Dismayed about the critism to the liverpool care of the dying pathwy

[ayla2004, ASN, RN]

Ive been reading online the press and blogs surrounding the letter of thiose 6 doctors who feel that the lcp is not always used as it should. i have felt people are jumping on the bandwagon to critise it and perhpahs they don't know The aim of the pathway is to guide the MDT to care for the dying perosn and their familly, to say that death is part of life and to let people have time to make their peace. I never really saw what hopistals did beofe they adopted the lcp but reading account they dying and thier relative care depended on the staff with no cohesion and often medical staff persuring a lost cause to treat/giving false hope.

The pathway sllows nurisng staff to care for the pt/familly without any non comfort care this mean blood.vital sign etc, we still postion for comfort provide hygeine espically mouth care will feed and give drink if patient is alert enough, try to provide a private room and encoruge the familly to be with the patient. liase with chaplincy etc.

If paitent are commenced on the pathway without any reverasl cause being investigated and treated then shame on the clinicans being so callous with a human life.

If however a patient as i do often have seen has been dying slowy over a period of time with systems gradually failing heart failure reanl failure that we can't correct them it is apprioate.

I have seen fluid going in to pt at the end of life iv site tissueing and sub cit not being absorbed and people swollen with oedma to arms legs and adobmen is this fluid making a differnce?

We do not treat every patient with a sedaitves running in high doses via pump. We do hav e comfort drugs prescribed. these include morphine/midizalom, cyclizine and glyopruvate using the s/c route either prn or syringe driver and notr all these drugs will be given to every person. also doctors tend to presribe the miniun amounts

and if prn nurses adminster the minun amounts.

There are lots of articles on the drawing up of the lcp and are worth reading.

[LiverpoolJane]

From what I viewed on TV it seems some Docs were suggesting it was being used as a way to almost euthanize patients. From my personal experience the Docs I come into contact with, in my opinion under use it, often delay putting pts on the pathway and when they do, will insist on continuing with certain observations and interventions.

I feel that the Docs who have raised this may have done more harm as Joe Public will now have a false picture of palliative care and feel reluctant to accept symptom control when their conditions would benefit from it.

[XB9S, BSN, MSN, EdD, RN, APN]

I've not seen the criticisms of the end of life care pathway, but I think it depends from doctor to doctor. I work with some excellent and very caring doctors and we work very closely with our palliative care teams to make sure that our end of life patients are comfortable, not distressed and receive appropriate care. I have to be honest we rarely use the care pathway, but that's not because we don't do these comfort measure but because most of the things on the care pathway have already been put into place before the actual paper work gets out of the cupboard.

IV fluids / SC fluids in end of life patients are down to the individual patients, dehydration can cause the patients discomfort for various reasons, so they should be assessed clinically and if it is felt fluids are appropriate then they should be given. As far as problems with the IV / SC sites, these are addressed fairly easily and should not be a reason not to give an appropriate comfort measure.

The comfort care measures that are described in the pathway are things that as nurses we should be advocating anyway, a dying patient should have a single room, we should be rationalising the observations we do on all our patients rather than recording vital signs for the sake of it. If we are not going to act on the results then why are we recording the observations.

I've found a lovely article on end of life care

http://www.jaoa.org/cgi/reprint/101/10/609.pdf

I am very lucky where I work, our palliative care team are around the wards every day and will always be available for advice and support when we need it.

[LiverpoolJane]

There was an artical in the telegraph with the following title (link below)

Sentenced to death on the NHS

Patients with terminal illnesses are being made to die prematurely under an NHS scheme, the Liverpool Care Pathway, to help end their lives, leading doctors warn today.

this was followed by an item on This Morning, which thankfully was much more positive.

http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html

[eternalsunshine]

I couldnt help but reply to this thread as I was also very upset by the negative and inaccurate remarks that were made by the mindless and thoughtless media.

I work in a hospice and was furious at the newspaper reports, One of the newspapers which I saw who were blowing it out of all proportion without looking at it in more depth or having the facts and actually referred to it as back door euthanasia - how very insulting to us nurses who consider this valuable pathway as a good guidance tool. This pathway contains flow charts of paths to follow if patients are in pain, experience excessive secretions or are terminally agitated and a check list of all the items that should be addressed. The family's understanding, the patient's spiritual and religious needs and so forth.

When a patient is commenced on this pathway, it is a multi disciplinary decision where we all discuss whether it is appropriate for an individual and identify the rationale for our decision. These newspapers should find out all the facts before they go frightening the life out of society :angryfire

[ayla2004, ASN, RN]

I stareted this thread and ive observed 2 occurenace since were familly have been unhappy that the pathway was commenced in the past 3 weeks.

however inm both cases the pt has redused food/fluids etc for documented days/weeks whilst they are in hospital.

i feel ina way that a refual to eat and drink can be a way a person says ive had enough and they are letting us know their wishes i would be cautios about ng feed etc.

[madeleine]

Sorry Ayla but I find your writing so poor as to be virtually incomprehensible.

[eternalsunshine]

I stareted this thread and ive observed 2 occurenace since were familly have been unhappy that the pathway was commenced in the past 3 weeks.

however inm both cases the pt has redused food/fluids etc for documented days/weeks whilst they are in hospital.

i feel ina way that a refual to eat and drink can be a way a person says ive had enough and they are letting us know their wishes i would be cautios about ng feed etc.

Ayla, I think you are quite right, it is amazing how many times you observe people who actually get to a stage that their quality of life for them is no longer acceptable and they have had enough and actually say they are ready to die.