scholarly journals End-of-Life Care and the Use of an Integrated Care Pathway

2020 ◽  
Author(s):  
Marianne Brattgjerd ◽  
Rose Mari Olsen ◽  
Inger Jorun Danielsen
Keyword(s):  
End Of Life ◽  
Integrated Care ◽  
End Of Life Care ◽  
Care Pathway ◽  
Coupled System ◽  
Life Care ◽  
Loosely Coupled ◽  
Dying Patients ◽  
Collective Sensemaking ◽  
Integrated Care Pathway

Liverpool Care Pathway is an integrated care pathway (ICP) designed to ensure the provision of high-quality end-of-life care. However, the ICP has come under substantial criticism, suggesting that its use is related to poor care. This study explores nurses’ use of the ICP to dying patients in Norwegian nursing homes. We conducted a qualitative study using an abductive, mystery-focused method to analyze the experiences of 12 registered nurses. Our findings show that the nurses experienced the ICP as a very useful tool in end-of-life care, although they were actually working independently of the ICP in the provision of ongoing bedside care for the dying patients. This can be understood as following: (I) the ICP is not compatible with the complex problems of dying patients; therefore, nurses must tinker with the ICP in order to give dying patients proper and dignified care; (II) the ICP is a myth with symbolic power, legitimizing care makes nurses positive towards the ICP; and (III) using the ICP as a loosely coupled system creates novel effects on nursing practice. In this study, we have shown how the ICP creates a common culture through a process of individual and collective sensemaking, which we labelled clinical mindlines.

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.

scholarly journals End-of-life care in a psychiatric hospital

2016 ◽  
Vol 40 (3) ◽  
pp. 149-152 ◽  
Author(s):  
Lauren Z. Waterman ◽  
David Denton ◽  
Ollie Minton
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Psychiatric Hospital ◽  
End Of Life Care ◽  
Care Pathway ◽  
Life Care ◽  
Staff Members ◽  
Dying Patients ◽  
Care Guidelines ◽  
The Uk

SummarySince the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers.

scholarly journals End-of-life care in psychiatry: ‘one chance to get it right’

2016 ◽  
Vol 40 (1) ◽  
pp. 38-40
Author(s):  
Nuwan Galappathie ◽  
Sobia Tamim Khan
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Mental Health Problems ◽  
Care Pathway ◽  
Acute Hospital ◽  
Care Pathways ◽  
Life Care ◽  
Healthcare Settings ◽  
Dying Patients

SummaryEnd-of-life care has been given increasing importance within healthcare settings. In June 2014, the Leadership Alliance for the Care of Dying People published One Chance to Get it Right. This nationally accepted guidance replaces previous end-of-life care pathways such as the Liverpool Care Pathway and outlines how dying patients should be managed irrespective of setting. Increasingly, patients with mental health problems are entering their final days of life within psychiatric in-patient or acute hospital settings, and psychiatrists need to be aware of the new guidance and ready to implement it within psychiatric practice.

Implementation of an End-of-Life Care Pathway in Cancer Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4689-4689
Author(s):  
Meinolf Karthaus ◽  
J Riesle-Keil ◽  
Ursula Weber ◽  
Ingeburg Wolf
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Conflicts Of Interest ◽  
Care Pathway ◽  
Symptom Control ◽  
Unmet Need ◽  
Control Group ◽  
Life Care ◽  
Dying Patients

Abstract Abstract 4689 Background: Supportive care for dying hemato-oncological patients in the hospital remains an unmet need. The Liverpool Care Pathway (LCP) has been developed in Europe for patients in the final 24–72 h of life to help physicians and nurses in the end-of-life care (ELC). We evaluated appropriately timed cessation of treatment in a Hemato-Oncology Department after integration of a modified LCP in a tertiary Munich cancer center. The End-of-life Care Pathway was modified to suit local conditions. The aim of the trial was to include over 40% of dying patients in the ELC. The effectiveness of symptom control which included termination of not necessary drugs, sufficient pain relief, control of agitation, bronchial fluid secretion, dyspnoea, nausea and emesis was compared with a control group (CG). The ELC was in accordance to local ethics. Nurses and physicians were trained. The ELC was periodically reviewed by a local multidisciplinary steering group for improvements. Patients and Methods: From 01/10 until 06/11 a total of 228 cancer deaths were observed. Criteria for entry onto the ELC were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. 96 pts (41 male/55 female) went on the ELC (42%), while 132 dying cancer pts were not enrolled due to a variety of reasons (e.g. lack of informed consent, rapid deterioration). The mean age was 72,6 ys (range 33 to 91 ys). The median duration of ELC use was 41,3 hours (range 0.5 to 189 h). Six patients improved after they had entered the ELC and left the ELC consecutively. Out of these four patients reentered the ELC and died, one of these six patients died without being reentered on the ELC. Symptom control (ELC/CG in %) was achieved in pain in 92/50%; agitation 89/50%, nausea 96/40%, dyspnoea 92/55% while unnecessary medication was terminated in 95/90%. All patients had current medication assessed and non-essential drugs were discontinued. Inappropriate interventions with antibiotics (85/65%), blood tests (95/75%), iv fluids (90/70%) were terminated more often when pts entered the ELC. Conclusion: Integration of an ELC in a hematology unit provides a better symptom control for dying patients. Inappropriate interventions could be reduced. Appropriate template design and supervision are the keys to success for end-of-life care in cancer patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals DEVELOPMENT OF AN INTEGRATED END OF LIFE CARE PATHWAY FOR PATIENTS WITH COPD

2014 ◽  
Vol 4 (Suppl 1) ◽  
pp. A93.1-A93
Author(s):  
Pauline Berry ◽  
Christopher Jackson ◽  
Tarek Saba ◽  
GIllian Au ◽  
Michelle Martin ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Pathway ◽  
Life Care

Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes

2017 ◽  
Vol 32 (1) ◽  
pp. 299-308 ◽  
Author(s):  
Sofia Andersson ◽  
Olav Lindqvist ◽  
Carl-Johan Fürst ◽  
Margareta Brännström
Keyword(s):  
End Of Life ◽  
Residential Care ◽  
End Of Life Care ◽  
Care Pathway ◽  
Care Homes ◽  
Life Care
Sign in / Sign up

Export Citation Format

Share Document