Death Confirmation – OSCE Guide

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This death confirmation OSCE guide provides a step-by-step approach to confirming death in an OSCE setting, with an included video demonstration.


Before death confirmation

Prior to death confirmation, you should check the patient’s resuscitation status:

  • If the patient is not for resuscitation, death confirmation can proceed.
  • If there is uncertainty as to the patient’s resuscitation status, CPR should be commenced whilst this is clarified.

Review the patient’s notes to gain further details about their medical history.

Clarify the circumstances surrounding the death with the relevant staff and family members. This information will need to be documented in the patient’s notes.

If family or friends of the patient are present, introduce yourself and offer your condolences. Explain the need to confirm death and offer the family the opportunity to leave or stay whilst you do this. Check if the family have any questions or concerns.


Death confirmation

To perform death confirmation:

1. Wash your hands and don PPE if appropriate.

2. Confirm the identity of the patient by checking their wrist band.

3. Inspect for obvious signs of life such as movement and respiratory effort.

4. Assess the patient’s response to verbal stimuli (e.g. “Hello, Mr Smith, can you hear me?”).

5. Assess the patient’s response to pain using one of the following methods:

  • Apply pressure to the patient’s fingernail.
  • Perform a trapezius squeeze.
  • Apply supraorbital pressure.

6. Assess the patient’s pupillary reflexes using a pen torch: after death, the pupils become fixed and dilated.

7. Palpate the carotid artery for a pulse: after death, this will be absent.

8. Perform auscultation in an attempt to identify any heart or respiratory sounds:

  • Listen for heart sounds for at least 2 minutes.
  • Listen for respiratory sounds for at least 3 minutes.

The recommended amount of time to listen for heart and respiratory sounds can vary, but it is generally accepted that a minimum of five minutes of auscultation is required to establish that irreversible cardiorespiratory arrest has occurred. 1

9. Wash your hands, dispose of PPE appropriately and exit the room, making sure the relevant doors and/or curtains are closed/drawn behind you. 

  • Confirm the patient's identify

Documentation

Once you have completed the required steps to confirm the death, you need to document your assessment.

Document each of the steps you performed and the result of each step. Then document that death has been confirmed, including the time at which this occurred.

Sign and print your full name, grade, registration number and contact number.

Read our guide to documenting death confirmation for more details.


To complete death confirmation

Inform the relevant nursing staff that you have confirmed the death. Either yourself or the nursing staff should inform the next of kin if not already present and contact the porters to arrange transfer of the body to the morgue.

Consider if the death may need referring to the coroner. If this is the case, a death certificate should not be issued and you should discuss the situation with the consultant responsible for the patient.

To learn more about completing a death certification, read our guide.


References

  1. Academy of Medical Royal Colleges. Code of Practice for the Diagnosis and Confirmation of Death. Published in 2008. Available from: [LINK].

 

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