11/13/24, 7\:40 PM Guide | Completing a death certificate

Completing a death certi

Table of contents

Introduction

Completing a death certi
and something you will need to be able to do as a junior doctor. This guide will cover what to do when a patient has died, and
you are asked to complete a death certi

What to do when a patient has died

Assess the patient and consee our guide).
Discuss the death with the consultant in charge of the patient's care - this will help to clarify the cause to be written on the
certi
Liaise with the bereavement o
death certi
Perform a full external examination of the patient's body in the mortuary to ensure no implantable devices are present.

Death certi

We have included an example of a blank death certiPDF copy for OSCE practice.
Death certi

Completing the death certi

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Personal details of the deceased

Age
You should record the age of the deceased in completed years or, if under one year, in completed months.
Place of death
You should record to the best of your knowledge the precise place of death (e.g. the name of the hospital, or a private
address).

Circumstances of certi

Last seen alive by me
Record the date you last saw the deceased alive.
Information from post-mortem
Indicate if the cause of death takes into account information gained from a post-mortem.
Seen after death
Indicate who saw the deceased after death.

Part I - Cause of death

Consider the main causal sequence of conditions that lead to death.
The disease or condition that led directly to death should be documented on the 1a line. You should then work your way
back through the other diseases that led to the eventual cause of death until you reach the underlying cause of death which
initiated this chain of events. The lowest completed line in part 1 should, therefore, contain the underlying cause of death.
Some deaths may have only one condition that lead directly to death, such as a subarachnoid haemorrhage. In these cases, it's
acceptable to complete only line 1a.
When stating the cause of death, be as speci
" A d e n o c a r c i n o m a o f t h e r i g h t m a i n b r o n c h u s" rather than " L u n g c a n c e r"
.
In some circumstances, there can be two separate conditions that led directly to death and in these cases, you should enter
them both on the same line and then in brackets state that these are joint causes of death.
A few things that you CAN NOT write as a 1a\:
"Failures" as a sole 1a (e.g. heart/kidney/liver/respiratory failure). However, it is ok to use congestive cardiac failure.
Asphyxia
Asthenia
Cachexia
Cardiac arrest
Coma
Exhaustion
Old age/frailty as a sole cause of death\: this can only be used in patients over 80 years old.

Part II - Conditions that may have contributed to the death

Part II allows you to document other conditions that were not part of the main causal sequence of death but likely played a
role in hastening the death. An example might be ischaemic heart disease in a patient who died of pneumonia.
It is NOT somewhere where you should list the patient's entire past medical history.
Cause of death list
The Royal College of Pathologists publishes a cause of death list listing acceptable conditions
which may be included on the death certi
death list also provides guidance on when a death should be referred to the Coroner.
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Other details

You should sign the death certi
included beside or under your name.
Document your GMC approved quali
The residence is typically the hospital's address (not your own personal address).
If the patient died in hospital, document the consultant's name on the little line at the bottom of the certi
missed).

Counterfoil

There is a counterfoil on the left-hand side which gets left in the death certi
You need to document the patient's name, the cause of death (Part 1) and conditions potentially contributing to death (Part
2).
You also need to document your personal details again.

Other tips

_____ day of ______ refers to the "5th" day of "April 2015" (sounds simple, but I know someone who wrote "Tuesday
" in an OSCE).
1a should be the disease, illness or complication which led to death and not a mode of dying.
Circle either 1, 2 or 3 and a, b or c with regards to a post-mortem.

The back of the certi

There are two boxes on the back of the death certi

Box A

If you have referred a death to the coroner put your initials here. If you have discussed the case with the coroner and they
have said no referral is required, then you DO NOT need to complete this box.

Box B

If you may be in a position to provide more information about the cause of death in the future then you need to initial this
box. This is the case when there are pending investigations not yet back or performed (e.g. histology, microbiology culture
results, genetic analysis, post-mortem information). A request for this information will be sent to the consultant responsible for
the patient.

Reasons to refer to the Coroner

There are several situations in which a patient's death should be referred to the Coroner including\:
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
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The cause of death is unknown
The registered medical practitioner suspects that the person died while in custody or otherwise in state detention
There was no attending registered medical practitioner, and there is no other registered medical practitioner to sign a
medical certi
The attending medical practitioner is not available within a reasonable time of the person’s death to sign the certi
cause of death
The identity of the deceased person is unknown
The Noti
In the UK, the Noti set out the circumstances in which a death should be reported
to the Coroner. The Ministry of Justice has published guidance for doctors on the regulations which provide more detail
on when a death should be reported to the coroner.

How to refer to the Coroner

Coroners are often lawyers and occasionally doctors, or dual-quali
advice on how to contact the local Coroner's o

Example 1

Mrs June Morbid was an 87-year-old lady, whom you last attended to yesterday on the ward round with the consultant (Dr
Spot). She had advanced Parkinson's disease and was admitted 4 days previously with aspiration pneumonia. Unfortunately, the
pneumonia did not respond to antibiotic treatment and the decision to palliate was made by the consultant after discussion
with the family. Mrs Morbid peacefully passed away last night with her family around her, and her death was veri
colleague on the night shift. You have been asked to
Example 1
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Example 2

Mr Clive Matchstick (86-years-old) was admitted to the ward a week ago from a local nursing home having vomited and whilst
in hospital, he developed urinary incontinence and sepsis. He was treated for urosepsis, under the care of Dr Johnson, but
unfortunately, he passed away. You con
home. He has a past history of ischaemic heart disease, type 2 diabetes mellitus, Charcot's deformity of the left foot and
amputation of the big toe on the right foot.
Example 2

Example 3

Mr Samuel Clock (75 years old) had been an in-patient on the ward you are working on for 2 weeks. He was being treated for a
community-acquired pneumonia which was a CURB-65 score of 4. His condition had progressively worsened when you
reviewed him with his consultant Dr Tyvand last night and the decision was made to switch to a palliative approach of
management. He passed away this morning, with his wife by his side. You con
medical history of ischemic heart disease, hypertension, mesothelioma, type 2 diabetes and benign prostate hypertrophy.
This is a situation where the medical practitioner should have a conversation with the Coroner prior to issuing any certi
cause of death as a post-mortem will most likely be required. Mesothelioma is a is almost always attributed to asbestos
exposure and therefore falls into category of disease related to occupation which may have contributed to the death. The
damage most often occurs 20 - 60 years after asbestos exposure. It would be very unlikely that you would issue a certi
but if the Coroner instructed that you could do so, it might look a bit like this.
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Source\: geekymedics.com
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