Mortuary & Bereavement Services

Bereavement support office

The role is to offer support to families at what is a very difficult time for them. An immediate point of contact so that they feel they are being listened to and dealt with in a timely, organised way by people who understand their individual needs and who can give them time. An area where they will be given the first steps of guidance from registering the death to where, how and if they need any follow on guidance. To feel that this is not the end for them but that we are still there if they have any issues or just further support in the near future.

A quality bereavement service is an essential component of an end of life care pathway.

The aim is to:

Assist staff in caring for the patient's families/representative around the time of death and assist in the issuing of 'The Medical Certificate of Cause of Death (MCCD)'.
Provide appropriate support to families, carers and significant others who are subsequently bereaved. Guiding and supporting the deceased representatives through the complexities of registering a death, making the initial contact with funeral directors, and any other complex administration and paperwork required.
Liaise with the Trust's contracted Funeral Director on all hospital funerals for deceased patients who have no next of kin or where the families have no financial means in which to pay for the funeral.
Develop and update the booklet 'Information and Advice for the Bereaved' which is for all bereaved and given at time of death.

Quality of care is crucial for individuals at the end of their life

The experience around the time of death and how this is delivered and received by the Families/ carers and representatives afterwards can have an influence on the grieving process and the long term health of the bereaved.

Overall impression left with the individual of how as a Trust we cared/managed their loved one can be changed not because of the care given but the failure to manage the issuing of the MCCD, belongings and any other issues in the following hours after the death. A good experience around the time of death and afterwards can positively influence the grieving process.

We must always remember that the deceased is still a patient in our care until they leave the mortuary.

Autopsy general information

Requests

Before completing any consent form or request for a hospital autopsy, telephone the appropriate pathologist through their secretary (Ext. UHND 32457) Advice regarding what tissue is likely to be retained, who is eligible to obtain consent for the autopsy and consent for the possible subsequent retention of tissue can then be given directly. The pathologists will ask for the case notes, request form and consent form to be sent to the laboratory.

If you are interested in viewing findings then please provide availability details and contact numbers.

When reporting a death to the Coroner, the Coroner's Office should be contacted:

Phone: 03000 265 556
Email: co-office@durham.gov.uk or: HMCoroner@durham.gov.uk

As a general guideline deaths listed below should be referred to the Coroner (the list is not comprehensive and if there is any doubt contact the Coroner's Office for advice).

All deaths in which the doctor has not attended in the last illness or within 14 days of the death. This usually refers to deaths in the community.
Sudden Unexpected Death - When a sudden death occurs in an in-patient, which was NOT to be expected from the nature of his illness. Persons brought in dead, who die during admission or shortly after admission to the wards, where insufficient clinical history, examination or investigations are available to justify a firm opinion as to the cause of death (the underlying cause of death, NOT the MODE of death).
Accidents and injuries OF ANY DATE which are considered to have contributed to the cause of death.
Anaesthetics, Surgical Operations and Therapeutic Procedures:-Deaths during or before complete recovery from anaesthetic are reportable, as are deaths during, or as a consequence of any operation or therapeutic procedure (such as cardiac catheterisation, endoscopy, angiography or any other radiological diagnostic procedure).The common misapprehension that only deaths occurring within twenty-four hours of operation are reportable should be discarded - no time limit exists, if any caused connection is thought to exist, e.g. pulmonary embolism within the first fortnight. Where the procedure was performed as a consequence of any injury, the death is always reportable.
Deaths due to crime or suspected crime.
Deaths due to Industrial Disease (or in which industrial disease was possibly contributory), see Appendix 1. Of particular importance are miners with pneumoconiosis and any suspected mesothelioma.
Deaths due to starvation or neglect (including hypothermia).
Deaths in which the deceased was in receipt of an industrial or war disability pension.
Infant deaths which are unexplained (S.I.D.S.).
Persons dying in legal custody.
Deaths due to poisoning of any cause (includes food poisoning as well as more obvious causes).
Traumatic deaths (e.g. R.T.A., domestic injuries).
Suicide/suspected suicide.
Unidentified bodies.
Circumstances in which a relative or similar expresses dissatisfaction or outright criticism of the standard of medical or nursing care (best discussed with the Pathologist in the first instance).
Alcoholism - where acute intoxication but not the effects of chronic alcoholism is suspected as the cause of or contributing to death.
Death related to the use of recreational drugs.
Deaths related to abortion where any cause other than natural is suspected.

Turnaround time

All post-mortems are performed as soon as possible depending upon the circumstances of each particular case.

Clinicians are encouraged to attend and prior notice will be given as regards the time of the autopsy wherever possible.

Summary findings (issued as a cause of death) will be sent to the deceased's GP within several hours of completion of the autopsy in most cases (a notable exception being Coroner's autopsies which will proceed to an inquest).

High risk cases (infectious disease)

Please note that all such bodies submitted to the mortuary (for post-mortem or not) must clearly be identified as a high risk and all appropriate staff (nursing, portering, mortuary) must be informed. Appropriate body bags and labels must be used. (See Infection Control Manual, Chapter 9).

In general known high risk cases will not be autopsied unless this is vital. The request form must clearly identify infectious risk and its nature. The cases must be discussed with the relevant pathologist. Cases of HIV and Hepatitis B (or similar infections) will be performed as a 'high Risk procedure. CJD and other category 4 infections will not be performed. If an autopsy is required on these cases the pathologist will liaise with other hospitals.

Disposal of Foetal tissue

For any queries as regards disposal of foetal tissue, kindly refer to the unit policy (available in the department of Obstetrics and Gynaecology).

For viewing of bodies

Please liaise with mortuary technical staff prior to directing relatives to the mortuary for body viewing (extension UHND 32300, or DMH 43594). Unbooked attendance for relative viewing can lead to unnecessary conflict, delays and distress for relatives of their expectation for viewing cannot be accommodated.

Consent & the Hospital Post Mortem:

Can be performed with the prior consent of the deceased.
Deceased's nominated representative
Person in a qualifying relationship

Nominated Representative

Adults may appoint one or more persons
Where deceased persons wishes are not known, the nominated representative must give consent.
Must verify the NR's authority to act on behalf of the deceased person

Appointment of a Nominated Representative: