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Liverpool Care Pathway for the Dying

(27 Posts)
McDreamy Tue 23-Mar-10 15:46:24

Has anyone had any experience of this either medical or as a friend or relative. This is new to me (haven't nursed for 7 years) and I have some issues with it. My Nan has been put onto it. sad

Bananaketchup Tue 23-Mar-10 18:13:09

I'm sure others who know more than me will be along but I saw this was unanswered so wanted to post. I work with young people with cancer and if they are in hospital when they are very unwell and unlikely to get out, the Liverpool pathway is used. As I understand it it means being kept comfortable with pain meds etc but not having medical interventions. I have seen it overridden though and eg blood or antibiotics given, usually by arrogant registrars who think they know better, sometimes over the objections of the family sad

I'm sorry your nan is in this situation, I wish you the best.

brimfull Tue 23-Mar-10 18:16:53

The idea is that if a person is at the end of their life and active treatment for illness is no longer suitable.
explained here

Do you feel you gran is not getting the right care?

spudmasher Tue 23-Mar-10 18:36:39

A tough time for you McDreamy.
My dad trod this 'pathway' at the end of his life when he had cancer. It was a gentle end. It enabled us to call the doctor, hand over the booklet and he just gave dad what he needed rather than asking us loads of silly questions and asking dad about 'the pain in his tummy' which one call out doctor did just before the plan was put in place.

It was fairly alarming though. It detailed how his medication would be increased in the last part of his life. He died peacefully but I feel he slipped into the twilight zone slightly before he was ready. At times it was as though there were things he needed to say and the meds were stopping him. That has haunted me for a while.

What issues do you have with it?

Homebird8 Tue 23-Mar-10 19:01:23

My mum was put on the "pathway" in her final 24 hours. Her treatment just wasn't working, she was exhausted, and the symptoms were starting to cause significant distress. We all knew it was the end and though Mum didn't want to be at that point in her life she accepted that now was the time to make her comfortable and withdraw treatment.

The Liverpool Pathway ensured that she made the most of her final hours of consciousness and that as her symptoms got harder to deal with, that she was supported with pain relief and sedation as necessary. The only thing that was done not exactly to the Pathway was that she was maintained on some oxygen to reduce the discomfort and potential for reflex actions which would have distressed both her and us.

After a few hours she slipped into her final coma, which was in part induced by the medication. This meant that we could all be with her as she died and that her death was peaceful and not encumbered by invasive procedures.

I don't have a problem with the Pathway but I do feel very strongly that the staff caring for the patient should believe firmly that this is the very best they can do for them in their time of need.

If you still have reservations then you need to voice them and make sure you have all your questions answered before you support patients and their families through this difficult time.

McDreamy Tue 23-Mar-10 20:17:57

I do agree with the pathway in principle but I was quite surprised that fluids do not feature. I didn't expect IV fluids but I did think they would have some sub cut fluids going slowly for comfort.

She was put on it on Sat and is still with us, which I am quite surprised about (she always was a tough cookie) but now I am questioning whether she is ready to die and we have brought it forward by agreeing to this pathway. If you with hold fluids from any human death is inevitable.

I am obviously in quite a sad place at the moment, just waiting, and realise my rational me is being severely influenced by my emotional me sad

spudmasher Tue 23-Mar-10 20:34:59

You have to let the emotional you dominate otherwise you will never get to the place you need to be which is a very sad place.

I too struggled with the fluids thing. He had a little sponge on a stick to wet his mouth.Heart breaking.
My thoughts and sympathies are with you at this difficult time. As awful as all the feelings are you have to feel them with full force. xx

QueenofWhatever Tue 23-Mar-10 21:38:15

I know some stuff about the LCP and, on the whole, I think it's positive that she is on it. I am sorry this is such a difficult time for you.

With your clinical knowledge, do you think sub cut fluids would make her more comfortable? Or would it lengthen this final stage? Symptom management is crucial to a good death and I hope her pain is being managed well. My (limited clinical) understanding of these things is that the drop in fluids will not increase her distress. But if it is distressing to you, I think you should discuss it with her care team.

McDreamy Tue 23-Mar-10 21:58:41

I remember having this discussion many times over when I was nursing and this is way before the LCP came into being.

Some thought fluids just prolong the inevitable which is why I think IV fluids is probably not necessary but I do wonder if sub cut fluids would make her more comfortable. Would she not have an overwhelming thirst? I don't know. I have been carrying out oral care with the pink sponges when I visit.

I'm not sure I can discuss this with her team as I don't really want my mum to know what I am thinking. She is having such a difficult time at the moment. One of our close friends is a Pallative Care Consultant, I think I need to talk it over with him, why it is not part of the LCP. I think in Nan's case she is beyond fluids now, they were stopped on Saturday so I don't think starting them now would be right.

Oh I don't know my brain is just in over ride! Thanks for listening to me smile

brimfull Tue 23-Mar-10 22:13:48

Sub-cut fluids can still be given if dehydration is causing distressing symptoms -but ,bearing in mind that giving fluids is probably not being given if the your Nan was unable to take it orally anyway.
The overriding purpose of the pathway is to reduce distress to the patient and the fmaily.
Bear in mind that conditions like heart failure may contra-indicate this.Talk it over with the staff.
Sorry you are going through this.

brimfull Tue 23-Mar-10 22:14:36

sorry should have reviewed-came out all garbled

Homebird8 Wed 24-Mar-10 16:02:03

Just wanted to say that I was thinking of you. sad

spudmasher Wed 24-Mar-10 19:21:26

Yes, me too.

McDreamy Wed 24-Mar-10 20:41:46

Aw thank you. Nan died this morning, it's been a tough day and I'm glad it's nearly over. Nice to think she passed away peacefully.

brimfull Wed 24-Mar-10 22:06:40

So sorry about your Nan Mcdreamy.

spudmasher Thu 25-Mar-10 18:17:40

Sorry to hear that McDreamy. Wishing you strength at this difficult time.

Homebird8 Thu 25-Mar-10 19:21:02

I'm glad it was peaceful McDreamy but really sorry that she's gone.

ohmeohmy Thu 18-Oct-12 07:30:35

The lcp is not always a one way street. Patients who plateau or improve a bit are taken off it in the hospice I know well

carocaro Thu 18-Oct-12 10:47:12

Sorry for your loss. Wishing you the strength you need.

carocaro Thu 18-Oct-12 10:47:28

Is it for cancer patients only?

merlottits Thu 18-Oct-12 10:48:41

This I an old thread. The OP's nan died in March.

merlottits Thu 18-Oct-12 10:49:06


carocaro Thu 18-Oct-12 11:00:27

So what!?

merlottits Thu 18-Oct-12 12:18:09

Sometimes old threads get dredged up and posters don't notice. I have fallen for this myself and sometimes it's inappropriate. I never look at the date usually.

I was only pointing it out. Jeez.

Ettie72 Mon 29-Oct-12 11:19:12

My mum had terminal cancer and fought it for 2 years, even though the doctors gave her only 3 months. She was finally admitted, really against her will, to hospital for treatment for pneumonia. I have no doubt my mum was near the end, thus when a doctor I formed us she had been placed on the LCP, we went along with it, believing that absolutely nothing more could be done for her.
However, what I didn't realise at the time was that fluids were bring actively withdrawn from my mum, who had I lu kne kidney, as well as antibiotics. At the time she was still conscious so we were able to give her water. However, the nurses then started to sedate her and again, we as a family believed this was the natural order of things.
My mum died about 25 hours later, despite sitting up in bed and eating a trifle. Whilst very very I'll, we thought we might at least be able to bring her home, where she could die when the time was fight. I now have no doubt though that her death was hastened due to withdrawal of fluids and continuous sedation. A patient who is constantly put to sleep is unable to ask for a drink
If my mum had been allowed water, then we could have got her home. At no stage did the medical staff tell us part of the "care" plan was to Withold fluids. If only I had cottoned on to this, but grief doesn't always make you think rationally.
The LCP has lots to commend it, but people MUST u d'état and it fully. We were given an edited version. We would never have agreed to our mum's death being accelerated due to dehydration.
I think the term euthanasia is one that, unfortunately, springs to mind1

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