1. LCP V12 A brief review MBHT 2011

2. LCP 12 Fully implemented in the Acute Trust, Coming soon in the Community! Any problems?

3. Audit National audit of all patients dying on the LCP in acute hospitals between April – June 2011 inclusive National audit of all patients dying on the LCP in acute hospitals between April – June 2011 inclusive Managed by Marie Curie Palliative Care Institute Liverpool and Royal College of Physicians Managed by Marie Curie Palliative Care Institute Liverpool and Royal College of Physicians Data is collected locally then collated and published as “National Care of the Dying Audit” Data is collected locally then collated and published as “National Care of the Dying Audit” Feeds into ongoing development of the LCP Feeds into ongoing development of the LCP

4. LCP QUIZ- test yourself! Where is the LCP sited on the intranet and how many ‘clicks’ does it take to navigate to it from the home page? Where is the LCP sited on the intranet and how many ‘clicks’ does it take to navigate to it from the home page? Where are the symptom control algorithms sited? Where are the symptom control algorithms sited? What 4 drugs constitute the just-in-case/core drugs in your area? What 4 drugs constitute the just-in-case/core drugs in your area? The patient has needed 1 dose of sedation and 1 dose of antiemetic in 24h. Do they need a syringe driver starting? The patient has needed 1 dose of sedation and 1 dose of antiemetic in 24h. Do they need a syringe driver starting? What would be a suitable dose of sedation over 24h if required? What would be a suitable dose of sedation over 24h if required? What would be a suitable dose of antiemetic over 24 hours if required? What would be a suitable dose of antiemetic over 24 hours if required? What written information should be provided to the patient’s family when starting the LCP? What written information should be provided to the patient’s family when starting the LCP? A patient’s IVI on the LCP ‘tissues’. What needs to happen next? A patient’s IVI on the LCP ‘tissues’. What needs to happen next? A patient on the LCP has laboured breathing. What may help relieve this symptom? A patient on the LCP has laboured breathing. What may help relieve this symptom?

5. QUIZ- answers! To navigate to the LCP and symptom control algorithms: Home page>Clinical Services>Palliative care>End of Life Tools (left hand side of page)>Liverpool Care Pathway/Algorithms (4 clicks) To navigate to the LCP and symptom control algorithms: Home page>Clinical Services>Palliative care>End of Life Tools (left hand side of page)>Liverpool Care Pathway/Algorithms (4 clicks) Morphine, midazolam, Cyclizine, Hyoscine hydrobromide (MBHT & Cumbria), Diamorphine, Midazolam, Levomepromazine, glycopyrronium (Lancaster Community) Morphine, midazolam, Cyclizine, Hyoscine hydrobromide (MBHT & Cumbria), Diamorphine, Midazolam, Levomepromazine, glycopyrronium (Lancaster Community) No need for a graseby unless the patient has required 2/3 doses of sedation or antiemetic- just continue with prns No need for a graseby unless the patient has required 2/3 doses of sedation or antiemetic- just continue with prns 10mg midazolam/24h, Cyclizine 150mg/24h, Levomepromazine 6.25-12.5mg/24h (this may be given stat as long acting) 10mg midazolam/24h, Cyclizine 150mg/24h, Levomepromazine 6.25-12.5mg/24h (this may be given stat as long acting) Front sheet of LCP 12, additional LCP/Macmillan leaflets if available Front sheet of LCP 12, additional LCP/Macmillan leaflets if available Clinical decision on whether they need clinically assisted hydration Clinical decision on whether they need clinically assisted hydration Morphine + or – midazolam. Oxygen therapy rarely helps- may be intrusive/uncomfortable, fan Morphine + or – midazolam. Oxygen therapy rarely helps- may be intrusive/uncomfortable, fan

6. Remember! Dr & nurse to complete initial assessment together Dr & nurse to complete initial assessment together Give front information sheet to family Give front information sheet to family MDT review at least every 3 days MDT review at least every 3 days Don’t keep writing in the medical notes Don’t keep writing in the medical notes No need for long narrative on MDT sheet No need for long narrative on MDT sheet Don’t use the LCP as a means of stopping obs for patient Don’t use the LCP as a means of stopping obs for patientThank-you