Implementing the Liverpool Care Pathway for the Dying Patient (LCP) in hospital, hospice, community, and nursing home

2003 ◽  
pp. 121-140
Author(s):  
Alison Foster ◽  
Elaine Rosser ◽  
Margaret Kendall ◽  
Kim Barrow
Keyword(s):  
Nursing Home ◽  
Care Pathway ◽  
Dying Patient

scholarly journals Experiences with the Liverpool care pathway for the dying patient in nursing home residents: a mixed-method study to assess physicians’ and nurse practitioners’ perceptions

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Maartje S. Klapwijk ◽  
Natashe Lemos Dekker ◽  
Monique A. A. Caljouw ◽  
Wilco P. Achterberg ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Electronic Health Record ◽  
Nurse Practitioners ◽  
Care Pathway ◽  
Nursing Home Residents ◽  
Health Record ◽  
Electronic Health ◽  
Dying Patient

Abstract Background The Liverpool care pathway for the dying patient (LCP) is a multidisciplinary tool developed for the dying phase for use in palliative care settings. The literature reports divergent experiences with its application in a nursing home setting related to its implementation and staff competencies. The aim of this study is to understand how the LCP is being used in the context of the nursing home, including for residents with dementia, and experienced from the perspectives of those responsible for medical treatment in nursing homes. Methods A mixed-methods approach was used, consisting of a survey followed by interviews. A link to a 9-item online survey with closed and open-ended questions was emailed to all physicians and nurse practitioners of 33 care organisations with nursing homes in three regions of the Netherlands (North, West and South). In addition, 10 respondents with particularly positive or negative experiences were selected for semi-structured interviews. Results The survey was completed by 159 physicians and nurse practitioners. The respondents were very positive on the content and less positive on the use of the LCP, although they reported difficulties identifying the right time to start the LCP, especially in case of dementia. Also using the LCP was more complicated after the implementation of the electronic health record. The LCP was judged to be a marker of quality for the assessment of symptoms in the dying phase and communication with relatives. Conclusion An instrument that prompts regular assessment of a dying person was perceived by those responsible for (medical) care to contribute to good care. As such, the LCP was valued, but there was a clear need to start it earlier than in the last days or hours of life, a need for a shorter version, and for integration of the LCP in the electronic health record. Regular assessments with an instrument that focusses on quality of care and good symptom control can improve palliative care for nursing home residents with and without dementia.

Symptom Management: The Liverpool Care Pathway for the Dying Patient (LCP)

2014 ◽  
pp. 214-218
Author(s):  
Richard Latten ◽  
John Ellershaw ◽  
Deborah Murphy
Keyword(s):  
Symptom Management ◽  
Care Pathway ◽  
Dying Patient

Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital

2011 ◽  
Vol 25 (4) ◽  
pp. 293-303 ◽  
Author(s):  
Silvia Di Leo ◽  
Monica Beccaro ◽  
Stefania Finelli ◽  
Claudia Borreani ◽  
Massimo Costantini
Keyword(s):  
Care Pathway ◽  
Italian Hospital ◽  
Dying Patient

The Welsh Collaborative Care Pathway Project: Implementing an Integrated Care Pathway for the Dying Patient in Wales

2002 ◽  
Vol 6 (2) ◽  
pp. 59-62 ◽  
Author(s):  
Andrew Fowell ◽  
Ilora Finlay ◽  
Ros Johnstone ◽  
Lindsey Minto
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Care Quality ◽  
Baseline Measure ◽  
The North ◽  
Telephone Helpline ◽  
Integrated Care Pathway ◽  
One Year ◽  
Dying Patient ◽  
Care Of The Dying

The primary goal of this project was to improve the care of the dying patient through the introduction of a pre-developed integrated care pathway (ICP), while concurrently seeking to determine the feasibility of implementing a pre-developed ICP throughout Wales. Thirty-eight teams, reflecting four care settings crossing the statutory and voluntary sectors, participated in the project. Training was delivered on a regional basis in the north, south and middle areas of Wales. Participating teams' implementation of the ICP was monitored for one year. Support was provided by quarterly regional meetings, a project website, quarterly newsletters and a telephone helpline. After one year, 80% of the 38 teams participating in the project were using the ICP in their workplace. A further 10% were prepared and ready to use the ICP when a suitable patient was referred, while only 10% were unable to implement the ICP. The feasibility of implementing a pre-developed care pathway for the last days of life across different care settings and sectors throughout Wales was clearly demonstrated. The central collection and analysis of variance sheets established a baseline measure of palliative care quality, facilitated local and national benchmarking, and indicated future directions for research and development to improve the care of the dying patient in Wales.

scholarly journals Inequity in rehabilitation interventions after hip fracture: a systematic review

2019 ◽  
Vol 48 (4) ◽  
pp. 489-497 ◽  
Author(s):  
K J Sheehan ◽  
L Fitzgerald ◽  
S Hatherley ◽  
C Potter ◽  
S Ayis ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Randomised Controlled Trials ◽  
Care Pathway ◽  
Data Extraction ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomised Controlled

Abstract Objective to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. Design systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane’s PROGRESS-Plus framework). Results twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. Conclusion the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO CRD42018085930.

scholarly journals Continuous quality improvement in care of the dying with the Liverpool Care Pathway for the Dying Patient

2009 ◽  
Vol 13 (2) ◽  
pp. 51-56 ◽  
Author(s):  
Maureen A Gambles ◽  
Tamsin McGlinchey ◽  
Judith Aldridge ◽  
Deborah Murphy ◽  
John E Ellershaw
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Care Delivery ◽  
Care Pathway ◽  
Action Planning ◽  
Collaborative Reflection ◽  
Continuous Quality ◽  
The Future ◽  
Dying Patient ◽  
Care Of The Dying

In order to illustrate the usefulness of a continuous quality improvement approach in care of the dying, this paper focuses on the process and outcomes of the first National Care of the Dying Audit in Hospitals in England. One hundred and eighteen individual hospitals delivering care to patients in the last hours and days of their lives using the Liverpool Care Pathway for the Dying Patient participated in the audit and provided 2672 patient datasets. The results illustrate both that important information can be gained about care delivery using this method and that the opportunity to engage in formal and collaborative reflection, discussion and action planning is useful in promoting continuous quality improvement. This process is likely not only to be of interest to clinicians working in the field but also to managers and planners striving to ensure continuous quality improvement for patients and carers and to inform the process of benchmarking for the future.

Drugs at the End of Life: Does an Integrated Care Pathway Simplify Prescribing?

2005 ◽  
Vol 9 (2) ◽  
pp. 78-80
Author(s):  
E Grogan ◽  
L M Peel ◽  
E T Peel
Keyword(s):  
End Of Life ◽  
Integrated Care ◽  
Rescue Medication ◽  
Care Pathway ◽  
Rescue Dose ◽  
Dying Patients ◽  
Retrospective Audit ◽  
Symptom Stability ◽  
Integrated Care Pathway ◽  
Dying Patient

The Liverpool integrated care pathway for the dying patient (LCP) facilitates management of dying patients, but does not provide guidance regarding medication. A retrospective audit was performed of patients using the LCP to assess what medications were required, how requirements changed and which of the four symptoms outlined in the LCP were most troublesome (pain, agitation, sickness and respiratory secretions). Over a five-month period, 68 patients died on the LCP, and were included in the audit. The most unstable symptom (stability defined by rescue medication requirements) at the end of life was agitation − 37 of the 68 patients required regular sedatives and 45 patients needed at least one rescue dose of sedative. Sickness was the most stable symptom − 39 patients needed regular antiemetic, but only three patients needed rescue doses. These findings have implications in writing guidelines for symptom management at the end of life.

Hospital liaison palliative care

2010 ◽  
Author(s):  
Max Watson ◽  
Caroline Lucas ◽  
Andrew Hoy ◽  
Jo Wells
Keyword(s):  
Palliative Care ◽  
Care Pathway ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Hospital Specialist ◽  
Palliative Care Services ◽  
Acute Hospital Setting ◽  
Dying Patient

This chapter covers the need for hospital liaison palliative care services, challenges in an acute hospital setting, aims and evaluation of the hospital specialist palliative care team, things to think about when considering a referral, urgent discharge of a dying patient who wants to die at home, dying in the intensive care unit (ICU), and using the Liverpool Care Pathway (LCP) in the hospital setting.

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