Clinicians should go “out of their way” to check if end of live care patients and their families have any concerns, whether or not the Liverpool Care Pathway is being used, according to NHS England.
It highlighted that they may be experiencing “increased anxiety” resulting from the “heightened awareness about the LCP at the moment”.
NHS England has published a short guideline for “doctors and nurses caring for people in the last days of life” – in the wake of the government’s announcement earlier this week that the LCP was to be phased out over the next six-12 months.
The guidance stated: “Where the LCP is being properly used, this must not stop abruptly. The principles of good palliative care, on which it is based, must continue to be upheld: regular assessment and management of symptom control and comfort measures, effective communication with patients and their families, and provision of psychological, social and spiritual support.
“These principles hold true, whether or not the LCP or any integrated care pathway or plan for the dying is used. In keeping with standard good practice, a named senior clinician should be accountable for the care of the individual patient.”
The NHS England guidance noted that for patients who are currently on the LCP, nurses and doctors should:
- Continue to reassess the patient regularly and frequently
- Ensure a consultant review of the decision for the patient to remain on the LCP
- Ensure that the patient’s family is aware that the patient is on the LCP
- Communicate with the patient (wherever possible) and family/carers regularly to address questions or concerns about any aspect of care, or the LCP itself
- If a patient remains on the LCP, continue to implement it properly
- If a patient comes off the LCP, continue to pay attention to, and address, symptom control, comfort measures, and psychological, social and spiritual care, alongside any other treatment
- Reassess the patient regularly and frequently so that the care plan can be adjusted
The announcement the LCP was to be phased-out followed the publication of findings from an independent review, headed by Baroness Julia Neuberger, which was set up to investigate concerns that the pathway was flawed.
The review concluded that in the right hands the LCP helped patients have a dignified and pain-free death. But it also found too many cases of poor practice, especially relatives not being properly engaged.
The review concluded the LCP should be “replaced by a personalised end of life care plan, backed up by good practice guidance specific to disease groups”. It also called on the Nursing and Midwifery Council to urgently issue guidance on end of life care.
- Guidance for doctors and nurses caring for people in the last days of life
- Review of the Liverpool Care Pathway
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