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HSE finalising policy to allow nurses to pronounce death in certain circumstances

In 2015 the HSE established a National Project Working Group with the aim of producing a “policy for the pronouncement of expected death by registered nurses”.

“The policy is in final drafting phase and is progressing through an approval process prior to final adoption by the HSE,” an Executive spokesperson told the Medical Independent (MI).

The policy will allow pronouncement of death by nurses in certain prescribed circumstances where the death was expected and where it occurred in HSE residential, long-stay or specialist palliative care services.

The HSE told MI that there has been significant GP input into the policy.

“The HSE National Clinical Advisor and Group Lead Primary Care and members of the ICGP Quality in Practice Committee have been actively involved and have contributed significantly to the recommendations on governance arrangements for the safe pronouncement of expected death by registered nurses in specific circumstances,” said the HSE spokesperson.

“All of the above continue to contribute to the development of a safe, evidence-based policy.”

The HSE told MI that the new policy does not deal with the certification of the cause of death or the issuing of a death certificate.

“As such it has nothing directly to do with certification of the cause of death,” said the HSE spokesperson.

“Where expected death occurs in a nursing home, medical and nursing staff are mindful of the legal constraints around certification of the cause of death and have policies and procedures for this. 

“…. A post mortem is unlikely to arise in a circumstance where the death has been anticipated; where a coroner requests a post mortem it is because the death is not truly an expected one or because some circumstance arises, which mandates a post mortem.”

However, the ICGP has expressed considerable doubts on how practical these proposals would work in reality.

In the UK designated registered nurses have the authority to confirm expected death, notify the relatives, and arrange for last offices and the removal of the body to the mortuary or the appropriate funeral parlour.

These principles can apply in any healthcare setting in the NHS or independent sector. The nurse must be trained and deemed competent to confirm the death and there must be an explicit local policy in place, which the nurse must check for specific details, according to Royal College of Nursing guidelines. 

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