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When should you use the Liverpool care pathway in practice?

  • Comments (54)

When should you use the Liverpool care pathway in practice?

A group of doctors have suggested the LCP is being used to ease the pressure on resources.

The Department of Health said the decision to use the pathway should involve patients and family members, and a patient’s condition should be closely monitored.

Sometimes patients improve and they are taken off the LCP and given whatever treatments best suit their new needs.

  • Comments (54)

Readers' comments (54)

  • Anonymous

    The MacMillan nurses group have produced a very useful and comprehensive guide to when the LCP should be used.

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  • The LCP is a good concept in principle but application in practice is varied. If you are in the end of life stage with cancer then it is used very effectively to manage symptoms such as excess secretions, agitation etc. But heaven help you if you are end of life with any other condition. I know we always go on about training....... but it seems to me that if key prescribers for the medications required to initiate the pathway don't seem to understand the rationales and the benefits to patients and their families from experiencing a peaceful expected death with well managed symptom/pain control then heaven help us. (Mind you in my experience GP's are so varied in their practice, prescribing and partnership working; from being fully engaged, respecting, valueing and utilising other professionals expertise for the good of the patient, through to the clinical dinosaurs) still in their defense I guess that applies to any profession and so the question is how can it be addressed??

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  • Anonymous

    It seems to me that the LCP is totally reliant on good training in its implementation and excellent communication at all times and at all levels between patient, or if not possible their representatives, and all staff involved. Without this it can fail tragically.

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  • michael stone

    raggedtrouseredphilanthropist | 19-Jul-2012 7:30 am

    End-of-Life behaviour and discussions definitely tends to be much more comprehensive for cancer patients than for most other patients -one possible reason is that the patients might initiate the discussions, because people tend to associate a diagnosis of cancer with 'so i'm going to die'.

    But there is clearly a lot of confusion about the LCP. Nurses on this site, have stated that the LCP is 'for the final 72 hours of life': barmy, because no doctor could honestly say 'he will die in 3 dyas time, and I would be surprised if he died in 2 or 4 days time' - so '72 hours' is an absurdly precise statement, of a concept which can only meaningfully be 'last few days'.

    Anonymous | 19-Jul-2012 9:17 am

    Definitely !

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  • Anonymous

    To me, the LCP is a tool for documenting end of life care and helping to remind you to document what is going right as well as symptoms that need action. It is not an excuse to give up on care or a means to hasten the end of someones life. I would turn a palliative patient for pressure relief if I felt it appropriate for that person or not if it was not - the decision would be based on patient comfort not on whether they were on the LCP. What started as a useful tool is fast turning into something that is unusable and feared. Suddenly its a full MDT every three days to keep someone on it - why? it is not an excuse to give up but a useful means of ensuring someone receives all the care they need. Well that is how my team and I see and use it. Its a shame to loose it because, probably through lack of education it has been abused. Most of the changes in the latest version are directed towards an attitude of 'put them on the LCP and forget them'. That is surely only a minority of cases that should have been tackled with education [and probably better staffing] not with a revamp that complicates it and puts people off using it.

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  • Anonymous

    when I get to that stage I shall bring my own pre-determined pathway with me for staff to follow!

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  • Anonymous

    The LCP is a careplan for patients who are dying, if they are not dying they don't need to be on the LCP.

    Does anyone else here remember the use of the Brompton Cocktail and the days when people expected the elderly and unconscious patients to develop pneumonia and referred to it as 'the old mans friend'.

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  • Anon 7.50pm
    The LCP has been changed to allow moving the patient in the bed because of the number returning to health who had developed severe pressure sores.
    Some people on here think that the LCP is the equivalent of a firing squad and the first instruction is for stat 2 pillows applied to face till struggling discontinues. Far from it.

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  • Anonymous

    people have been dying in hospital for years, we didn't used to have to be told that they needed turning for comfort. When someone is unconscious or dying they should be cared for by caring nurses.

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  • Anonymous

    Anonymous | 21-Jul-2012 5:10 pm

    I agree with you and said words to the similar effect higher up but now it seems nurses are too busy or no longer considered competent to use their own clinical judgement and their skills and experience to care for their patients. What is happening?

    Our patients were very well looked after without an LCP and I would hate to look after patients now with all these protocols, pathways, guidelines, etc. and living in the constant fear of making errors,even though far more seems to go wrong, or nurses and staff being accused of wrongdoing, now than ever before.

    It just seems as if the media and the public are unable to accept the fact that some people in hospital will sadly die when there is no more that medicine has to offer them, as they have always done in the past.

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