Liverpool Care Pathway

Jenny LoweTutor: Palliative Care2010

Integrated Care Pathways

Template of care Organise the process Multidisciplinary Evidence based practice Integrate education and practice Replace and reduce documentation Legal record - electronic record

Aims

To provide the best possible care for Dying Patients

Recognise when patients are entering the dying phase

Holistic care Multidisciplinary care

Liverpool Care Pathway

Last few hours/days of life “Dying well” means something

different to everyone but generally includes maintaining dignity and autonomy, having choices and receiving appropriate pain relief as well as emotional and spiritual support.

Background The modern hospice movement was established in

response to the poor quality of care of the dying patient

The hospice model of care is now generally regarded as the ‘gold standard’ for the dying patient

A major challenge is to transfer best practice from a hospice setting to other care settings

The Liverpool Care Pathway (LCP) for the Dying Patient is a multi-professional document that provides a template for client centred best practice and facilitates appropriate standards of record keeping (see Essence of Care, DOH, 2003)

Background

The development of the LCP has led to measurable outcomes of care

The LCP was awarded Beacon Status in September 2000 to facilitate the process of dissemination of good practice

More than 120 centres across the UK are involved in work related to the pathway

Background

4 Documents (Very similar)HospiceCommunityHospitalCare home

Version 11 at present but Version 12 now agreed by the Hospital Trust (June 2010)

3 Sections of the LCP:

1. Initial assessment and care

2. Ongoing assessment and care

3. Care after death

Goals of care for patients encompassed by the LCP

Physical

Psychological

Religious / Spiritual

Social

LCP Eligibility

MDT must agree that the patient is dying and fulfils at least 2 of the following

Semi comatose Only able to take sips of fluid Bed bound No longer able to take tablets

Initial assessment and careJoint by the Doctor and Nurse

StopInappropriate drugsInappropriate Medical interventionsAssess Routine nursing interventions

Set upSyringe DriverPRN requirements

AssessPatients insightFamily insightSpiritual/religious needsCommunication with Family/others

Ongoing Assessment

Pain-Agitation-Respiratory-Nausea Mouth care, micturition, medication Comfort measures and symptom control Psychological / insight measures Religious / spiritual support Communication with patient / family Communication with the health

professional

Comfort Measures (n=20) 2003 – 2005 Base Review

0

20

40

60

80

100

Medicationassessed

Pain relief Nausea &vomiting

Agitation Respiratorytract

per

cen

tag

e

Documented

Variance

Not documentedPost Pathway

0

20

40

60

80

100

Medicationassessed

Pain relief Nausea &vomiting

Agitation Respiratorytract

per

cen

tag

e

Other Parts of the Pathway

Care after death Goals either Achieved or Variance Education documents on pain,

agitation, respiratory secretions, nausea

Written information for relatives

Benefits of the LCP Education tool Multidisciplinary Decreases Inappropriate

interventions Less documentation – Concise – easy

to use Get to know family well Demonstrates what is done well Evidence based

Some comments about the LCP “I’m far more confident since the pathway

came in” “I think it brings the care of the relatives

into the care of the patient more than previously because you are discussing a lot”

International Journal of Palliative Nursing

References

www.lcp-mariecurie.org.uk

Care of the dying A pathway to excellenceJohn Ellershaw, Susie Wilkinson

For further informationTel: Jenny Lowe St John’s Hospice 01524 382538