Transcript Slide 1

Death Certification
Responsibilities of nursing and other non medical
staff and the importance of getting it right
March 2015
[email protected]
[email protected]
Quality Education for a Healthier Scotland
• Background
• Death Certification Review Service
• Person-centred communication with
people who have been bereaved
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Overall aim of session
The overall aim is to:
• provide an overview of the new national
randomised system of scrutiny of medical
certificates of cause of death (MCCDs)
• that will be undertaken by the Death
Certification Review Process (DCRS), and
• to explore the ensuing implications for
practice locally
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Objectives
• Be aware of the purpose of the new Death
Certificate Review Service (DCRS)
• Understand the responsibilities for nursing
and other non medical staff in relation to this
service
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Background
• Scotland’s legislation did not reflect 21st
century life.
• Part of the recommendations arising from
the Sheriff Brodie Burial and Cremations
Review Group
• The Certification of Death (Scotland) Act
2011 received Royal Assent on the 20th April
2011
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Why?
• To introduce a single system of independent
scrutiny that is applicable to all deaths that
do not require to be reported to the
procurator fiscal, and does not include
stillbirths
• To improve the quality and accuracy of the
MCCD
• To strengthen clinical governance in relation
to death certification
• And to improve public health information
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When?
MAY 2015
WEDNESDAY
13th
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What are the changes?
• A new national review system to provide
independent checks on the quality and
accuracy of MCCDs
• An end to additional paperwork and fees for
cremations to make the process the same for
everyone, and
• A requirement that all deaths must be
registered before either a burial or cremation
can take place
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What are the changes?
(contd.)
• The review system will be undertaken by the
Death Certification Review Service under the
auspices of Healthcare Improvement
Scotland
• The Service is led by a senior medical
reviewer (SMR) working with a team of
medical reviewers (MRs), and supported by
medical reviewer assistants (MRAs)
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How are cases selected?
• National Records of Scotland (NRS) will use
computer software to randomly select MCCDs to be
reviewed by the Death Certification Review Service.
In addition, medical reviewers can ask NRS to select
MCCDs as part of a targeted review, for example, to
look at the trends of a particular condition causing
deaths
• Level 1 review – 1 working day – 10% of all deaths
• Level 2 review – 3 working days – a minimum of
1,000 deaths per year
• This will not include deaths reported to the PF or
stillbirths
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Who does this affect?
• People who have been
bereaved
• Anyone involved in
caring for the bereaved
• General public
• Everyone needs to be
aware
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Randomised Review Process Flow Chart
Death Occurs
Death Is Registered
Funeral Can take Place
Review Process Happens
MCCD is
completed by
certifying doctor
and paper copy
given to next of
kin
Case is not
selected for
review
Case Selected &
Level 2 Review
carried out
Case Selected &
Level 1 Review
carried out
Burial
MCCD to be
amended
If completed
electronically,
the MCCD
information is
transferred to
NRS and may be
selected for
review at this
point
MCCD
Accurate
Cremation
SMR Reviews the
Case
MR and certifying
doctor unable to
agree on
amendments
Certifying doctor
agrees to sign
replacement or
amendment to
MCCD
Amendments not
agreed, MCCD
released without
changes
Replacement or
amendment is
checked by the
MR or SMR & is
sent to the
Registrar
Death is sent to
the PF for
investigation
Optional
escalation process
followed (Clinical
Governance)
In the future
alternative
methods of
disposal may
become available
Additional Important Information
• Advanced Review Process:
– Request can be made for an advance registration
procedure, for example, for religious, cultural,
compassionate, or administrative reasons
• Interested Person Review:
– Certain categories of people can request an
interested person review in particular
circumstances
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Local application of DCRS
Person dies
Informant registers death – possibility
of medical certificate review process
Doctor / Nurse
discusses cause of
death with family.
Bereavement pack
given. Issue MCCD
Form 11.
Inform re possibility of
medical review
process
•Level 1 – 10% of deaths (1 working day)
•Level 2 – approx. 1000 deaths per year
(3 working days)
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Local Operational Procedure...
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Local Operational Procedure...
FVRH: MR contacts the Named Person, contact is then made with
the Doctor and he/she is asked to return the call to MR within the
agreed specified time of 4 hours
Community Hospital: MR contacts the ward direct, ward staff take
contact details then contacts the GP, message is passed to GP
to return call to the MR within the specified time
Primary Care: MR calls direct to GP practice, if GP is available
then receptionist puts call through if not message is passed to
GP to return call to MR within the specified time
• If for any reason the certifying doctor is not available (annual
leave, sick leave, night shift, part-time hours) then follow own
health board or national guidelines
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What are my responsibilities as a ...
nurse?
• Ensure the bereaved family are provided
with information about the DCRS and the
possibility that the MCCD may be selected for
a review
• Ensure the family have enough information
about what to do next- use leaflets to support
verbal communication
• Ensure the content of the MCCD has been
discussed with the family and any questions,
or concerns addressed
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What are my responsibilities as a ...
nurse? (contd.)
• Emphasise that the scrutiny process relates
to the content of the MCCD and not the care
received
• If communicating with the MR, only fact can
be communicated not opinion (as agreed by
RCN and NMC)
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What are my responsibilities as a ...
member of the healthcare team that is
contacted by the DCRS?
• Ensure timely response to any
communication with the MR
• Ensure any information requested by the MR
is submitted as a priority
• To be aware of the local systems in place
that apply for Out of Hours
• To minimise the risk of delay in funeral
planning
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Person Centeredness in
Bereavement
Key messages re communication :
• Ensure those who are bereaved are given the
opportunity to ask questions
• Address any concerns raised by taking appropriate
action
• Provide practical information including the potential
for the MCCD to be randomised for review
• Key Principle 4 highlights the importance of good
communication in bereavement care (SG 2014)
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Person Centeredness in
Bereavement (contd)
Key messages re communication :
• Consider using a model such as SPIKES (Baile
and Buckman 2000) or the Five steps approach
when speaking to people who have been
bereaved
• Provide people who have been bereaved with
information regarding the cause of death in
language they understand
• If the person collecting the death certificate is
not the next of kin - or a close relative or legal
Guardian please do not discuss the content of
the MCCD
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Suggested models:
SPIKES & Five Steps
• Setting up the interview
• Perception?
• Invitation
• Knowledge
• Emotions – Empathy
• Summary and Strategy
1. Prepare yourself
2. Make a connection
3. Give the headline
information
4. Acknowledge any shock
and identify concerns
5. Follow up with practical
advicehttp://hospicefoundation.ie
/education-training/videowall/communication/
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Summary
• The new system of scrutiny will commence from
13th May 2015
• All staff have a responsibility to understand this
process
• All healthcare staff involved in caring for the
bereaved have a responsibility to inform the
bereaved re the possibility of the MCCD for their
loved one being selected for review
• Explanation of content of MCCD should be given
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Useful Resources
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Suggested Reading and
Useful Resources
Baile WF, Buckman R, Lenzi R, Gloiber G, Beale EA, Kudelka AP (2000) SPIKES:A six step protocol
for delivering bad news: application to the patient with cancer The Oncologist 5 pp302-311
COPFS (2014) Reporting Deaths to the Procurator Fiscal: Information and Guidance for Medical
Practitioners
http://www.copfs.gov.uk/images/Documents/Deaths/Reporting%20Deaths%20to%20the%20Procurator%2
0Fiscal%20%20-%20Feb%2015.pdf
Guidance for Doctors Completing MCCDs Scottish Government (2014) Guidance for Doctors
Completing Medical Certificates of the Cause of Death and Its Quality Assurance
http://www.sehd.scot.nhs.uk/cmo/CMO(2014)27.pdf
SG (2011) Shaping Bereavement Care, A Framework for Action –Edinburgh/Scottish Government
SG (2014) Guidance; caring for people in the last days and hours of life Edinburgh/Scottish
Government
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Other information that you may
find useful
COPFS and Scottish Government (2013) Agreement between Crown Office and Procurator
Fiscal Service and the Scottish Transplant Group In Regard to Organ and Tissue Donation
http://www.scotland.gov.uk/Publications/2014/10/3139/5
List of notifiable diseases
http://www.scotland.gov.uk/Topics/Health/Policy/Public-Health
Act/Implementation/Guidance/Guidance-Part2
NES (2006) A Multi-Faith Resource for Healthcare Staff
http://www.nes.scot.nhs.uk/media/3720/march07finalversions.pdf.pdf
NHS Scotland Feedback and Complaints
http://staging.nhsinform.com/~/media/nhsinform/rights/professional/charter/a4yourhealthyour
rightsfeedbackandcomplaints.ashx
The Certification of Death (Scotland) Act 2011
http://www.legislation.gov.uk/asp/2011/11/pdfs/asp_20110011_en.pdf
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Local Contacts
• [email protected]
• Chair of NHS FV Bereavement Steering group
[email protected]
• Margery Collins, Lead for Spiritual Care NHS FV
[email protected] – OOH contact via
FVRH switchboard
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