This is in follow up to the workshop for the 18 UCL final year students who attended today summarizing the points made

The objectives were

  • Plan how you would confirm and certify a dead patient
  • Describe and discuss how you would do it
  • Recognize any pitfalls in exam or real life situation
  • Explain and justify your method
  • Complete three death certificates

The following was the scheme suggested (but make it your own)

On entry

  • Washes Hands on entry
  • Introduce yourself to the nurse and asks who the nurse is
  • take a brief history from the nurse
  • need to consider resuscitation
  • Asks for patient’s case notes

The patient

  • Confirm patient’s identity using the wrist band
  • Observes patient’s general appearance
  • Notes the absence of respiratory movements
  • Ascertains that patient does not rouse to verbal or tactile stimulus
  • Feels for radial pulses , femoral , carotid pulses
  • Confirms that pupils are fixed and dilated
  • Indicates need to examine the fundi
  • Auscultates over precordium Indicates need to auscultate for one minute
  • Checks for the presence of a pacemaker
  • Auscultates over lungs Indicates the need to listen for three minutes
  • Covers the patient in a dignified manner


  • Indicates the need to make an entry in supplied patient’s case notes
  • Date and time of death stated Who you are (signature name in full beep number)
  • Who called you Who was there at the time you assessed the patient

Other considerations

  • Indicates the need
    • for relatives to be informed
    • to inform the team
    • to make arrangements to inform GP
    • to consider a  post-mortem or refer to the coroner
    • to complete the MCCD (death certificate ) if you can
  • Washes hands

Death certification

It is ultimately the responsibility of the consultant in charge of the patient to  ensure that the death is properly certified. Make sure you have the right consultant.

The following are recommendations to be found in the “notes” that come with the MCCD

  • State the cause of death to the best of the doctor’s knowledge and belief
  • No expectation of infallibility
  • The degree of certainty will vary
  • The listed sequence must be logical and timed
  • Do not use abbreviations on MCCD
  • Line 1a is for the immediate, direct cause of death
  • Lines 1b & 1c are to record the sequence of events or conditions that led to the immediate cause of death – logically
  • The condition on the ‘bottom line’ should be the underlying cause
  • Statisticians and epidemiologists use the underlying (not the immediate) cause for mortality statistics
  • The stated causes should follow the ICD (International Classification of Diseases) coding rules.
  • Record causes of death, not modes of dying eg Uraemia is a Cause Heart Failure is a mode
  • Part 2 is to record other diseases, injuries, conditions or events that contributed to the death but were not part of the direct sequence
  • Part 2 is not a rag bag or dustbin to record every illness from which the individual suffered during life
  • Do not use the terms “metastatic” or “metastases” unless it is clear whether you mean metastasis to, or metastasis from, the named site
  • Remember to specify the histological type and anatomical site of the cancer.Try to avoid the term “cerebrovascular accident” if at all possible
  • Give as much detail about the nature and site of the lesion as is available to you.
  • In deaths from infectious disease, you should state the manifestation or body site, eg, pneumonia, hepatitis, meningitis, septicaemia, or wound infection.
  • You should also specify the infecting organism, eg, pneumococcus, influenza A virus, meningococcus
  • Antibiotic resistance, if relevant, eg, methicillin resistant Staphylococcus aureus (MRSA), or multiple drug resistant mycobacterium tuberculosis
  • The source and/or route of infection, if known, eg, food poisoning, needle sharing, contaminated blood products, post-operative, community or hospital acquired, or health care associated infection.

Further reading

This is a good guide to be kept until new changes come in in April 2018