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The Liverpool Care Pathway for the dying patient

An overview of the LCP for medical students
by

Jessie Fairfield

on 15 March 2011

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Transcript of The Liverpool Care Pathway for the dying patient

What is the LCP? Does it acheive its aims? What are the criticisms of the pathway? The Liverpool Care Pathway for the Dying Patient Key Themes Key Sections Key Domains of care To improve the knowledge related to the process of dying To improve the quality of care in the last hours or days of life Initial assessment Ongoing assessment Care after death Physical Psychological Social Spiritual Key Requirements for Organisation Governance Clinical decision making Management and leadership Learning and teaching Research and Development Governance and risk What does the LCP involve? The LCP is a pathway that aims to improve the care of the dying in the last hours or days of life

It was developed by the University of Liverpool and the local Marie Curie Hospice during the late 1990s

The current version (V12) is a 24-page document which stays with the patient throughout their care
The LCP consists of: A multidisciplinary team is involved in deciding whether or not to put a patient on the pathway

All members of staff caring for the patient use the document as a guide to care

A full MDT review is undertaken every 3 days A patient is put on the pathway If all reversible causes of their condition have been considered

and

2 of the following apply: The patient is bedbound
The patient is only able to take sips of fluid
The patient is semi-comatose
The patient is no longer able to take tablets An audit from 2009 looked at 4000 patients in 155 hospitals

The vast majority of patients were comfortable in their last 24 hours
65% needed no subcutaneous medications to improve comfort
31% needed low dose medications; only 4% required high dose Less positive points:

Staff training was not consistent between centres
Not enough provision for spiritual/religious needs Letter to The Times (2009)

Artificially hastens death of some patients
"The inevitable outcome is death"
Accepts that checks and balances are built into the pathway
Concerns about the level of staff training Conclusions

The LCP is recommended by NICE and widely used
There are guidelines for entering a patient onto the pathway
A recent audit showed generally good outcomes, but highlighted some problems
Areas for improvement include staff training and better spiritual support
Full transcript