On death and dying: The Liverpool Care Pathway
In the late 1990's in collaboration with the Marie Curie Hospice, The Royal Liverpool University Hospital launched a pathway designed to guide healthcare professionals care for the dying. In recent months there has been significant critisism of the pathway.The Liverpool Care Pathway (LCP) is widely used, and recognised as best practice when caring for patients who are end of life. It aim is to guide the multi-disciplinary team in areas such as discontinuation of fluids, medicines and the pathway gives guidence around comfort measures during the last days and hours of life.
Organsised into sections, it has provided consistency, support and guidence for those who make use of it to promote and ensure a comfortable, dignified death.
In recent months there has been a great deal of scrutiny around the use of the pathway, orginanating from a Daily Mail article by Melanie Phillips who suggested that the pathway has been used to expidite death and without the full knowledge of relatives of dying patients. (I must warn the reader, the Daily Mail is a tabloid paper reknown for it's condemnation of the National Health Service and the UK healthcare workers)
The original article has caused great anxiety within the healthcare world, not because the information provided is correct but because the scaremongering tactics of this tabloid could potentially lead to end of life patients being denied best practice and subjected to painful, prolonged deaths.
There have been concerns voiced on medical forums, in the British Medical Journal and via facebook fictional characters such as the "Medical Registrar", "the Palliative Care registrar" and "the Consultant Vascular Surgeon"
I have used the pathway on many occasions, and in fact have on a number of occasions initiated it's use with discussions with the medical teams. I have only once had the experience of a patient who survived after being put on the pathway, it was discontinued when she showed signs of improvment (she was an elderly lady who had fallen, fractured her ribs, had a splenic bleed and had a multitude of chronic illness' ) It was felt she was unlikely to survive. She stopped bleeding and woke up a week after the pathway had been commenced, the comfort drugs were tailed off when she asked for a cup of tea.
In response to the Daily Mail's article the government has responded, demanding that investigations be carried out in areas that have been named as having poor practice, there is a suggestion that healthcare organisations receive money for putting patients on the pathway, there has been an overwhelming response from medics stating that the care pathway is used after full clinical assessment and where the patient is felt to be in the last days of life.
There are now genuine concerns that if healthcare professionals suggest the care pathway to families of patients who are felt to be end of life, there will be fear, misunderstanding and there is the real risk that patients will suffer as a result.
Descriptions such as the "death Pathway", claims that it is used to expidite death only contribute to add to the misconceptions and further undermine the general public's trust in healthcare professionals. I have been truly saddened to see the assassination of such a helpful, clinically driven and patient focused pathway by a tabloid paper be taken by the government, and rather than getting facts and looking at the evidence behind the pathway, politicians jump on the bandwagon to condemn and give credibility to the scaremongering.Last edit by Joe V on Nov 4, '12
XB9S is an Advanced Nurse Practitioner with over 20 years experience in critical care and general surgery.
XB9S has '22' year(s) of experience and specializes in 'Advanced Practice, surgery'. From 'United Kingdom'; Joined Sep '06; Posts: 8,559; Likes: 3,908.0Nov 4, '12 by Altra, BSN, RN GuideThis NYT column chronicles a family's positive experience with the Liverpool pathway.http://www.nytimes.com/2012/10/08/op...RtAUq3HSTlTIHA0Nov 4, '12 by brandy1017I have heard concerns that people are placed on this when they are simply confused from a UTI or infection and obviously not able to speak for themself and yet could make a full recovery with approriate care, IV fluids and antibiotics. I think it leads to the slippery slope of euthanasia and more scrutiny is a good thing. The journalists and news media many times are able to bring light and expose problems that would otherwise be hidden.
Scrutiny is not a bad thing and may lead to reforms for better outcomes and to protect people from euthanasia. We have palliative care and hospice in the US, which is helpful when appropriate, but many people have similar concerns about euthanasia.0Nov 5, '12 by ayla2004I must say 3 years ago my hospital started using a different version of the LCP which can continue abx. Oxygen. Artificial feeding peg/ng artificial hydration IVI. At first I was puzzled as if we think a person is dying are some of the above comfort measures. If a person is dying and body systems are shutting down . Do they need lines attached go them and flhis being pumped in can their body's absorb the fluids or will the becomes oedamtous? I felt initially other would put the medics off the decision to start tbd pathway. However I now feel that in light of oppevents to the LCP having these option included and it Bei ng reviewed every 3 day means we can reassure family that nothing will be nelgeted.0Nov 5, '12 by XB9S GuideBrandy thanks for your comments, and I do agree that reviews and evaluations are important, these were already taking place. What the daily mail has done is scaremongering, there are nothing constructive about that article, no positive stories or experiences.
Ayla, the care pathway is guidance rather than prescriptive, we look at the individual and decide fluids, nutrition, antibiotics in consultation with MDT and family.
Altra, there are many such experiences across the UK in medical, nursing and the general press.1Nov 5, '12 by JDZ344I find the comments on the daily mail to be offensive in the extreme. Comparing LCP to Auschwitz and hospital staff to Nazi SS members? Beyond offensive, and I will no longer give them the time of day or their sponsors an audience for their ads.Last edit by JDZ344 on May 14, '140Nov 6, '12 by XB9S GuideJust read this more balanced piece on the LCP
End of life care through the eyes of a doctor and a patient | drkategranger
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