liverpool care pathway

[devonshiredumpling]

i am fed up to the back teeth of reading about innapropriate use of the liverpool care pathway in terminal illness cases. i work in a hospital and all the patients we have had on the pathway have had peaceful and dignified ends . The papers are full of scare stories and does not do justice to the thousands of hard working doctors ond nurses up and down the country who do a brilliant job at adminstering to the patients who are on the pathway. the pathway is only given to patients where there is no hope of life and have satisfied certain criteria .AIBU to want to shoot the scaremongers who do not know what the fuck they are on about it makes me so cross

Well said! I'm also a nurse in a hospital and I can't stand the scaremongering from the Daily Fail! Making out that doctors and nurses are 'bumping' people off as there aren't enough beds? Wtf? Having had personal experience of the LCP when my sister died earlier this year, I can, hand on heart, say it was the best scenario for my sister. She died with dignity, something I think that as professionals that we all aspire to achieve for dying patients.

No you certainly are NBU. Are you talking in general or have you got a link to a certain article? Is it the Doomsday Times Liverpool Echo?

Agree totally.
I work in the community and the Liverpool Care Pathway is brilliant. It allows patients to stay pain free at home if they wish to spend their remianing days with their families.
The protocols beore this was introduced was totally inaccurate.
However you only ever hear of bad experiences in papers like the Daily Fail, you never hear of all the successful ones

YANBU,it drives me mad to read he crap written about it and the suggestion that dying people are being bumped off is ridiculous!

no it is in the daily fail

Well, I am glad it all works well in your hospital.

I am a nurse. When my (dearly loved) relative died recently, the LCP was implemented after 2 weeks of appalling neglect in a medical ward. Indeed the hospital car park would have been more private and dignified.

So, not everywhere is the same.

YANBU

It is about people dying with as little pain and other symptoms as possible. It is about addressing their and their families emotional and spiritual needs when they are dying. It is NOT about bumping people off
IMHO there needs to be a wider debate in society about death.... dying is an inevitability and we should all think about what sort of death we want when we do die and let others know of our wishes in advance.

A good death for me would be peaceful and surrounded by my family- which is what the LCP aims to achieve

Hear hear! It drives me mad to read all the hogwash the Daily Fail have been writing about the LCP. Having implemented it with patients and my mum dying on it a few months ago, I think its a fantastic protocol and the people writing these lies should be ashamed of scaremongering.

I've never seen it used inappropriately.

Well that explains (as if I hadn't guessed) my mum saying in an 'aren't I clever?' Way yesterday 'I'm sure they had her on the lcp until her neice turned up, poor old lady, now she's home and well' etc etc . Guaranteed my mum has no idea of what it is beyond the bloody Mail.

What would have been nice for us was for us to have been told that Daddy was on a DNR, not to have found out by accident; we didn't know anything about the LP either

I found the L P cruel and unkind at the time, because no one explained it to us; all we could see was fluids and nutrition withdrawn and four days later he died. Horribly. (I shan't bother you with the details but suffice to say managed poorly)

This was in 2005.

Can you explain it to us?
All it appears to be, to someone not medically trained, is allowing someone to die of starvation.
How is that a peaceful end?

starving people to death does not seem like a good idea.
painfree death at home, or with family close by, sounds better.
can't see how the two fit together.

I am with you OP. YANBU

It seems that the cases in the papers involve poor communication with relatives rather than inappropriate use of the LCP.

My much loved auntie who died of cancer two years ago went onto the LCP in the last week of her life. She still had all medication, she still ate and drank when she felt like it. She was not denied fluid or food if she wanted it but they didn't put up drips, stick down NG tubes or perform any other procedures which might add to her suffering. My auntie did well with Calipo ice lollies, just about the only thing she wanted and had one the day before she died.

I think the LCP came out of a desire not to prolong suffering by lots of procedures which add to distress without adding any extra quality or length to a persons life.

It has to be discussed with relatives though, they need to understand when it is appropriate. Some will never accept it because they want a dying relative to be saved even when that is not possible.

When my DH was put on the pathway in 2005, food and fluids where denied. We had to use mouth swaps, to stop his lips from drying out.

His death was still a lot more peaceful and less painfull than other relatives that had died of terminal illnesses pre Pathway.

I went to work in end of life care a few months after his death.

It was and has been good to see that there have been changes made and starvation/dehydration is not the norm.

I have had both professional and personal experience of pathway in the years since 2005.

Communicating with all of the relatives can be difficult as the patient has a next of kin and not all of the relatives will agree with the pathway process.

My dad's mum died on the LCP at Christmas (2011); she had heart failure & aspiration pneumonia.
She had dementia so she kept pulling out cannulas.

The heart failure caused pulmonary oedema; that's why IV fluids are useless in end-stage heart failure.
The IV Antibiotics used to treat the pneumonia also caused kidney failure (exacerbated by the heart failure. or something.)

Anyway none of the treatment worked & it was the nurses who put the idea of the LCP to the drs, because they knew Nan was dying.

It was difficult to get hold of a dr to sign the LCP on bank holiday weekend so Nan was in pain & distress for hours without the drugs that are part of the LCP.
The LCP injected medications are all 'double checked & given' in our hospital - had to be subcut as it would have been cruel to put it yet more cannulas.
Sadly weren't enough staff on the ward (2 Staff nurses & 1 HCA for 30 patients at night, most patients were men with dementia who were wandering or aggressive; several patients on LCP or critically ill & having blood transfusions etc).
So once the LCP was signed (later than necessary sadly) the meds would be given up to an hour after Nan first needed them (eg. morphine for chest pain, hyosine for fluid in the lungs.)

The nurses really did their best in a very difficult situation; they genuinely cared & tried hard.
The staff were lovely & explained everything to us (Nan's family).
They allowed us to stay with her continually until she died.
The staff & family gauged whether Nan could or would eat or drink even while on the LCP; her last meal was Purbeck vanilla ice cream; but after that she could no longer swallow so we moistened her mouth with cold tea (her favourite).
She had oxygen via nasal specs to keep her comfortable still but after she pulled the oxygen off we did ask for it to be removed as we worried that the oxygen was prolonging her discomfort to be honest.

Nan fought all the way - & medications couldn't calm her as she was not mentally relaxed. She was too scared to let go & leave us.
The hospital chaplain visited & despite not being religious Nan visibly relaxed so much with him there.
Nan died suddenly & not that peacefully, but with family & nurses present.

In retrospect i'd say that the LCP was a good thing - invasive treatment stopped but food & fluid were always offered; also the injected medications were purely given to treat the symptoms that make the process of dying so horrible.

For the LCP to be more effective the hospital would benefit from more drs & nurses on duty at all times.

The staff were so good but more nurses would have made all the difference on Nan's ward as they never had breaks in 12 hour night shifts; they were struggling to cope with an overcrowded ward with often violent patients as well as those seriously ill.
Sadly with the present government that won't happen.

I've stopped reading the Daily Mail as their attitude stinks.
My other Nan reads it & now refuses to even see a Dr (despite having unpleasant yet easily treatable conditions) - thanks to the Daily Mail; i hate that paper actually.

Any care plan is only as good as the people delivering it.

In our case it involved lots of paperwork and box ticking, but no actual care of any description, no compassion, no awareness of the spiritual or emotional needs of anybody, no communication at all.

I wish we had been in one of the hospitals described here.

My mam was put on LCP on the Sunday, on the Wednesday she was taken back off it because she was fighting so hard. She lasted 2 more weeks. I do not know if she was put back on it at the end as unfortunately i could not be with her (she lived 300 miles away) I thought it cruel at the time as she was asking for a drink but we weren't allowed to give her one, just swab her mouth, we agreed because we thought she was at the end, but she was determined to see her grandkids one last time, which i took down on the Monday after she was taken off the lcp to see her.

When you are entering the last stages of life, your body cannot tolerate food and fluids.
It may appear unkind, but giving Iv fluids to dying patients would cause them more discomfort as their bodies are shutting down and their organs are unable to tolerate the extra fluids.
I've often seen sub cut fluids put up for dying patients to appease the family. The lcp is not at fault, and used appropriately offers dignity to patients in their last days.
The problem as I see it is medical staff and society as a wholes attitude to death and our reluctance to be frank and transparent about it. If the lcp and withholding fluids was fully explained, people would be less worried.

YABU.

After watching my aunt be admitted to hospital following a d&v bug when she needed rehydration and monitoring (at 82) she left 6 days later dead after LCP was her "treatment"

She had no underlying conditions. Previously she was fit and well.

There has been an investigation into her death. She was essentially neglected to death whilst apparently receiving treatment.

I've seen it work fantastically well. And what the daily fail forget to mention is that people come off them. Diagnosing dying is incredibly hard and sometimes patients who were thought to be at that point rally and recover. Yes I am sure that rarely it is not implemented well. But it is a huge improvement to what was before. Food and drink are allowed as the patient wants.

The idea that its used to create beds is probably one of the most offensive and disgusting things I've ever heard.

My DM (66) died, supported by the LCP for her final two days in 2010. She was denied nothing, she took a few sips of warm tea only hours before she passed away, calmly and with dignity and all her family around her.

DGF (92) was on the LCP a couple of years before but after a couple of days of being practically unconscious suddenly woke, demanded porridge and ate it. They took him off the pathway and it was a couple more weeks during which he received excellent medical care before he went back on the pathway for the final time. There was nothing wrong with this management. It was always working with the evidence from him as an individual at any moment in time.

YANBU to be so angry at dramatic and inaccurate reporting. Some deaths aren't as calm as the ones I have described but I believe that more would be a great deal worse without the LCP. The motive is always one of care for the dying and their family and those who want to spend energy on raising a stink about something should choose a topic that really warrants it.

YANBU

But a 'pathway' can only be as good as the staff who use it.
It's meaningless unless ALL staff understand it completely and utilise it properly. In the wrong hands it CAN and HAS been harmful.

I have post-grad qualifications in palliative care and have implemented the Liverpool Care Pathway in my workplace but managing it on daily basis and making sure it's used appropriately takes time and effort.

Although the Daily Mail have been sensationalising it (as they do most things) I think it IS a lesson to us all that it is NOT perfect and in itself is meaningless and sometimes dangerous unless used properly.

Any care plan is only as good as the people delivering it.

^^ This. A thousand times over. I say that as a nurse of almost 20 years.

It is a great concept, and a useful document to use in order to guide and steer care.

However, unless we radically review the current system of nursing in this country, it will be as useful as a chocolate teapot in a lot of places.

Indeed MidnightinMoscow.

I understand the LCP.

Unfortunately, in some cases (mine included), when the staff do not understand it, it means:

withdraw all observations and nursing care
do not allow any fluids or mouthcare
ignore patient
ignore relatives

awful.