The Registered Nurse Verification of Expected Adult Death (RNVoEAD) is an essential part of providing seamless care to both patients and bereaved families at the time of death. The second edition of the RNVoEAD has now been published on the Hospice UK website.
The impact on clinical practice of the Hospice UK (2016) 1st edition RNVoEAD guidance has been evaluated through a national survey distributed through the network of the Royal College of Nursing, Royal College of General Practitioners, National Nurse Consultant Group Palliative Care, Care Home Association and Association of Hospice at home. The 45 survey respondents came from acute trusts, community trusts, care homes, GP practices and hospices.
The survey found that RNVoEAD has great relevance in improving care after death particularly in the community and care home settings (hospitals have access to junior doctors who can undertake this role in a prompt manner). Over half of respondents felt that the guidance had contributed to a positive impact for the bereaved whereby families could expect a prompt response after the death of a family member, support and a smoother transition of the deceased to the funeral director. Respondents could identify that the guidance had led to improved training opportunities and confidence to deliver this aspect of clinical care.
There remains some tension about the requirement for advance care planning and specifically a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decision in order for RNs to verify an expected death. A DNACPR decision is considered essential in order that a RN can verify a death without concern for the need to resuscitate. It should be noted that an RN can verify the death of a patient when a DNACPR is in place but the GP has not seen them in the previous fourteen days. The RN would only be obligated to not verify if there were suspicious circumstances to the death. The coroner will need to be notified in order to issue the medical certificate of cause of death (MCCD).
Subsequent to the survey and from discussion with senior national colleagues representing such organisations as the Royal College of Nursing, The Care Home Association and the Royal College of GPs, two major changes have been made from the first edition of the guidance:
- The number of supervised practices after training to achieve competencies, has been reduced to a maximum of one and reliance on RNs assessment of their own confidence and competence.
- The requirement for doctors to give written permission in advance of the death for nurses to verify an expected death has been removed.
From respondent’s replies to the survey there remains a nursing issue to be addressed and this is of the perceived reluctance of RNs to undertake the RNVoEAD training and role. The report recommends:
- Via the RCN, to seek to understand and address the perceived RN reluctance to take part in this aspect of clinical care.
- Discussion with Health Education England regarding RNVoEAD becoming part of undergraduate nurse training
- Discussion with NHS England and NHSi regarding a multi-professional approach to this aspect of care to include doctors and nurses.
- To consider the opportunity for newly registered Band 4 Nursing Associates undertaking this practice.