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Liverpool Care Pathway
In response to concerns expressed by members we have produced a laminated card. supplied with an information leaflet - 5p.
What is the Liverpool Care Pathway?
The Marie Curie Palliative Care Institute Liverpool supported by
Marie Curie Cancer Care, pioneered the implementation of the Liverpool Care Pathway for the Dying Patient. It provides guidelines for healthcare professionals to focus on care in the last hours or remaining days of life.
The LCP is used when a multidisciplinary team has agreed that the
patient is dying and that all reversible causes for the condition
have been considered. The patient, where possible, and relatives /carers must be fully informed by the doctors of the decision to put the patient on LCP and they must be kept up to date on any changes in the care. Good, comprehensive and clear communication is pivotal.
Once commenced, the medical team must decide whether non-essential treatments and medications should be discontinued. The recognition and diagnosis of dying is always complex. There must be regular assessment of the patient's condition and this involves continuous consultation amongst the team and critical decision-making and clinical skills. The Pathway is not a "one way street" and if no further deterioration of the patient's condition occurs, pathway-based palliative care is halted and all previous treatments restored.
The LCP does not preclude the use of clinically-assisted nutrition
or hydration or antibiotics. A blanket policy on either continuing
or withdrawing this nursing care is ethically indefensible. The pathway
suggests treatments to manage any pain, agitation, nausea vomiting
or shortness of breath. These interventions are usually given by subcutaneous injection.
Spiritual needs of the patient must be addressed. For a Catholic,
a priest must be called.
The aim is to enable patients, in the last hours of their lives,
to die a dignified, pain-free death and provide support for their
relatives/carers.
(this information was taken from leaflets published by the Marie Curie Palliative Care Institute explaining the Liverpool Care Pathway Version 12 which was launched on 8 December 2009)
The following comments have appeared in the press.
Medical reactions
Medical professionals have expressed serious concerns about the implementation of the scheme. The LCP is only as good as the professional teams using it. Decisions are often taken by relatively inexperienced staff. Doctors say it can be used well with great benefit to patients and relatives/carers. However it can also be used for euthanasia. Evidence suggests that LCP has been abused in order to bring about death on the basis of medical and nursing prejudice (so-called "best interests" criteria). Many with readily treatable conditions such as pneumonia or urinary and chest infections have been put on LCP. In some quarters there would seem to be a medical bias against the elderly. Those with strokes, the disabled and demented for instance, are not always treated appropriately.
How can relatives/carers help?
-relatives/carers should keep a close watch on the patient during
these last few hours or days of life. Ask if the patient is on the
LCP and have a clear picture of what care is proposed. Make sure to
speak to a senior doctor.
-relatives/carers can help assess how well the patient can communicate to check they can understand what is happening and are not over-sedated.
-ensure that the patient is receiving nursing care including hydration
however administered. The LCP guidelines state that if a patient is
judged to be able to eat or drink, this should be encouraged. Often
sick, elderly people tend to stop drinking. Hydration is vital to
prevent them becoming confused. Withdrawal of hydration and the use
of terminal sedation could actually cause a distressing death.
25 March 2010
These cards are the same size as a credit card and the same quality. With the information leaflet they cost: card plus leaflet 30p each + stamped addressed envelope. Contact us for larger quantities.
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