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

3littlefrogs

the way we administer the pathway is

1. talk to the family to make sure thay know exactly what is going on
2. administer any medications to ease any symptoms that patient has
3. relax visiting hours so family and friends can be with patient 24/7
4. offer lots of tea and meals to the patient if they can take them and also offer the same to the family 5)keep popping in and out of the patients room to see if patient has got any worse and make sure that they have not leaked any bodily fluids 6)keep lines of communication open between us and the family and having it as we as nursing staff and the family are working together as a team for the benefit of the patient

hope this helps

Devonshire that sounds amazing, so calm and peaceful
So reassuring to hear, I wish we'd had you and your team

I am and even more as to where it says on the lcp to not give food or fluids??

I am a community nurse and that is a decision based purely on what is appropriate for the individual patient and has absolutely nothing to do with the lcp. If a patient is able to eat or drink safely (without aspirating) they would never ime be withdrawn.

The 'coverage' in the daily fail is IMO, dangerously close to libel. The LCP is, when used properly, an amazing opportunity to facilitate a dignified and peaceful death in any healthcare or home setting.

It does NOT advocate stopping food and fluids - when entering the terminal stages of disease, many people gradually lose the natural ability to swallow safely and effectively. The LCP recognises that when this happens, that the patients condition is deteriorating. When this happens. choking becomes a risk, as does the risk of food/fluids being aspirated into the lungs and causing a painful pneumonia. Fluid drips and tube feeds cannot be tolerated by a dying person - the extra fluid cannot be effectively processed by the body and the person can 'drown'. This loss of ability to swallow is a criteria for implementing the use of the pathway, rather than an OUTCOME of using it.

The 'aim' of the LCP is to enable ALL healthcare clinicians, whether they are trained in end of life care or not, to ensure that dying patients do so peacefully.

I don't pretend that all clinicians use the pathway effectively. I will not pretend that clinicians communicate properly with patients and families properly about end of life care. But please don't believe the horrible myths pedalled by the fail

www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/Innovation/LCP%20consensus%20statement%2024%2009%2012.pdf

www.mariecurie.org.uk/en-gb/healthcare-professionals/innovation/liverpool-care-pathway/

The doctors on the oncology ward when my DM died whilst on the LCP, checked their every move with Macmillan to make sure they were delivering best practice in DM's individual case.

We all agreed that her death was in no way traumatic for her or for the family although her loss is a different matter. If it had to happen, that was the way we would have wished it.

ya so nbu
don't want to post about my dear old dad, but we were praying for this,

I also work with the LCP in the community setting, and have found it to work well in the last days of life. I sometimes wonder if it works better in community nursing, as relatives seem to accept impending death more easily, especially as there are no pieces of equipment, monitors or anything else that 'medicalises' something that is part of the natural cycle of life. One issue that seems to arise most often in the media, is that of denying food or fluids. I certainly do not deny this to my patients, and relatives are encouraged to give what the patient fancies until they cannot swallow anymore. Regular mouthcare is then instilled, often with pleasant tasting fluids. There is quite a bit of work in the area of using intravenous fluids in the dying, and in the main it has been found to have little to no benefit as regards patient comfort, and in fact may be detrimental in some cases. If nurses are properly educated in the execution of the LCP, then it is a good way to allow patients to have a peaceful dignified death.

YANBU. The LCP makes a critical difference to the way many people die in hospital. There's no problem with the pathway. There is a problem with our attitude to dying.

I've seen the LCP in action twice in the last 2 yrs, My Dad & MIL. They had dignified & peaceful deaths & I am eternally grateful for that.

Used properly the LCP is a good thing.

I'm against it, I really had an elderly loved one at the end stages begging for a drink of water and denied it on the grounds that he might choke - he went on to live for a few more weeks, but I don't think his desire for water should have been denied even if he had have choked - we can't take away that kind of choice.

I agree Sim. Your poor relation!

My DM took sips of tea whenever she wanted them right up until a few hours before she died. She only stopped as she started to slip away. I think it's a poor understanding by staff of the LCP and a lack of individualisation which results in horrifying stories like yours. When staff understand, they do it so well and it is such a good way to go.

YANBU

As a healthcare professional who used to work in the NHS, the way that the LCP was presented by the media really annoyed me. What is particularly galling is hearing how patients are being 'starved to death' - what often happens (particularly in dementia, as someone mentioned upthread) is that the person can no longer swallow safely, which would mean food and drink causing pneumonia (in addition to the underlying condition they were admitted with). People also often do not feel hunger or thirst when they are dying, so why force it? Mouthcare is often what gives most comfort.

Seems to me that it's so much easier for the media to say that a patient is being starved to death (ooo..look at the bad doctors and evil NHS) than accepting that someone may no longer want or request food or fluid, and that death is sometimes the inevitable conclusion.

And just to add to ^, if people DO ask for food and drink, then they are offered it. Or should be.

My mother had excellent care at home when she was dying of acute myeloid leukaemia.

She had a syringe driver to deliver her morphine. Her name was listed with the local GPs as a priority patient so I just called them if necessary and someone came out immediately. They liaised with the local hospice who sent a doctor out to visit her to review medication etc. The community nurses visited daily to see to the syringe driver and give her a wash. We were given an overnight nurse in the last two weeks so that I could get a sleep. (can't remember if it was Marie Curie or McMillan).

To be honest she had no desire to eat or drink in the last few days and it was the nurse who advised me to moisten her lips etc. We were never told NOT to feed her - it was just a natural occurrence that she didn't want to eat or drink.

On the night my mother died she was in a lot of pain, despite the syringe drive having been turned up that day (and for several days previously). I called the emergency doctor who came out immediately. He fully explained that the level of pain medication she would require to ease the pain meant that her death may come quite quickly. As she was writhing about at that point of course I agreed to it. He, however, was very clear that was NOT his intention - it just sometimes happened as a side effect.

There was no indication whatsoever that any decision was ever made regarding my mother's care which was influenced by finance or to free up beds or medical staff etc. - either when she was being treated with aggressive chemotherapy in the hospital, during an eight-week stay, or when she moved to palliative care at home. Indeed the hospital were more than happy for her to stay there for her end of life care, and in fact pointed out to me how difficult it would be for me, but my mum wanted to go home and I of course agreed.

Without exception the medical staff were helpful and compassionate and not only looked after my mother, but were always asking me how I was coping and if I needed anything.

I don't know if she was under the Liverpool Care Pathway officially or not, but her treatment certainly sounds similare to how it's described.

Poor communication between relatives and Health Care Professionals causes a lot of the reported problems IMHO.
And of course, no-one ever reports on the tricky navigation that the HC Professionals have to negotiate when "the family" (as if this is somehow a united body) all want something different.
It's interesting too that the measures outlined by devonshiredumpling, to me, should be measures provided to ALL patients rather than just those patients who are dying.(Other than feeding all the visitors!).

OP, I work in a residential home for the elderly with mental health problems. Inevitably, this involves end of life care. I had not read the LCP until today, prompted by you.

Quire honestly, it appears to be a document stating the obvious to me. It seems from some posts that it is not so obvious though.

SIM - A person with a 'poor swallow reflex' can choke on every drop of fluid; & it will go into their lungs & speed up their death from aspiration pneumonia.
It's desperately sad & hard to accept that you cannot help that thirsty person; if you give Intravenous fluid in a drip or give them oral fluids then they will slowly drown, choking to death on their own body fluids.

That is the reality of dying for many people, all the LCP is for is set out the care given during that dying process & to ease the symptoms.

Many people now do not understand what the dying process is; & sadly many drs & nurses do not have time to sit down & explain that process.
This is often because relatives don't ask so it's assumed that they understand the process of dying.

If any relatives are unsure of why something is or is not being done - then they should ask staff.

Relatives can contact the patient's Consultant's Secretary through Hospital Switchboard & ask for an appointment asap to discuss anything they are unsure of; or make an appointment with a senior nurse.

It's important for relatives to appoint an agreed 'next of kin' to communicate with staff, that way everyone in a family understands what is happening.

In the midst of life is well worth a read, imo!

Sim your poor relative, that is horrendous. Was she actually on the LCP? There are all kinds if thickners to help those with a poor swallow reflex. Have you ever been back and asked someone to review the care your relative had? I understand the issues with poor swallow reflex and concerns about further harm but did they do anything else for hydration? As your relative went on for a few weeks I am assuming a drip at the very least.

I read the Daily Fail article whilst sitting in a coffee shop and wanted to shout out loud.

The LCP is clearly well understood by MNers on here - we're a well informed lot - but I was really annoyed about the term 'death lists' used by the DF for those under end of life care policies (of which the LCP is a specific pathway)

Nowhere did it say that applying an end of life care policy would allow a patient access to palliative care in appropriate settings - the article just implied that if you were under the policy you'd basically be euthanised in the next 24 hours. Totally outrageous reporting. Alarmist and deliberately misleading. I don't think the reporter had ever even met a doctor let alone done any research or fact finding on what palliative care is all about.

The Daily Fail is not even fit to wrap chips in, let alone be called a newspaper.

Had one OK experience here with the LCP and one bad experience.

What I cannot understand is if diagnosing someone dying is not an exact science then why are not more people who are put on the LCP re-diagnosed and taken off it when there has been a reassessment of their condition?
What are the stats for people starting the LCP and then been taken off the pathway (and then maybe put on it again at a later stage or not???)

Have not read the Daily Mail

i am against it