Introduction of Liverpool Care Pathway in Hospice Setting

By Louise Stebbings

Introduction

Attendance of study day in Liverpool

o Ward manager

o Team leader

o Specialist registrar

Planningo Meeting o How to implement new guidelines into clinical

practiceo Preparation of presentationo Study days arranged for staff of all disciplines

and made compulsory

Education – Staff Training

o 1 hours study sessiono Power point presentationo Discussion forumo All staff given a copy of the pathwayo Opportunity for staff to look at pathway and

discuss any areas of interest or concern

Implementationo A decision was taken by the implementation

group that the pathway would not be implemented until all staff had attended the session

Oppositiono Some initial concern as staff felt it was a

paper exercise as they were already caring for dying patients and delivering a high standard of care

o Advised just a change in documentation and multidisciplinary

Positive

o Some staff had already asked about implementing the pathway and were really keen

o Implemented quite easily into practice due to all staff having attended the mandatory education session

o Staff felt it was user friendly and prompted you to look at all aspects of care for example: religious/spiritual needs and discontinuation of routine medications

Following Implementation

o In 2002 after first 10-15 pathways used it was reviewed and areas of that caused concern were raised

o After this time some areas were reviewed and changed for example the attached symptom management guidelines were taken out as we use the Yorkshire cancer network guidelines

o Some amendments were made to the last page about property and the computer system

Review

o Initially reviewed after first 10-15 used

o Then after 6 months

o Audited after first year of implementation in December 2003 by ward manager and senior health care assistant

Audit

o Audit focused on the documentation and which boxes had been filled in correctly

Results

o 27% of notes had a variance for agitation but

no documentation for what action was taken

o 7% had a variance for pain, respirations,

miturition, mobility, pressure area care, bowel

care and psychological insight with no

documentation

Action Plan From 2003

o Nursing staff to ensure completion of all areas of documentation mainly by documenting what action was taken when a variance occurred

o Nursing staff to ensure they sign and date the front sheet prior to documenting in the pathway

o Verification of death sheet had to be in two different colours depending whether patient on the pathway as people were using the wrong sheet for people not on the pathway

o Clearer identification who should contact social services where necessary as appeared to be being overlooked

Problems

o Issues for some nursing staff with regard to pressure area aspect of the pathway and 12 hourly turning of patients for comfort as opposed to pressure relief

o Some staff argued it was prescriptive and not

holistic

Benefits

o Multidisciplinary documentation

o Easy to implement and use

o Reduction in amount of documentation

o Standardised care for all patients from all disciplines

o Prior to implementation all bereaved people were seen by either ward manger, matron or clinical services manager to receive property and death certificate

o No documentation of this now clearly documented on pathway

Recommendations for Future Audit

o To complete an audit focusing on the variances and how they were managed in practice

o Identify if there is a need for more staff education surrounding symptom control in dying phase

The End