Death Certification

1. Death Certification Responsibilities of nursing and other non medical staff and the importance of getting it right March 2015 FV-HUB.bereavementservice@nhs.net Sandra.campbell2@nhs.net

2. Background Death Certification Review Service Person-centred communication with people who have been bereaved

3. 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

4. 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

5. 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

6. 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

7. When?

8. 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

9. 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)

10. 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

11. Who does this affect? People who have been bereaved Anyone involved in caring for the bereaved General public Everyone needs to be aware

12. Randomised Review Process Flow Chart Death Occurs Death Is Registered Funeral Can take Place Review Process Happens Case Selected & Level 1 Review carried out Case Selected & Level 2 Review carried out Case is not selected for review MCCD is completed by certifying doctor and paper copy given to next of kin Burial MCCD to be amended MCCD Accurate If completed electronically, the MCCD information is transferred to NRS and may be selected for review at this point Cremation Certifying doctor agrees to sign replacement or amendment to MCCD MR and certifying doctor unable to agree on amendments SMR Reviews the Case Death is sent to the PF for investigation In the future alternative methods of disposal may become available Replacement or amendment is checked by the MR or SMR & is sent to the Registrar Optional escalation process followed (Clinical Governance) Amendments not agreed, MCCD released without changes

13. 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

14. Local application of DCRS Person dies Doctor / Nurse discusses cause of death with family. Bereavement pack given. Issue MCCD Form 11. Inform re possibility of medical review process • Informant registers death – possibility of medical certificate review process • Level 1 – 10% of deaths (1 working day) • Level 2 – approx. 1000 deaths per year (3 working days)

15. Local Operational Procedure...

16. 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

17. 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

18. 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)

19. 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

20. 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)

21. 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

22. 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/video-wall/communication/

23. 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

24. Useful Resources

25. Suggested Reading andUseful 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

26. 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

27. Local Contacts FV-HUB.bereavementservice@nhs.net Chair of NHS FV Bereavement Steering group Sandra.campbell2@nhs.net Margery Collins, Lead for Spiritual Care NHS FV fv-uhb.spiritualcare@nhs.net – OOH contact via FVRH switchboard