Liverpool Care Pathway Jenny Lowe Tutor: Palliative Care 2010

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) Hospice Community Hospital Care 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 care Joint by the Doctor and Nurse Stop Inappropriate drugs Inappropriate Medical interventions Assess Routine nursing interventions Set up Syringe Driver PRN requirements Assess Patients insight Family insight Spiritual/religious needs Communication 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 Documented Variance Not documented

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 Care of the dying A pathway to excellence John Ellershaw, Susie Wilkinson For further information Tel: Jenny Lowe St John’s Hospice