Liverpool care pathway

[stella1w]

Posting here for traffic, not debate,
distraught friend just told her mum, demented, at home with 24 hour care has been put on liverpool care pathway. She spoke to the gp about palliative care thinking it would mean a nursing home and was not consulted about lcp. Gp is refused to let her mum have sedatives or water and my friend is v v v upset and feels this is like euthanasia. She doesn,t seem to know what to do or if she has any rights to stop it. It could take four weeks.
I said if she had doubts she should ask for lcp to be postponed until the children had been consulted and undertood and consented.
What can she do?

It just gets me so cross. My mum was a nurse - she knew the score, she knew the prognosis and she met it with dignity and bravery.

She was very explicit that we should let her go (when she was lucid) and the last few days I cherish, we sat and talked to her, laughed, cried (alot!) sang her favourite songs to her and held her hand. Her care was not compromised - she had oral care too (they even cleaned her teeth and sprayed her perfume on because she was paranoid about smelling) the LCP just stopped her being disturbed unnecessarily.

She passed away quietly and in her sleep. Just how I would like to go.

jake
do you not believe a patient if they truly are dying and lets be clear about this no doctor can predict .. should be left to die in a humane way without any intervention either way .... i dont see how anyone can say the lcp framework and its protocols can be a good and peacefull death ..
this is proven it is not being used as it was meant forget telling the families for a moment .. do you not think that in an acute hospital hospital they do not have the time or the right ambiance in which to die .people can die a pain free death without being dehydrated and sedated to death ... as we know the effects of a dehydrated patient is very similar to that of someone close to death ... also the drugs used morphine ,haldol ,medazalam ,lorazapam only bring on the symtoms of an already dying patient

hotstepper - leaving someone to die with no pain relief when they have terminal cancer is not humane, that's barbaric and there is masses of research to back that up.

What exactly can no doctor predict?

Still waiting for your care plan.

colley Sounds like she knew her stuff and you had a good last few days together.

Having been a HCP myself (was a student nurse) I think it can be a great help when it comes to dealing with hospitals and other HCP's either for your own care or your loved ones. Gives you much more confidence I think ! Maybe one day it will help me have a good death too. Knowing when to let go is very important I think.

Don't let anyone on here upset you will you ?

What made you decide not to go into nursing Juggling?

a care plan without incentives and patients who have not had a peacefull and dignified death on the lcp or a care plan with compassion care and love ? i can only wish that everyone on the lcp had such a wonderfull and peacefull death . the sad thing is we will never know how peacefull if it is untill we are unlucky enough to enter the incentive led lcp .. how can a patient explain they are having as good as death on the lcp when they are sedated heavily and the lack off fluid unables them to speak of what they feel ... we assume by there non responsive body movements or vocal response that they are indeed having a good peacefull death

No doctor can predict the exact time of death, that has to be at best an educated guess, as for a care plan, why do you need a plan if the death is supposed to be as you put it "natural" or as natural as possible!

Thank you 5Speckledhens, much appreciated.

I can agree with the use of painkilling drugs, but what about overuse? There have been a lot of reports of people being knocked out altogether? Would someone here mind defining what is reasonable use of painkillers and can overuse lead to premature death?

colleys mill, there is no question that the nurses looked after your mum, but is that down to the LCP or the nurses themselves. If it is down to the nursing care then surely there is no need for the LCP anyway? Since it is just a framework!

Hi GothAnne - Whilst doing my training I just found myself getting interested in teaching and learning and decided to do a PGCE in primary teaching once I'd finished my training. I was doing psychiatric nursing too and felt there might be more opportunity to make more difference in people's lives if you get 'em young !
I found myself moving towards early years education.
Am still interested in learning, advice, and counseling areas though ...
Perhaps there's still time for at least one more career change before I'm done ?
You are an HCP ?

goth dark ... a doctor cannot predict a patients death and i have already answered you in care plan question sorry not you but i am not repeating myself twice look on the thread ...and your question with regards pain relief there is no reason except that it will speed up respirity problems ... but there is no use for the amount of drugs given through a syringe driver either ... and re the nil by mouth what will that do to a patient other than speed up the symtoms that a patient is in the last hours of death .. but most patients are not placed on this framework in the last hours they are placed on this alot earlier ...

A poster, I believe mentioned incentives which hospitals were paid as regards this, did not a Dr Tony Cole, chairman of the Medical Ethics Alliance pressure group say that If death is accelerated by a single day that will save the NHS nearly £200 ? that is the estimated cost of a patient per day in hospital? If that is true, it is certainly an incentive, so would trusts actually deny that this is the case?

It has also been reported that hospital trusts have received a financial bonus of some £12,000,000, of course that sounds a bit high, but even the Government has acknowledged that trusts have received financial incentives, for placing people on the pathway, confirm or deny, what is the total of financial incentives which have been paid?

goth please tell me what is not barbaric and torture in the framework of the lcp ???? i keep hearing people say mistakes happen well im sorry if that was your family member would you say oh well its still good its the doctors or nurses fault ???? they have not implemented it correctly tell me . what part of medicine can you do that ....were is it straight forward and can go from a tick box to every patient .. . all patients are different and should be treated as such

The question which then should be asked, has saving money, become part of some NHS strategy and are deaths being accelerated because of some financial incentive? If so then then is it feasible that structure of the Liverpool Care Pathway is being abused, if so is that abuse widespread or contained to a few specific hospitals?

If there is no abuse of the LCP then why are cases of abuse and claims of premature death being reported, or are the people who have experienced the loss of their relatives in this manner lying? Is there a case for neglect and abuse of the Liverpool care pathway framework to be answered? If not then why is there a need for a review?

Hotstepper - how on earth can you say there's no reason to stop someone's pain?

I've Ctrl+F your name. No reference to an actual care plan, just you repeatedly saying that giving pain relief and sedation is somehow cruel.

Actually doctors can predict patient's death in many cases. Many terminal conditions in the end stages will create very obvious signs in blood gases, blood results, baseline observations, etc that death is imminent as the body is essentially shutting down. There is some element of science to medicine, it's not just about throwing drugs at patients.

Juggling - I'm glad you found your niche.

GothAnneGeddes If you say that doctors can predict the death in many cases why are so many cases being reported that the LCP is actually being abused?

Or perhaps has this been down to NHS financial incentives, if doctors are so accurate?

Also you cannot reasonably argue that doctors can predict the death of patients in many cases, without having concern for those who happen to fall into the few cases, are these few cases simply to be left to die?

GothAnneEddies, I asked if death is natural, why do you need such a plan anyway? Surely adequate care is enough, without some national guideline which could lead to the problems like the Liverpool Care Pathway has? Let us be totally honest, the NHS has not exactly come out of this smelling of roses to be honest.

Whilst you may expect a few cases to go wrong, the number is growing by the day and alarmingly are they not, does that not disturb you at all?

Actually, if you look at the total number of cases where the LCP has been used, you will find that the number where concerns have been raised is a tiny proportion. Additionally, a number of those cases where concerns were reported have been proved to be unfounded or ones where the LCP is not involved. Some newspapers with a track record of being very careless with their facts have chosen to make a sensationalist campaign out of this issue, and frankly I would not trust anything the report on it unless it is independently verified.

Thank you Veritate. That is exactly the point I was going to make.

Veritate I do not call 558 patients who died of severe dehydration a small proportion, But even if the numbers are lower than that it should be a matter of concern do you not think?

Could you also please state which cases have been reported which are proven to be unfounded, or not related to LCP? Also define this sensationalist campaign, all the newspapers have seemingly done is to report as they find, surely by now there would be a case for libel, if the papers have not reported accurately?

should we not rather thank our media for being forthright and frank about the care of people, rather than trying to hide all the mistakes and pretend that they are not happening. After all if something has gone wrong is it not best to face up to it and try to rectify what is wrong. Surely improvements in care are what we all seek, nurses, doctors and patients alike. What is best for the patient after all comes first does it not?

I would have more faith in the media if it didn't rely so heavily on uncritically reproducing soundbites from Dr Anthony Cole and other members of the Medical Ethics Alliance.

A very short time spent Googling makes it clear that this is a religious pro-life pressure group which opposes the LCP because it considers it to be euthanasia.

Amazinglily, how many of those 558 deaths from dehydration were people on the LCP? There are a number of medical conditions which lead to severe dehydration, and some people who die of dehydration arrive at hospital in that condition and cannot be saved. Of course it is a matter of concern if anyone on the LCP died from dehydration rather than the illness that caused it to be used, and of course it is a concern if medical professionals make mistakes - but medical mistakes happen for all sorts of reasons.

So far as the unfounded cases are concerned, one classic example is the report of the LCP death of Fiona Bruce MP's father. Only he's still alive. And have a look at blog.practicalethics.ox.ac.uk/2012/11/the-liverpool-care-pathway-in-the-news-even-by-the-mails-standards-this-is-low/. The mere fact that papers print inaccurate reports does not necessarily found a libel case - after all, they rarely actually identify the doctors and nurses involved, and they are the ones who would have to bring libel claims. And what doctor or nurse could afford to bring libel proceedings anyway? You have to realise, not everything you read in the papers is true.

Oh, and welcome to Mumsnet Hotstepper and Amazinglily. Are you by any chance acquainted with CherylAmber and her dad?