health care, but none more so than nursing. It isincumbent upon nurses to be aware of the different religious and cultural rituals, whichaccompany the death of a patient. Nurses are also required to possess the informationpertinent to the legal requirements for the care of the dead.The subject of ‘death with dignity’ has received much prominence of late in the health carepress (Hayes & van der Poel, 1990; Helman, 1990; Green & Green, 1992) and rightly so, forit is the execution of last offices with care and dignity that concludes the care which hasbeen offered. From the viewpoint of many bereaved relatives, the way that a deceasedloved one is treated forms an important part of their memory of a hospital’s care.It is essential then that the correct procedures are followed during last offices, and that everyeffort is made to accommodate the wishes of patients’ partner or relatives (Neuberger, 1978:Olivant, 1986; Hospital chaplaincies Council, 1992; Speck, 1978). This is central to theconcept of holistic care for the patient, and if we disregard such procedures for our patients,we also disregard both patients’ and families’ dignity (McGilloway & Myco, 1985; Wald,1986; Speck, 1988; Spector, 1991).The following are only guidelines, taken from the Manual of Clinical Nursing Procedures(2004): individual requirements may vary even among members of the same faith. Varyingdegrees of adherence and orthodoxy exist within all the world’s major faiths. The givenreligion of a patient may occasionally be offered to indicate an association with particularcultural and national roots, rather than to indicate a significant degree of adherence to thetenets of a particular faith.For further information, please refer to the booklet Privacy, Dignity, Religious and CulturalBeliefs that is available on the ward.11/34

BAHAI1 Bahai relatives may wish to say prayers for the deceased person, but normal lastoffices performed by nursing staff are quite acceptable.2 Bahai adherents may not be cremated or embalmed, nor may they be buried morethan an hour’s journey from the place of death. A special ring will be placed on thefinger of the patient, which should not be removed.3 Bahais have no objection to post-mortem examination and may leave their bodies toscientific research or donate organs if they wish.Further information can be obtained from the nearest Assembly of the Bahais (seetelephone directory).Alternatively contact:National Spiritual Assembly of the Bahais of the United Kingdom27 Rutland GateLondon SW7 1PDTelephone: 020 7590 8792BUDDHISM1 There is no prescribed ritual for the handling of the corpse of a Buddhist person, socustomary laying out is appropriate. However, a request may be made for aBuddhist monk or nun to be present.2 As there are a number of different schools of Buddhism, relatives should becontacted for advice as some sects have strong views on how the body should betreated.3 When the patient dies, inform the monk or nun if required (the patient’s relatives oftentake this step). The body should not be moved for at least one hour if prayers are tobe said.4 The patient’s body should be wrapped in an unmarked sheet.5. There are unlikely to be objections to post-mortem examination and organ donation,although some Far Eastern Buddhists may object to this.6. Cremation is preferred.For further information contact:The Buddhist Hospice TrustP O Box123AshfordKent TN24 9TF12/34

CHRISTIANITY1 There are many denominations and degrees of adherence within the Christian faith.In most cases customary last offices are acceptable.2 Relatives may wish staff to call the hospital chaplain, or minister or priest from theirown church to either perform last rites or say prayers.3 Some Roman Catholic families may wish to place a rosary in the deceased patient’shands and/or a crucifix at the patient’s head.4 Some orthodox families may wish to place an icon (holy picture at either side of thepatient’s head.For further information, consult the telephone directory for the local denominationalminister or priest.Alternatively contact:Hospital Chaplaincies CouncilChurch HouseGreat Smith StreetLondon SW1 3NZTel: 020 7898 1894HINDUISM1 If required by relatives, inform the family priest or one from the local temple. Ifunavailable, relatives may wish to read from the Bhagavad Gita or make a requestthat staff read extracts during the last offices.2. The family may wish to carry out or assist in last offices and may request that thepatient is dressed in his or her own clothes. If possible, the eldest son should bepresent. A Hindu may like to have leaves of the sacred Tulsi plant and Ganges waterplaced in his/her mouth by relatives before death. It is therefore imperative thatrelatives are warned that the patient's death is imminent. Relatives of the same sexas the patient may wish to wash his or her body, preferably in water mixed with waterfrom the Ganges. If no relatives are present, nursing staff of the same sex as thepatient should wear gloves and apron and then straighten the body, close the eyesand support the jaw before wrapping in a sheet. The body should not be washed. Donot remove sacred threads or jewellery.3. The patient's family may request that the patient is placed on the floor and they maywish to burn incense.4. The patient is usually cremated as soon as possible after death. Post-mortems areviewed as disrespectful to the deceased person, so they are only carried out whenstrictly necessary. Consult the wishes of the family before touching the body.For further information contact the nearest Hindu templeGita Bhavan Temple (Manchester) Tel 0161 861 0606or:National Council of Hindu Temples (UK)40 Stoke RowCoventry CV2 4JP Tel 0121 622 6946JAINISM13/34

1 The relatives of a Jainist patient may wish to contact their priest to recite prayers withthe patient and family.2 The family may wish to be present during the last offices, and also to assist withwashing. Not all families will want to perform this task, however.3 The family may ask for the patient to be clothed in a plain white gown or shroud withno pattern or ornament and then wrapped in a plain white sheet. They may providethe gown themselves.4 Post-mortems may be seen as disrespectful, depending on the degree of orthodoxyof the patient. Organ donation is acceptable.5 Cremation is arranged whenever possible within 24 hours of death.6 Orthodox Jainists may have chosen the path of Sallekhana, that is, death by ritualfasting. Sallekhana is rarely practised today although it may still have an influence onthe Jain attitude to death.For further information contact:The Institute of JainiologyUnit 18, Silicon Business Centre26 Wandsworth RoadGreenfordMiddlesexUB6 7JZTele: 020 8997 2300JEHOVAH’S WITNESS1 Routine last offices are appropriate. Relatives may wish to be present during lastoffices, either to pray or to read from the Bible. The family will inform staff shouldthere be any special requirements, which may vary according to the patient’s countryof origin.Jehovah's Witnesses usually refuse post-mortem unless absolutely necessary.Organ donation may be acceptable.Further information can be obtained from the nearest Kingdom Hall (see telephonedirectory) or:The Medical DeskThe Watch Tower Bible and Tract SocietyWatch Tower HouseThe RidgewayLondon NW7 1RN14/34

JUDAISM1. The family will contact their own Rabbi if they have one. If not, the hospitalchaplaincy will advise. Prayers are recited by those present.2. Traditionally the body is left for about 8 minutes before being moved while afeather is placed across the lips and nose to detect any signs of breath.3. Usually close relatives will straighten the body, but nursing staff are permitted toperform any procedure for preserving dignity and honour. Wearing gloves, thebody should be handled as little as possible but nurses may:Close the eyesTie up the jawPut the arms and hands straight by the side of the body leaving the hands open.Straighten the patient's legs.Remove tubes and instruments unless contraindicated4. Patients must not be washed and should remain in the clothes in which they died.The body will be washed by a nominated group, the Holy Assembly, whichperforms a ritual purification.5. Watchers stay with the body until burial (normally completed within 24 hours ofdeath). In the period before burial a separate non-denominational room isappreciated, where the body can be placed with its feet towards the door.6. It is not possible for funerals to take place on the Sabbath (between sunset onFriday and sunset on Saturday). If death occurs during the Sabbath, the body willremain with the watchers until the end of the Sabbath. Advice should be soughtfrom the relatives. In some areas, the Registrar's office will arrange to open onSundays and Bank Holidays to allow for the registration of death where speedyburial is required for religious reasons. The Jewish Burial Society will knowwhether this service is offered in the local area.7. Post mortems are permitted only if required by law. Organ donation issometimes permitted.8. Cremation is unlikely but some non-orthodox Jews are now accepting this inpreference to burial.For further information:Reform Synagogues of Great Britain (Reformed)80 East End RoadLondon N3 2SYTel: 0208 349 4731The Office of the Chief Rabbi (Orthodox) Reform Synagogue of Great Britain735 High Road The Sternberg Centre for JudaismNorth Finchley80 East End RoadLondonFinchleyWC1N 9HNLondon N3 2SYTel: 020 8343 6301 Tel: 020 8349 4731MORMON (CHURCH OF JESUS CHRIST OF THE LATTER DAY SAINTS)15/34

1 There are no special requirements, but relatives may wish to be present during thelast offices. Relatives will advise staff if the patient wears a one or two piece sacredundergarment. If this is the case, relatives will dress the patient in these items.MUSLIMFor further information contact:The nearest Church of Jesus Christ of the Latter Day Saints (See telephonedirectory). orThe Church of Jesus Christ of Latter Day Saints751 Warwick RoadSolihullWest Midlands B91 3DQTel: 0121 712 11451 Where possible the patient’s bed should be turned so that their body (head first) isfacing Mecca. If the patient's bed cannot be moved, then the patient can be turnedon to their right side so that the deceased's face is facing towards Mecca.2 Many Muslims object to the body being touched by someone of a different faith oropposite sex. If no family is present, wear gloves and close the patient’s eyes,support the jaw and straighten the body. The head should be turned to the rightshoulder, and the body covered with a plain white sheet. The body should not bewashed nor the nails cut.3 The patient’s body is normally either taken home or taken to a mosque as soon aspossible to be washed by another Muslim of the same sex. Burial, never cremation,is preferred within 24 hours of death.4 Post-mortems are only allowed if required by law, and organ donation is not alwaysencouraged although in the UK, a Fatwa (religious verdict) was given by the UKMuslim Law Council which now encourages Muslims to donate organs.For further information contact:London Central Mosque Trust Ltd146 Park RoadLondon NW8 7RGTel: 020 7742 3363Islamic FoundationMarkfield Dawah CentreRatby LaneMarkfieldLeics LE67 9RNTel: 01530 244944RASTAFARIAN1 Customary last offices are appropriate, although the patient’s family may wish to bepresent during the preparation of the body to say prayers.16/34

2 Permission for organ donation is unlikely and post-mortems will be refused unlessabsolutely necessary.For further information contact:Rastafarian Advisory Centre290-296 Tottenham High RoadLondon N15 4AJTel: 020 8808 2185SIKHISM1 Family members (especially the eldest son) and friends will be present if they areable.2 Usually the family takes responsibility for the last offices, but nursing staff may beasked to close the patient's eyes, straighten the body and wrap it in a plain whitesheet.3 Do not remove the 5Ks which are personal objects sacred to the Sikhs:Kesh - do not cut hair or beard or remove turbanKanga - do not remove the semi-circular comb, which fixes the uncut hairKara - do not remove bracelet worn on the wristKaccha - do not remove the special shorts worn as underwearKirpan - do not remove the sword; usually a miniature sword is worn4 The family will wash and dress the person’s body.5 Post-mortems are only permitted if required by law. Sikhs are always cremated.6 Organ donation for transplant is permitted but some Sikhs refuse this, as they do notwish the body to be mutilated.For further information contact the nearest Sikh temple or Gurdwara (see telephonedirectory)Alternatively contact:Sikh Missionary Society UK or Sikh Temple Charity Organisation10 Featherstone Road Tel: 01254 581965Southall.Middlesex. UB2 5AATel: 020 8574 1902ZOROASTRIAN (PARSEE)1 Customary last offices are often acceptable to Zoroastrian patients.2 The family may wish to be present during, or participate in, the preparation of thebody.17/34

3 Orthodox Parses require a priest to be present, if possible4 After washing, the body is dressed in the Sadra (white cotton or muslin shirtsymbolising purity) and Kusti (girdle woven of 72 strands of lamb's wool symbolisingthe 72 chapters of the Yasna (Liturgy)).5 Relatives may cover the patient’s head with a white cap or scarf.6 It is important that the funeral takes place as soon as possible after death.7 Burial and cremation are acceptable. Post-mortems are forbidden unless required bylaw.8 Organ donation is forbidden by religious law.For further information contact:The Zoroastrian Information Centre88 Compayne GardensLondon NW6 3RUTel: 020 7328 6018In addition to the addresses given above, further information is available from:The Shap Working Party on World Religions in EducationThe National Society’s RE Centre23 Kensington SquareLondon W8 5HN Tel: 0207 937 722918/34

SECTION SIX – RELEASE OF BODIES6.1 RELEASE OF BODIES OUT OF HOURSSuch requests will only be considered in exceptional circumstances in order to comply withspecific religious customs where the body is required urgently. These customs DO NOToverride English Law and so the Hospital Manager must be certain that the following appliesBEFORE giving permission to release:DEATH IN THE HOSPITAL1. That the death is not required to be reported to the Coroner. If there is any doubt, theCoroner MUST be contacted. Tele: 01925 442478/442479, 07730 075820 or SeniorCoroner’s Officer - 01925 442471 and a release note from the Coroner issued beforerelease of body. The Coroner’s office is open 7.30 am – 3.00 pm weekdays. Thecoroner can be contacted 24 hours a day for urgent advice.2. All documentation relating to the death must be available and SIGNED.These include:a. Death Certificate *b. Hospital Release note *c. Cremation forms (signed by two doctors) if applicable *d. Mortuary Register* a, b & c are available by arrangement with General OfficePlease contact Switchboard (ext 1999) who will advise out of hours contact telephonenumbers for the General Office staff in order to complete the above paperwork.3. If all the required documentation is available and the Manager is prepared to releasethe body, the Mortuary Technician on-call MUST be contacted (via switchboard) andrequested to attend and supervise the release of body once a Funeral Director hasbeen contacted and an estimated time of arrival agreed.4. The body MUST be transferred to the Mortuary prior to release so that theappropriate official records can be completed and signed.5. On NO ACCOUNT should any release be undertaken by hospital portering staff.6.2 GUIDELINES FOR DEATHS IN THE ACCIDENT & EMERGENCY DEPARTMENTAfter discussion with Her Majesty's Coroner for Cheshire, it has been agreed that in caseswhere:1. The cause of the death is natural and known: either a doctor in the A & E or thepatient's GP can issue a medical certificate of death. It is not necessary for the police orcoroner's officer to be called to attend. For example where a patient arrives at the A & Edept with chest pain, is diagnosed as having had a Myocardial Infarction and who diesshortly afterwards.In all such cases, the medical notes, a copy of the A & E notes and the Notification ofDeath should be sent as soon as possible to the General Office, via the Porters only,NOT in the internal mail system for the Coroners Officer to deal with the following day at19/34

09.00 hours. The doctor involved should advise general office (ext 1107 leaving his/hername and bleep number), as to whether or not a death certificate is to be issued.It is hoped that in these cases this procedure will remove the need for relatives to wait fora police officer to attend: the deceased can be moved more quickly to the mortuary andbooked in to the register by the porters as when dealing with a ward death.2. If the cause of death is unknown or is unnatural: doctors CANNOT issue a MedicalCertificate of Death. A Coroner's Post mortem may need to be carried out. The policemust be informed by contacting the police control room on 01625 610000. Police willattend.3. For any death in A & E that has occurred within 30 days of an operation, an incident formmust be completed.6.3 DEATH IN THE HOME AND BROUGHT TO THE MORTUARY VIA A & EThese are normally reported to the Coroner even if the GP is able to sign the deathcertificate or the hospital doctor in A & E is able to. The same procedures are to be followed:1. If GP is able to sign death certificate, contact Coroner on 07730 075820OR2. If doctor in A & E is able to sign certificate (in General Office), contact Coroner asabove.3. Release note received from the Coroner.4. Contact Registrar of Births, Deaths and Marriages on call via switchboard betweenthe times of 9.00am to 4.30pm.5. Family to contact Funeral Director of their choice and an estimated time of arrivalobtained.6. Mortuary Technician on call to be contacted via switchboard to attend release detailswith documentation.7. If a post mortem is required to be performed, it will be on the first working day. Thepolice must be informed by contacting the police control room on 01625 610000.Police will attend.8. For any death in A & E that has occurred within 30 days of an operation, an incidentform must be completed.See also section 76.4 PROCEDURE FOR ENSURING CORRECT IDENTIFICATION OF DECEASEDPRIOR TO VIEWING BY RELATIVESInformation required by portering staff to ensure correct body details to include:o Nameo Date of birtho AddressPortering staff must check body identification on removal of deceased from storage.Body to be placed in viewing room only when correct identity has been ascertained.20/34

Individual taking relatives /friends to view body must first:o Check with relative's name of deceasedo Check information on shroud ticketo Ensure body is in a condition that would not cause undue distress to relative.o If there is any doubt regarding appropriateness of viewing, e.g. state of body,contact on call mortuary technician (via switchboard) to discuss.6.5 OUT OF HOURS VIEWINGOnly the next of kin, close relative or carer will be allowed to view the deceased out of hoursand at weekends.If visitors arrive unexpectedly at reception, the Bed Manager/Night Sister is contacted whowill use their discretion as to whether the viewing will go ahead.If they telephone, the Bed Manager/Night Sister again will assess the situation.Occasionally, the next of kin will object to certain members of the family visiting. In this case,hopefully they will already have left these instructions with the mortuary staff or the Police. Ifin any doubt, contact the next of kin.If other visitors telephone or arrive, they should be requested to make an appointment withthe mortuary staff between Monday to Friday, 9 am to 4 pm.If the Police request a viewing for identification purposes and the deceased needs to bemade more presentable, the technician on call will come in if notified via switchboard.21/34

SECTION SEVEN – MORTUARY DEPARTMENTCONGLETON WAR MEMORIAL HOSPITAL (Aston Ward) and KNUTSFORD &DISTRICT COMMUNITY HOSPITAL (Tatton Ward): Local procedures are in force, pleasecontact the wards directly.MACCLESFIELD DISTRICT GENERAL HOSPITAL: This department is provided to allow: Temporary storage of deceased patients prior to removal by funeral directors Post-mortem examinations to be carried out at the request of relatives or HM Coroner Viewing of deceased patients by their partner or relativesHOURS: The department is routinely staffed from:8 am - 4.30 pm Monday to Friday. Outside these times the technicians are available toprovide advice and assistance on an on-call basis (contact via the hospital switchboard).VIEWING DECEASED PATIENTS BY RELATIVES:During normal working hours contact the mortuary direct (tel ext 1847) to arrange anappointment.Out of hours viewing are arranged via the bed managers, however if additional assistance isrequired contact the technician on call.RELEASE OF BODIES:This will only be permitted when all documents have been completed and, in cases ofsudden death, where there is no need for the involvement of HM Coroner.Bodies will only be released to funeral directors and this must take place via mortuary.For releases out of hours the Bed Manager/Night Sisters must ensure that all relevantdocumentation is available and signed (see Release of Bodies Out of Hours protocol - seepink pages following this section). The Bed Manager/Night Sisters must contact themortuary technician on-call and request that they attend to supervise the release procedure.POST-MORTEM EXAMINATIONS:These are ALWAYS carried out in a respectful manner and with regard for the feelings ofbereaved relatives. The standards used during the examination are those set by the RoyalCollege of Pathologists.Initially the pathologist carries out a careful examination of the body. Photographs and X-rays are sometimes taken for more detailed study. The internal part of the examination thenbegins. An incision is made down the front of the body and internal organs are removed for adetailed examination. If the brain is to be examined an incision is made in the hair at thebase of the head. If the examination requires particular body parts or organs to be kept forsome time in the case of hospital post-mortems, partners or relatives will be asked for writtenagreement to this.With Coroner post-mortems consent is provided by HM Coroner whose officer will informrelatives of the need for such removal and obtain signed consent from the relativesregarding their wishes for subsequent disposal of these organs.Benefits Of A Post-Mortem Examination:22/34

The examination can give valuable information about an illness, its effect on the body andmay explain why a patient died. This information may make it easier for other familymembers to come to terms with the death.Post-mortem examinations can also provide valuable information, which can help doctors totreat other patients with the same kind of illness and can provide vital information forresearch.REASONS FOR HOSPITAL DEATHS TO BE REPORTED TO THE CORONER The cause of death is unknown or unclear. The doctor did not treat /attend the deceased in their last illness, or if they did arecurrently not available. The Registration Regulations cannot be satisfied for some other reason e.g. thename of the deceased is unknown. The deceased has not been seen by a doctor within the 14 days previous to theirdeath. Died within 24 hours of admission. The death was due to violence,unnatural, suspicious or unexpected. Death due to suicide attempt, drug or solvent abuses. Had an operation within the last 12 months (this could be any invasive procedure). Death as a result of injuries due to an accident or has a complication of theseinjuries, no matter when the accident occurred. (The year and a day rule no longerapply.) Suffered a fracture within the last 12 months. If the death is due to self neglect or neglect by others including poor care in aresidential or nursing home. The death may be due to an abortion. The death may be due to an industrial disease ie Asbestosis, or related to theiremployment or the deceased was in receipt of industrial/disablement pension or awar pension, even if the death does not appear to be related to the pensionablecondition. The death occurred during an operation or before recovering from an anaesthetic orif it linked to an operation, or any other medical procedure. The death may be due to lack of medical care or allegations of medicalmismanagement have been made. The death (whether natural or not) occurred while under arrest or during or shortlyafter detention in Police or prison custody. If a prisoner dies in hospital he is still incustody.CORONERS – GENERAL INFORMATION:To report deaths or to seek advice during the hours of 7.30 am to 3.00 pm, Monday toFriday, telephone 01925 442470 or 01925 442480Alternatively, telephone the Coroners office in Warrington on 01925 444216.answerphone is available for out of hours messages.AnTo report deaths at all other times telephone Police Control on 01244 350000.23/34

SECTION EIGHT - INFECTION PREVENTION & CONTROLHospital Guidelines on the precautions to be taken with the bodies of thosewho have died with a known or suspected infection1. INTRODUCTIONOpinion differs among health care workers on the management of a body associated withan infection and the measures taken or advised to control the perceived hazards areoften insensitively applied. The indiscriminate use of body bags may cause needlessanxiety for the bereaved family, friends and also among the hospital staff.Grieving is essential for the healing process and in some religions and cultures it mayrequire special rituals including washing the body and kissing. Not allowing the last rites tobe performed before placing the body in a plastic bag or sheet may cause deepresentment. Partners or relatives should be asked about their wishes before bodypreparation is commenced.The safety of all persons who may come in contact with a body associated with an infectionmust always be given high priority and this is covered in various Acts of Parliament and byRegulations made under these Acts. There should be a balance between what is requiredfor safety and the sensitivity and dignity of the bereaved.Not all cases of infection will have been identified before death and for this reason it isstrongly recommended that high standards are adopted for the handling of all bodies.2. SPREAD OF INFECTIONOrganisms in a dead body are unlikely to infect healthy people with intact skin, but there areother ways they may be spread.a. Needlestick injuries with a contaminated instrument or sharp fragment of bone.b. Contaminated aerosols or splashes from body openings or wounds.c. Aerosol from lungs, eg. tubercle bacilli when condensation could possibly be forcedout through the mouth.d. Intestinal pathogens from anal and oral orifices.e. Through and from abrasions, wounds and sores on the skin.f. Splashes or aerosols onto the conjunctivae.The risks of infection are not high (and no more than in life) and are usually prevented bythe use of appropriate protective clothing and the observance of COSHH (2002)regulations.If a risk of infection is known or suspected, certain procedures need to be followed (seeAppendix I and II).3. COMMUNICATION24/34

If a person has died with a known or suspected infection, it is essential and a legalresponsibility, that all persons who may be involved in handling the body are informed of thepotential risk of infection. They should be told of the risks but not the specific diagnosis asthis remains confidential, even after death. The persons who need to know include:a. In Hospital: ward staff, porters, mortuary staff, the bereaved relatives and the funeraldirectors.b. At Home: the nurse laying out, bereaved relatives and the funeral directors.c. Elsewhere: emergency services staff will usually take the same universal precautionsfor handling all bodies.The funeral directors should inform the relatives, in writing, of any risks.It is important that good liaison is maintained between staff on the wards, microbiology andhistopathology laboratories, portering and mortuary departments, the undertaker, the nextof kin and the Consultant Microbiologist. Communication between mortuary staff andfuneral directors is particularly important. Co-ordinating of viewing, hygienic and ritual bodypreparation and then bagging of the deceased in the ward, examination or storage in themortuary and, finally, collection for disposal by the funeral directors and any further hygienicpreparation or embalming that is to be done.4. LAST OFFICESThe most final act of care for a patient is that of laying out. It is necessary to be mindful ofany infection risks and the precautions necessary to protect others. Mortuary staff and/orfuneral directors must be informed if the patient was receiving specific infection controlnursing other than for antibiotic resistant organisms or protective isolation. Use a Biohazardlabel.Nursing staff performing the last offices must follow the same working practices as whenthe patient was alive as stated in the Infection Prevention & Control Good Practices Policy.When preparing the body consideration must be given to control the loss of blood and orbody fluids. Last offices should therefore include: Check identification band is on wrist. Cleaning the body of any soiling and body fluids, including nasal and oral cleansingalso putting in cleaned dentures. Observing the body for wounds and puncture sites and applying waterproof pressuredressings wherever practicable. If the death is to be referred to the coroner, newly introduced drains, intravenouslines, catheters, etc. must be left in situ. Tubing must be clamped, spigotted ordrainage bags attached to prevent syphoning. Plugging the mouth and nostrils, if necessary, to prevent discharges, eg. in cases ofsevere abdominal obstruction. Emptying the bladder, if necessary, by applying pressure to the abdomen.25/34

Body BagsA risk assessment must be made on the infectivity of the body prior to leaving theward/department.A body bag must be used prior to transfer of the body to the mortuary where there is:1. A high risk of infection - see Appendix I.2. Uncontrollable loss of blood or body fluids.3. No known medical history.4. No means of identifying the body.Whenever body bags are used a biohazard label must be attached to the body bag andthe body and the accompanying Notification Form (see Page 8) for the mortuary staff.Sheets MUST NOT be used on bodies placed in bags.Ensure that the relevant form is completed and placed in a sealed envelope (to ensureconfidentiality) for the attention of the mortuary technicians.Body bags and forms are available from the mortuary by request to the portering staff.There are two sizes of body bag, please request large or small according to need.Ensure the zip closure is left at the head end of the bag.Porters must be informed by the nursing staff of infected bodies. On collection of trolleyfrom Mortuary, portering staff must put on gloves. They do not need to wear specialclothing when transporting the body, but after moving the body to the mortuary andremoving their gloves, they must WASH THEIR HANDS - this is the greatest safetyfactor.26/34

THE MORTUARY STAFF MUST BE INFORMED OF THE INFECTION RISKS ASSOCIATEDWITH THIS BODY.Please complete the following:Patients Name ........................................................................................………D.O.B. .....................................................................................................….Hospital Number .........................................................................................…Ward/Department ..........................................................................................Risk of Infection ..........................................................................................…REASON FOR USE OF BODY BAG (Please tick the relevant section)NOTE Ensure that attempts have been made to control blood loss prior toplacing body in the bag.DO NOT USE A SHEET INSIDE THIS BAG.ONCE IT IS SEALED IT OUGHT NOT BE RE-OPENED.1. Risk of infection – see Appendix I. 2. Uncontrollable loss of blood/body fluids. 3. No known medical history. 4. Unable to identify patient. Signature ....................................... Print Name ........................................Date .............................................................PLACE THIS FORM IN A SEALED ENVELOPE MARKED FOR THE ATTENTION OF THEMORTUARY TECHNICIAN AND GIVE TO PORTERS REMOVING THE BODY OR PLACEIN POCKET ON BODY BAG27/34

In some cultures and religious groups, relatives expect to carry out the ritualpreparation before burial and, in most cases, this can be permitted but where arisk of infection exists, the hazard has to be assessed and appropriate advicegiven (see section 5 and Appendix I). This may mean only partial preparation andthe use of gloves and protective clothing and should be supervised.When the hygienic preparation is not done by nursing staff, funeral staff will do as much asthey can and this often includes at least partial embalming.5. BODY BAGSPlastic body bags are used for cases thought to be infective to handlers or to transportleaking or otherwise offensive bodies.Bodies cool more slowly inside a body bag, facilitating decomposition and making hygienicpreparation more difficult. It may only be possible to display the head for viewing and thismay cause additional distress to the bereaved.Body bags should be reserved for cases where a risk assessment indicates its use isnecessary. A black and yellow biohazard label should be attached to the shroud and thebag, in addition to the identification labels (see Appendix I).6. HOSPITAL WARD STAFFNursing staff performing the last offices should adopt the same universal routine protectiveprecautions as when the patient was alive and also wear gloves and a disposable plasticapron when handling the deceased. Any surface contamination should be removed bywashing. Any wounds or leaking openings should be covered with occlusive dressings.Care must be taken to avoid contamination of any wounds or skin lesions on the workershands, and hands must be washed thoroughly at the end of the procedure. If the death isnot to be reported to the Coroner, then all drains, catheters and intravenous lines should beremoved. Ensure that adequate occlusive dressings are applied to prevent leakage of bodyfluids.The ward nurse will inform the relatives on any restrictions, emphasising that the body maybe enclosed in a bag once it leaves the ward.Relatives may be ignorant of the true nature of the infection and an individual's right toconfidentiality continues after death but, nevertheless, the bereaved relatives must beadvised on how to avoid risk of infection themselves. The certifying doctor should discussthe precautions that are advised with the relatives.If relatives wish to carry out ritual preparation of the body themselves, it should be doneunder supervision, observing the universal precautions advised.Porters must be informed by nursing staff that they are transporting an infected body. Theymust put on gloves but no other special clothing is required. The mortuary staff must alsobe advised of the risk of infection. After removal to the mortuary is completed, gloves mustbe removed and disposed of in a yellow bag and hands thoroughly washed.7. SPECIFIC INFECTIONS – Precautions to be Followed (Also see Appendix I)28/34

The Advisory Committee on Dangerous Pathogens (ACDP) in the publication Containmentof biological agents according to hazard and categories of containment (4 th ed. 1995),contains guidance on the biological agents referred to in the control of SubstancesHazardous to Health Regulations 1994.The four categories of classification of biological agents are:Group 1 – Low Risk – Unlikely to cause human disease.Group 2 – Medium Risk – can cause human disease and may be a hazard to employees;it is likely to spread to the community and there is usually effective prophylaxis or treatmentavailable.Group 3 – High Risk – can cause severe human disease and may be a serious hazard toemployees; it may be spread to the community, but there is usually effective prophylaxis ortreatment available.Group 4 – Very High Risk – causes human disease and is a serious hazard to employees;it is likely to spread to the community and there is usually no effective prophylaxis ortreatment available.Group 1 – 3 will normally be covered by policies already established by the InfectionPrevention & Control Team and will be available through the Infection Prevention & ControlManual.Group 4 will require extra ordinary precautions and will generally NOT be admitted ornursed at the MDGH, unless absolutely unavoidable. In ALL cases of suspected Group4 patients, the Infection Prevention & Control Team MUST BE INFORMEDIMMEDIATELY. During normal working hours, contact via extensions 1810, 1769, 1597,1417 or bleep 3102, 3034, 3449. Out of normal working hours via the hospitalswitchboard.Once the Team have been notified they will respond to the ward or department and givesupport and guidance to management and staff.NB. The Health Protection Agency categorise cadavers as Low, Medium, High and High(rare). For completeness, both Groups 1 – 4 and categories Low to High (rare) havebeen included in the table (Appendix I).It must always be remembered that any body has the potential to be infectious andUniversal Precautions MUST always be used as a minimum standard.LEGISLATION, GUIDANCE AND REFERENCESAdvisory Committee on Dangerous Pathogens (1995)Protection Against Bloodborne Infections in the Workplace – HIV & HepatitisAIDSLINK August/September 1990Suggested Procedure following HIV Death at Home29/34

Bahkshi S.S. (1994)Infectious Disease: Last Offices – A Model Guidance for Medical Advice to HospitalWard Staff, Funeral Directors & the PublicDraft Model Guidance of Birmingham Communicable Disease UnitBroadgreen Hospital 1989Advice to Funeral Directors when there is a possibility or certainty that a deceasedpatient had Tuberculosis, Viral Hepatitis, AIDS, Infective Diarrhoea or other seriousinfective diseaseControl of Substances Hazardous to Health Regulations 2002 (COSHH)Healing, Hoffman and Young (1995)The Infection Hazards of Human CadaversCDR Review Vol 5, Review No 5Health Service Advisory Committee, Safety in Health Service Laboratories (1991)Safe working practices and the prevention of infection in the mortuary and post-mortem rmLiverpool Health District (1996)The Infection Hazard of Human CadaverDr C M Regan, DDCD, Department of Public Health, LiverpoolPublic Health Medicine Environmental Group (1995)Guidelines on Control of Infection in Residential & Nursing Homes30/34

APPENDIX IGUIDELINES FOR HANDLING CADAVERS WITH INFECTIONSInfectionNotifiable inEngland &WalesBodyBagCategoryof riskACDPMortuary/LaboratoryViewing Embalming HygienicPreparationAnthrax Yes HR 3 No No NoChickenpox/shingles No L 2 Yes Yes YesCholera Yes M 2 Yes Yes YesCrytosporidiosis No L 2 Yes Yes YesDermatophytosis No L 2 Yes Yes YesDiphtheria Yes M 2 Yes Yes YesDysentery Yes M 2 Yes Yes YesAcute encephalitis No L 2 Yes Yes YesFood poisoning No M 2 Yes Yes YesHaemorrhagic fever with renal syndrome No M 2 Yes Yes YesHepatitis A No M 2 Yes Yes YesHepatitis B, C, and non-A, non-B Yes H 3 Yes No NoHIV/AIDS Yes M 3 Yes No NoInfluenza types A, B and C No H 2 Yes Yes YesLegionellosis No L 2 Yes Yes YesLeprosy No L 3 Yes Yes YesLeptospirosis (Weil’s Disease) No M 2 Yes Yes YesLyme Disease No L 2 Yes Yes YesMalaria No M 3 Yes Yes YesMeasles No L 2 Yes Yes YesMeningitis (except meningococcal) No L 3 Yes Yes YesMeningococcal septicaemia (with or without meningitis) Yes M 2 Yes Yes YesAdv = advisable and may be required by local health regulations * = Requires particular care during embalmingL = Low Risk M = Medium Risk H = High Risk HR = High (Rare)DefinitionsBagging: Placing the body in a plastic body bag.Viewing: Allowing the bereaved to see, touch and spend time with the body before disposalEmbalming: Injecting chemical preservatives into the body to slow the process of decay. Cosmetic work may be included.Hygienic Preparation: Cleaning and tidying the body so it presents a suitable appearance for viewing (an alternative to embalming).NB. The advice given in specific cases may be varied if the Clinician in charge/Consultant Microbiologist/ Consultant in Communicable Disease Controldecide it is appropriate after assessing the risks.

APPENDIX I Cont …..InfectionNotifiable inEngland &WalesBodyBagCategoryof riskACDPMortuary/LaboratoryViewing Embalming HygienicPreparationMethicillin resistant Staphylococcal aureus (MRSA) No L 2 Yes Yes YesMumps No L 2 Yes Yes YesOphthalmia neonatorum No L 2 Yes Yes YesOrf No L 2 Yes Yes YesParatyphoid Fever Yes M 3 Yes Yes YesPlague Yes HR 3 No No NoAcute poliomyelitis No M 2 Yes Yes YesPsittacosis No L 3 Yes Yes YesQ Fever No M 3 Yes Yes YesRabies Yes HR 3 No No NoRelapsing Fever Yes M 2 Yes Yes YesRubella No L 2 Yes Yes YesScarlet Fever Yes M 2 Yes Yes YesSmallpox Yes HR 4 No No NoStreptococcal Invasive Group A Yes H 4 No No NoTetanus No L 2 Yes Yes YesTransmissible spongiform encephalopathies Yes H 3 Yes No Yes(eg Creutzfeldt-Jakob Disease)Tuberculosis Yes M 2 Yes Yes YesTyphoid Fever Yes M 3 Yes Yes YesTyphus Yes M 3 Yes Yes YesViral Haemorrhagic Fever Yes HR 4 No No NoWhooping Cough No L 2 Yes Yes YesYellow Fever Yes HR 3 No No NoAdv = advisable and may be required by local health regulations * = Requires particular care during embalmingL = Low Risk M = Medium Risk H = High Risk HR = High (Rare)DefinitionsBagging: Placing the body in a plastic body bag.Viewing: Allowing the bereaved to see, touch and spend time with the body before disposal

APPENDIX I Cont …..Embalming: Injecting chemical preservatives into the body to slow the process of decay. Cosmetic work may be included.Hygienic Preparation: Cleaning and tidying the body so it presents a suitable appearance for viewing (an alternative to embalming).NB.The advice given in specific cases may be varied if the Clinician in charge/Consultant Microbiologist/ Consultant in Communicable Disease Controldecide it is appropriate after assessing the risks.OTHER CONDIDIONS REQUIRING BODY BAG AND WITH RESTRICTION OF CONTACT (EXCEPT TOUCHING FACE), BUT SHOULD NOT BEREMOVED FROM BAG INCLUDE: Death in dialysis unit Known intravenous drug misuser Severe secondary infection Gangrenous limbs & infected amputation sites Large pressure sores Leakage & discharge of body fluids likely Post mortem Incipient decomposition

ACTION TO BE TAKEN WHERE A DEATH OCCURS &A RISK OF INFECTION IS KNOWN OR SUSPECTEDIN HOSPITAL/COMMUNITYAT HOME/COMMUNITYDEATHRISK OF INFECTION TOOTHERSASSESSED BYCLINICIANASSESSED BYGENERAL PRACTITIONERMAY CONSULTCONSULTANTMICROBIOLOGISTMAY CONSULT CCDC ORCONSULTANTMICROBIOLOGISTAGREE RISK OF INFECTIONCATEGORY 4 CATEGORY 3 CATEGORY 2 CATEGORY 1BODY BAG TO BE USED YES ADVISED ADVISED NOBODY MAY BE REMOVEDFROM BAGNO NO YES -EMBALMING PERMITTED NO NOT ADVISED YES YESVIEWING BODY BYBEREAVEDTOUCHING BODY BYBEREAVEDFACE ONLY FACE ONLY YES YESNO NO YES YESINFORMATION TO BE PASSED ONPATIENT DIED WITH A KNOWN OR SUSPECTED INFECTION (NOT THE DIAGNOSIS)ADVICE ON PRECAUTIONS REQUIREDWHERE FURTHER INFORMATION CAN BE OBTAINED FROMFUNERAL DIRECTORSSTAFFRELATIVES/BEREAVEDHEALTH CARE STAFFNB.More detailed information, in confidence, about the risk of infection may be necessary fornursing and mortuary staff.

Equality and Human Rights Impact Assessment FormPart 1 – AIMS AND IMPLEMENTATION OF THEPOLICY/PROCEDURE/STRATEGY/SERVICE SPECIFICATION1.1 What is being assessed? Name of the policy, procedure, strategy or service specification (hereafterreferred to as ‘DOCUMENT’):Adult post death procedure1.2 Details of person responsible for completing the assessment: Name: Helen Kershaw Job title: Deputy Director of Nursing and Quality Team: Nursing1.3 What is the main purpose or aims of the document?To support staff to ensure patients receive appropriate care post death in accordance to the law and thereligion/cultural belief of the patient.1.4 Who is this document intended for?Who will need to do something differently because of this document? Who will be affected by what thisdocument covers? All staff or just a team? All patients or just those who use a particular service? Any othergroup?All staff1.5 How will the document be put into practice and who will be responsible for it?This is an updated document so already put into practice. Amendments will be highlighted throughBusiness Unit Structure.Part 2 – CONSIDERATION OF DATA AND RESEARCH2.1 Give details of RELEVANT quantitative and qualitative data or information available that givesyou an understanding of who will be affected by this documentThe 2001 census data shows a very low percentage of ethnic minority groups in this area. The localauthority Cohesia report shows that this number, although small is growing. The local demographyshows a much older population than other areas of the country.2.2 Profile of users or beneficiariesWhat have you found out using this information? Are there any key groups of people who will be affected, orwho have been over/under represented?Local BME groups as their needs post death may be different from what we are used to dealing with.2.2 Relevant consultationHaving identified key groups, how have you made sure that the document will affect them in the way thatyou intend? Have you spoken to staff groups, charities, national organisations etc?Matrons, chaplains, and end of life specialists have been consulted and there is already a bookletavailable in the trust titled, ‘Privacy, dignity, religious and cultural beliefs.’2.3 Evidence of complaints relating to this document on grounds of discrimination. (Is there anyevidence of complaints either from patients or staff (grievance) relating to the document or its effects ondifferent groups?)No, although its intention is to treat different groups differently to ensure religious views arerespected.2.4 Does the information gathered from 2.1, 2.2 and 2.3 indicate any negative impact as a result ofthis document?

NoPart 3 – ASSESSMENT OF IMPACTRACE – testing of disproportional and adverse impacta. How are racial groups reflected in the numbers of people affected by this document?The 2001 census data shows a very low percentage of ethnic minority groups in this area. The localauthority Cohesia report shows that this number, although small is growing.b. From the evidence available does the document affect, or have the potential to affect, racial groupsdifferently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentNo, it is designed to be a positive impact so that there is no negative or unlawful discrimination. Documentdoes not differentiate racial groups unless for religious purposes.GENDER (INC TRANSGENDER) – testing of disproportional/ adverse impacta. How are different gender groups reflected in the numbers of people affected by this document?May be an impact on transgender patients, but staff should already be aware of the patient’s wishes regardingdress. Similarly, the wishes of female Muslim patients should be respected regarding clothing and keepingbody parts covered as is their wish pre death.b. From the evidence available does the document affect, or have the potential to affect, different gendergroups differently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentDISABILITY – testing of disproportional and adverse impacta. How are disabled people reflected in the numbers of people affected by this document?The trust does not currently collect statistics on the number of disabled patients it treats, however, these issuesare recorded in a patient’s notes.b. From the evidence available does the document affect, or have the potential to affect, disabled peopledifferently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentAGE – testing of disproportional and adverse impacta. How are different age groups reflected in the numbers of people affected by this document?The local demography shows a much older population than other areas of the country.There is a separate policy for still birth.b. From the evidence available does the document affect, or have the potential to affect, age groupsdifferently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?

Reason/evidence/commentCHILDREN - testing of disproportional and adverse impacta. Is there a direct or indirect impact upon children? Yes No b. If yes please describe the nature and level of the impact (consideration to be given to all children;children in a specific group or area, or individual children. As well as consideration of impact now or inthe future; competing / conflicting impact between different groups of children and young people:c. If no please describe why there is considered to be no impact / significant impact on childrenPolicy is for Adults onlyLESBIAN, GAY, BISEXUAL – testing of disproportional and adverse impacta. How are people with different sexual orientations reflected in the numbers of people affected by thisdocument?The national statistics show that between 6% and 10% of the population are lesbian, gay or bisexual. The trustdoes not collect patient statistics on this at the present time.b. From the evidence available does the document affect, or have the potential to affect, LESBIAN, GAYAND BISEXUAL people differently?Yes No c.If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentPartners are included in the text alongside relatives.RELIGION/BELIEF – testing of disproportional and adverse impacta. How are people with different RELIGIONS OR BELIEFS reflected in the numbers of people affectedby this document?The 2001 census data shows a very low percentage of ethnic minority groups in this area. The local authorityCohesia report shows that this number, although small is growing. The purpose of the document is to ensurepeople of different religions are treated in the way they wish to be.b. From the evidence available does the document affect, or have the potential to affect,RELIGIOUS/BELIEF groups differently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentNo it is designed to be a positive impact so that there is no negative or unlawful discrimination.CARERS – testing of disproportional and adverse impacta. How are people with caring responsibilities reflected in the numbers of people affected by thisdocument?Many patients will have relatives, friends, carers or partners who are identified as their main contact. Thisdocument recognises the relationship between partners including same sex partners.b. From the evidence available does the document affect, or have the potential to affect carers peopledifferently?Yes No c. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/comment See a.

OTHER – Additional groups that may experience impacts - testing of disproportional and adverseimpacta. How are OTHER groups reflected in the numbers of people affected by this document?/b. From the evidence available does the document affect, or have the potential to affect, OTHER groupsdifferently?Yes No xc. If yes, do any of the differences amount to barriers, negative impact or unlawful discrimination?Reason/evidence/commentPart 4 – CONSULTATION WITH EQUALITY AND DIVERSITY LEADYou can record the results of that conversation here: Advised to think about.Part 5 - CONCLUSIONS AND RECOMENDATIONS4.1 Summary of changes implemented The requirement to refer to section 5 earlier in the document to avoid staff missing potentiallyimportant information. Partners now detailed alongside relatives.4.2 Is there anything which you think may have an adverse impact but which you have not been ableto address in writing your document? No4.3 Have you identified any work which you will need to do in the future to ensure that the documenthas no adverse impact?ActionDate to be AchievedNameLeadAll actions completed4.4 When will the document be reviewed? (Include dates for completion and officer(s) responsible.)2013Helen KershawDate completed: 7 th October 2010Signed by (Manager):Helen Kershaw