1. Introduction to Liverpool Care Pathway By Louise Stebbings

2. Rationale for Development of Pathway oRoyal Liverpool University Hospital have 2000 deaths a year oHospital palliative care team are only involved with 15% of these deaths (Foster 2003)

3. oEmpower generic workers in hospitals and community settings to follow best practice oImprove standards of care for dying patients in all settings oIn palliative care facilitate multi-disciplinary documentation (Ellershaw and Wilkinson 2003)

4. ‘The care of all dying patients must improve to the level of the best’ (Department of Health 2000)

5. Agencies Responsible for Development of Pathway oSpecialist palliative care team based at the Royal Liverpool University Hospital oLiverpool Marie Curie Centre

6. Developed by Multidisciplinary Steering Group oSpecialist palliative care nurses oConsultant in palliative medicine oIntegrated care pathway coordinator oDevelopment officer from the trust oRepresentative from pastoral care team oMembers of the ward team

7. Research Changing Gear - Guidelines for Managing the Last Days of Life in Adults (Working Party on Clinical Guidelines in Palliative Care 2001)

8. Sources of Evidence oLiterature review oPatient documentation oMultidisciplinary discussion oFacilities leaflet oSymptom control guideline oBereavement leaflet

9. Implementation oBase review oSupporting documentation oEducation programme oPilot study oImplementation and ongoing support oAudit and feedback

10. Outcomes oMeasurable outcomes in care of dying patients oPatients dying in hospital have received standards of care almost comparable to those reached in a hospice (Ellershaw and Ward 2003)

11. Often inappropriate to use randomised and blinded research in care of the dying but care pathway results can be used in the production of data for audit and research purposes. ( Ellershaw et al 2001)

12. Recommendation for Use oKey recommendation number 14 “In all locations, the particular needs of patient’s who are dying from cancer should be identified and addressed. The Liverpool Care Pathway for the Dying Patient provides one mechanism for achieving this” (National Institute of Clinical Excellence 2004)

13. Reference List oDepartment of Health. (2000) The NHS Cancer Plan: A plan for investment, A plan for reform. London: DOH oEllershaw, J and Ward, C. (2003) Care of the dying patient: the last hours or days of life. British Medical Journal 326 Jan 30-34 oEllershaw, J and Wilkinson, S. (2003) Care of the Dying. A Pathway to Excellence. United Kingdom: Oxford University Press

14. oEllershaw,J., Smith, C., Overill, S., Walker, S.E., and Aldridge, J. (2001) Care of the dying: setting standards for symptom control in the last 48 hours of life. Journal of Pain and Symptom Management 21 12-17 oFoster, A. (2003) Implementing the Liverpool Care Pathway for the Dying Patient (LCP) in hospital, hospice, community and nursing home. In Ellershaw, J. and Wilkinson, S. Care of the Dying. A Pathway to Excellence. United Kingdom: Oxford University Press 121-140

15. oNational Institute of Clinical Excellence (2004) Improving Supportive and Palliative Care for Adults with Cancer. London: NICE oWorking Party on Clinical Guidelines in Palliative Care (2001) Changing Gear – Guidelines for Managing the Last Days of Life in Adults. Northamptonshire: COG

16. The End