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Coronavirus staff guidance University Hospitals Birmingham NHS Foundation Trust

Medical Examiner's Service

Documentation of expected or confirmed death

At the time of diagnosing a patient in the imminent dying phase (expected death) or when verifying a patient’s death, the most senior doctor should offer a likely cause of death to assist in the production of a Medical Certificate for the Cause of Death. This will facilitate accurate and timely completion of death certification. Write out the proposed COD in full e.g., 1a. COVID-19 PNEUMONIA, 2. DIABETES MELLITUS, HYPERTENSION in block capitals on PICS noting (or in the patient's notes until PICS is rolled out to all sites) along with your name and GMC number.

Verification of death for all patients during the COVID-19 pandemic

At the time of verifying a patient’s death in their notes (or on PICS), you are required to complete an additional checklist (available in the "Downloads" section).

This will reduce the number of times a body bag is opened after death and inform mortuary and bereavement staff of possible/confirmed infection. It will also alert them to the presence of devices that need removal prior to cremation and help flow through the mortuary.

The notice of death should still be completed by the nursing staff.

Please place this form on the front of the patient's notes.

Completing cremation paperwork

The Coronavirus Act 2020 came into law on Thursday 26 March 2020. Section 19 relates to the completion of Cremation paperwork.

There is no longer the requirement to have a confirmatory doctor to check and complete the second part of the form (part 5). This will put even more emphasis on the consultants responsible informing their junior staff what should be recorded on the MCCD and the first part of the Cremation paper (part 4).

Attending the Medical Examiner's office to complete MCCDs

The Medical Examiner Officers will contact the team involved with the care of the patient via email and agree an appointment time for a member of the team to attend the Medical Examiner’s Office. The attending doctor will discuss the proposed COD with the Medical Examiner and complete the MCCD (and cremation paperwork part 4 if required). Completion of the MCCD should take place no more than 3 days after the patient has died. Medical Examiner Officers will scan the MCCD and forward to the Registrar’s Office

Coroner referrals

If the death of a patient under your care requires a coroner’s referral, it is your responsibility as the treating consultant (or a member of your team) to ensure this takes place within two working days.

Circumstances in which a coroner referral should be made under Regulation 3 (in force from 1 October 2019)

  • The death was due to poisoning including by an otherwise benign substance
  • The death was due to exposure to, or contact with a toxic substance  
  • The death was due to the use of a medicinal product, the use of a controlled drug or psychoactive substance  
  • The death was due to violence, trauma or injury  
  • The death was due to self-harm  
  • The death was due to neglect, including self-neglect
  • The death was due to a person undergoing any treatment or procedure of a medical or similar nature  
  • The death was due to an injury or disease attributable to any employment held by the person during the person’s lifetime  
  • The person’s death was unnatural but does not fall within any of the above circumstances  
  • The cause of death is unknown  
  • The registered medical practitioner suspects that the person died while in custody or otherwise in state detention, including Hospitals, where the deceased was detained under mental health legislation (including instances when the deceased is on a period of formal leave), prisons, etc.
  • There was no attending registered medical practitioner, and there is no other registered medical practitioner to sign a medical certificate cause of death in relation to the deceased person  
  • Neither the attending medical practitioner, nor any other medical practitioner able to sign the medical certificate cause of death, is available within a reasonable time of the person’s death to sign the certificate of cause of death  
  • The identity of the deceased person is unknown  

The full guidance can be accessed below: 

The Coroners Portal will be live from 09:00 on Wednesday 25 November.

  • All referrals to the Coroner are to be made by the clinical teamresponsibleforthepatient’s care using the online portal which is available below
  • The code for hospital referrals is H01
  • The hospital ID field and GP surgery fields are mandatory
  • If the GP surgery is unknown or out of area please select "AA. GP unknown". There is an option to add the details for out of area GP’s to the medical/GP box
  • The referral needs to be completed within two days of the patient’s death
  • Further guidance on use of the portal is available in the Downloads section at the bottom of the page

We encourage you to discuss the referral with a Medical Examiner before submitting it. Medical Examiners are available Mon – Fri to discuss any queries you may have:

  • BHH ext. 41805 / 40495
  • GHH ext. 47628 / 49630
  • QEHB ext. 12452 / 12459

If you have any queries contact Dr Kaye England, Lead Medical Examiner or:

Email: MedicalExaminers@uhb.nhs.uk

Bereavement information for families

Booklets are available to give to families that describes the practical matters to manage following a bereavement of a relative with coronavirus. They can also be signposted to information on the UHB website.

Compassionate conversations

Please find below a useful webinar recording on compassionate conversations created by NHS Elect.

Please note to view the video you must provide an email address.

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