Makindo Medical Notes.com

Have sympathy with the bereavement office staff who are just doing their job. Try and help them. Any delays get passed on to the families. Take advice from your seniors as to what to enter as the cause of death. See the topic on Confirming death if that is what you need

Who can complete one

• A doctor who has seen the patient in the 14 days before death
• You are confident that you know the cause of death (discuss with your registrar/consultant if unsure)

Coroner

• In any circumstances you will discuss with the coroner's officer who will give guidance as to whether any further action is required.
• The officer may advise you to go ahead and release the death certificate. On the other hand, there may be a direction for a coroner's post mortem.
• Usual Indications are
  • Death that is suspicious in any way - assault, murder, neglect
  • Unknown cause of death
  • Patient not seen by certifying doctor in last 14 days
  • Deaths within 24 hrs of admission
  • Deaths related to surgery, anaesthesia, treatment complication
  • Deaths due to Road traffic collision
  • Traumatic deaths, Falls, Accidents, Industrial injury
  • Deaths due to Violence, Abortion, Suicide, Poisoning (alcohol)
  • Deaths in legal custody, arrested or a prisoner
  • Deaths due to Industrial disease or employment
  • Deaths involving allegations of negligence
• Discuss or complete the relevant paperwork
• Discuss with coroner and/or officers who will decide if it needs further investigations

Completing the form

• I(a) the direct cause of death e.g. Pulmonary embolism, Myocardial infarction, Bronchopneumonia. Not modes of death e.g. syncope, cardiac arrest, shock, off legs, respiratory failure or arrest, even liver and renal failure are not acceptable without qualification
• I(b) enter the cause of (a) e.g.. a fractured neck of the femur or Ischaemic heart disease. Leave blanks if I(a) gives enough information.
• I(c) enter the cause of (b) e.g. Osteoporosis or leave blank
• II enter other contributing diseases such as Morbid obesity, Diabetes, Ischaemic heart disease

Note

• No abbreviations so no PE, MI, STEMI, NOF.
• It is always wise to get the bereavement office staff to check the form for any simple errors.
• Sign your name and add your GMC number as good practice. Qualify disease e.g. "hepatitis" on a death certificate was taken by the undertaker to be infectious rather than alcoholic which led to unnecessary infective precautions with the body.

Identifying and examining the body

• You do have to identify the body - this will involve unwrapping usually the upper half and checking the hospital name band and make sure you do recognise the deceased.
• If you are doing cremation forms too then always check for a pacemaker. They tend to explode when cremated. Check below the clavicle on both sides.

Cremation

• Cremation allows "destruction of evidence" of any foul play that may be later alleged so has added safeguards and regulations without becoming too bureaucratic. The cremation form is straightforward.
• You need to know the details of the patient and discuss the case usually by phone with another independent doctor regarding the cause of death.
• You must see the body and do check again the notes and the patient for any ECG or CXR reports to make sure no pacemaker. Any radioactive implants also need to be removed.
• Incomplete cremation forms can delay funeral arrangements, cause distress to bereaved relatives and cause major difficulty for mortuary staff.
• It is sensible to complete a FormB cremation form for every death unless it is known for certain a burial is planned. It means only one visit to the office.