What is verification of expected death?
Verification of death means confirming, by examination, that a person has died. It sets the official time of death and allows the person to be moved to a mortuary or a funeral director. An expected death is one that follows a period of illness where death was anticipated and planned for, usually with a recorded DNACPR decision or ReSPECT form and an end of life care plan.
Verification is often confused with certification. They are different steps done for different purposes, and the difference matters when you are deciding what you are allowed to do.
| Verification | Certification | |
|---|---|---|
| What it confirms | That death has occurred, and when | The cause of death |
| Who does it | A doctor, or a trained and authorised registered nurse or paramedic | A registered medical practitioner |
| Document | Local verification form and clinical notes | Medical certificate of cause of death |
| Independent check (England and Wales) | None as such | Medical examiner review, unless the death goes to the coroner |
Since September 2024, a statutory medical examiner system has applied in England and Wales. A senior doctor not involved in the person's care reviews deaths that are not investigated by a coroner, speaks with the attending doctor and gives the family a chance to ask questions. Arrangements differ in Scotland and Northern Ireland.
Can nurses verify death in the UK?
Yes, in many settings. There is no law requiring a doctor to verify death, so registered nurses who have been trained and assessed as competent can verify an expected adult death where their employer's policy allows it. This is common in hospices, community nursing, care homes and many hospital wards. Paramedics also verify death in the community under their own guidance.
Hospice UK publishes the Care After Death guidance on registered nurse verification of expected adult death (often shortened to RNVoEAD), with a competency assessment tool. The current edition was published in 2025. The Academy of Medical Royal Colleges updated its code of practice for the diagnosis and confirmation of death, which took effect in January 2025. Local policies are built on these.
How do you verify an expected death? Step by step
The steps below describe the general principles in the Academy code and national nurse verification guidance. Your local procedure sets out the exact checks and form, and you must follow it.
- Check the circumstances first: Confirm identity from the identity band or another reliable method. Confirm the death was expected, that a DNACPR decision or ReSPECT form is in place, and that nothing suggests the death must be referred to the coroner (or procurator fiscal in Scotland). If anything is unclear, stop and seek advice.
- Observe for at least five minutes: Confirm irreversible cessation of the heart and breathing. The Academy code describes a minimum of five minutes of observation: continued unresponsiveness, no central pulse on palpation, no heart sounds on auscultation, and no breathing (no chest movement, no breath sounds).
- Confirm absent neurological responses: After the observation period, check that the pupils are fixed and do not react to light and that there is no motor response to a painful stimulus such as supraorbital pressure. The Academy code also advises checking corneal reflexes when death is confirmed soon after the heart stops. Follow the checks your policy lists.
- Record the time of death: The time of death is the time these criteria are met, not the time the family noticed the last breath. National guidance acknowledges these two times will differ, so explain this gently if asked.
- Note devices and infection risks: Record any pacemaker, implantable defibrillator or other implanted device and any infection risk the mortuary or funeral director needs to know about. An active defibrillator needs deactivating, and some devices must be removed before cremation; follow local policy.
- Inform the right people: Tell the responsible doctor so the certificate can be completed and the medical examiner process can begin. Inform the family if they were not present, in line with their wishes.
When should you not verify a death?
Verification by a nurse is for expected deaths where there are no concerns. Stop, do not verify, and seek medical or senior advice in line with your policy if:
- the death was unexpected, or there is no DNACPR decision or end of life plan
- you have any concern about the circumstances, including possible injury, neglect or harm
- the death followed a fall, a procedure, an incident or a medication problem
- the person may meet criteria for coroner referral and your policy excludes these
- you have not been trained and authorised, or the setting is outside your policy
- you are unsure, for any reason
What should a verification record include?
Verification records are read by the certifying doctor, the medical examiner, sometimes the coroner, and sometimes the family. Write factually and completely, and do not speculate about the cause of death.
Pt died 03:10. Family informed. Last offices done.
Expected death. Verified at 03:10 by RN [name, role] in line with trust policy. Observed for 5 minutes: no central pulse, no heart sounds, no respiratory effort. Pupils fixed and unreactive, no corneal reflex, no response to supraorbital pressure. DNACPR and ReSPECT form in place. No implanted device. No concerns about circumstances; no coroner referral criteria identified by verifier. Daughter present at death; son informed by phone at 03:25. Family request chaplain and wish to be present for care after death. On-call doctor informed for certification.
The weak note does not show what was checked, who verified, whether the death was expected, or whether there were any concerns. The strong note lets anyone reading it understand exactly what happened and why the verifier was satisfied.
Worked example: a night shift verification
At 2.40am Grace is called by a healthcare assistant who thinks Mr H, aged 88, has died. He had been recognised as dying two days earlier, with a DNACPR decision and an individualised end of life plan. Grace is trained and signed off under the trust's verification policy. She confirms his identity from his wristband and reads the plan. She observes him for five minutes and finds no pulse, heart sounds or breathing, then confirms fixed pupils and no response to supraorbital pressure. His notes show a pacemaker, not a defibrillator. There are no injuries or concerns. She records 02:51 as the time of death, completes the verification form, notes the pacemaker for the mortuary and bereavement office, and informs the on-call doctor. She phones his wife, who asked to be called at any hour, and arranges for her to visit.
Grace's care did not stop at the form. She gave his wife time with him, asked about religious and cultural wishes before care after death, returned his belongings with a record, and explained how the bereavement office would contact her about the certificate.
Care after death and supporting the family
Care after death (sometimes called last offices) continues the dignity and respect given in life. Ask the family about religious and cultural practices: who may touch the person, whether family wish to wash them, and whether rapid release for burial is needed. Many trusts have processes to support urgent release where possible, which depends on prompt certification and medical examiner review.
- Give the family private time with the person.
- Explain what happens next in plain words, including the certificate and registering the death.
- Give written bereavement information and support contacts.
- Record and return belongings carefully.
- Answer questions honestly and offer a later conversation with the team if they want one.
Deaths can stay with staff, especially after a long admission or a difficult death. Debriefing with colleagues, using your organisation's staff support and talking to your supervisor are healthy responses, not signs of weakness.
Learning more
This article is educational and does not replace your organisation's verification policy, training or competency assessment. If you want to build confidence in recognising dying, communicating with families, anticipatory prescribing and the principles of verification, the End of Life Care and Verification of Death course covers these with worked cases and a reflective exercise for your CPD record. Knowing when a death is not expected also means knowing when to start resuscitation, which is best kept current through accredited hands-on life support training.
Frequently asked questions
How long do you have to observe someone to verify death?
The Academy of Medical Royal Colleges code describes a minimum of five minutes of observation to confirm irreversible cessation of the heart and breathing, checking for no central pulse, no heart sounds and no breathing. Neurological checks follow, such as pupil response and response to a painful stimulus. Follow the exact checks in your local policy.
Can a nurse verify an unexpected death?
Most nurse verification policies cover expected adult deaths only. If a death is unexpected, there are concerns about the circumstances, or it may need coroner referral, nurses are usually told not to verify and to seek medical or senior advice. Some organisations have specific arrangements, so check your local policy and the training it requires.
What is the difference between verifying and certifying death?
Verification confirms that death has occurred and records the time. It can be done by a doctor or a trained, authorised nurse or paramedic. Certification records the cause of death on the medical certificate and must be done by a doctor. In England and Wales, a medical examiner then independently reviews deaths not investigated by a coroner.
Do I need training to verify death as a nurse?
Yes. Registration alone is not enough. Organisations require nurses to complete training and a competency assessment, often based on Hospice UK's registered nurse verification guidance, before verifying. Your employer's policy sets out who can verify, in which settings and for which deaths.
What time do you record as the time of death?
The time of death is recorded as the time the verification criteria are met, after the observation period and checks, not the time the person was last seen breathing. National guidance recognises these times will differ. If the family asks, explain this gently and record when they noticed the change in your notes.
What happens with a pacemaker or ICD after death?
Record any implanted device on the verification form and inform the mortuary or funeral director. An active implantable cardioverter defibrillator needs deactivating, and some devices must be removed before cremation. Follow your local policy on who does this and when.
Does a DNACPR form mean a nurse can verify the death?
A DNACPR decision or ReSPECT form is one of the indicators that a death was expected, but it is not enough on its own. You still need to check the circumstances, make sure nothing suggests coroner referral, and be trained and authorised under local policy. If anything worries you, seek advice before verifying.
Related courses
End of Life Care and Verification of Death
This course teaches you how to recognise when an adult may be in the last days of life, how to communicate with them and those close to them, and how…
Adult Advanced Life Support (UK Guidelines)
This course explains the recognition and management of adult in-hospital cardiac arrest, based on the current Resuscitation Council UK adult advanced…
Paediatric Life Support (UK Guidelines)
This course teaches the recognition of the seriously ill or injured child and the management of paediatric cardiorespiratory arrest, based on current…
Sources and further reading
- A Code of Practice for the diagnosis and confirmation of death: 2025 update. Academy of Medical Royal Colleges.
- Care After Death: Registered Nurse Verification of Expected Adult Death (RNVoEAD) guidance. Hospice UK.
- Care of dying adults in the last days of life (NG31). National Institute for Health and Care Excellence.
- Treatment and care towards the end of life: good practice in decision making. General Medical Council.
- Death certification reforms and the medical examiner system. Department of Health and Social Care.
- The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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