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A Nelmes, S Goodison, R Monteith, R Morse, 2837 Learning from deaths; embedding education in the process of certification of death during rollout of the medical examiner service, Age and Ageing, Volume 54, Issue Supplement_1, January 2025, afae277.019, https://doi.org/10.1093/ageing/afae277.019
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Abstract
The recent introduction of the Medical Examiner (ME) service changed the process for Medical Certificate of Cause of Death (MCCD) completion across Wales. This offered opportunity for local process redesign and embedding of team-based education and reflective practice, whilst reducing delays in MCCD completion for bereaved families.
We produced a process map and discussed with key stakeholders—ward teams, bereavement staff and the ME Office. We developed a team–based Proposed Cause of Death form (several PDSA Cycles) to prompt and stimulate early medical team discussion/reflection and to aid a clear formation of a proposed cause of death, in advance of ME review. This was piloted (paper form) on 2 wards (A&B) in 2022, followed by a further 3 wards (C,D&E) in electronic form in 2023. We collected data on numbers of deaths, forms completed and time between death and MCCD completion. Feedback sought from teams, bereavement, and the ME service re usefulness of the intervention.
The process was successfully adopted on 2 of the 5 pilot wards. For the 2 wards adopting the process, the educational discussion and form were completed in 71% (27/38) of deaths on ward B, and 60.9% (14/23) on ward C. Time from death to MCCD completion was not significantly increased by this additional step. Feedback from adopting teams was positive, commenting on educational opportunities and improved communication between the ward and bereavement teams.
Facilitators of adoption were ward level consultant engagement, availability of notes and prompting of the medical team by the bereavement team. Barriers to adoption were a perception of extra work and being unable to perceive usefulness of the process. Adoption of the process led to improved team ownership of cause of death decisions, educational opportunities and better communication with the ME and bereavement teams.
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