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Call for mandatory training in care of the dying patient

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End of life care experts are to call for all healthcare staff to receive mandatory training in how to care for patients nearing the end of their lives.

The latest version of the Liverpool Care Pathway for the dying patient (LCP) - a protocol-based model of care developed by nurses at the Marie Curie hospital in Liverpool - is to be unveiled tomorrow at the Marie Curie Palliative Care Institute’s annual conference in London.

Addressing the event, national lead for the LCP Deborah Murphy will call on all NHS organisations to provide some form of end of life care training for staff, dependent upon their needs.

“If staff are going to be involved in making decisions on end of life care, they need support from their organisation, education and training. At present, there is very little available. End of life care is not formally included in pre-registration training and there is no national guidance,” Ms Murphy told Nursing Times.

“Staff will need different levels of education and training depending on their involvement in end of life care. Organisations need to take responsibility for this, and tailor training to meet the needs of the workforce,” she added.

Version 12 of the LCP follows a two year consultation process. The updated document is based on evidence, including data from two national audits, and has been designed to be more explicit, particularly in the areas of sedation, nutrition and hydration.

“We do not support a blanket policy on hydration. Every situation has to be judged on an individual basis and based on clinical decisions. This has been made more explicit in the language used in the latest version of the LCP,” said Ms Murphy.

The updated pathway also has more clearly defined timelines on when patient assessments and observations should be undertaken. According to the document, patient assessments – including pain, nausea and mouth care - should be carried out at least every four hours.

Following an initial assessment prior to being put on the LCP, the document also recommends that all patients have a comprehensive review by the whole multidisciplinary team every three days. This is to assess their status and to determine whether they should still be on the pathway.

The Liverpool Care Pathway has been heavily criticised recently in the national media, but according to Ms Murphy problems stem not from the pathway itself, but from poor communication between healthcare staff, patients and relatives.

“The LCP isn’t a treatment, it is a model of care that should be used as a guide when making clinical decisions,” she said. “However, the model will only be effective if it is implemented and disseminated properly, including sharing how decisions are made with patients and their relatives, as well as the multidisciplinary team.”

The updated version of the LCP includes:

  • A new section on relative/carer information to support multidisciplinary conversations about the diagnosis of dying and the support of the LCP

  • A more defined, specific multidisciplinary detailed assessment for each individual on commencement of the LCP and every three days thereafter

  • Continuous ongoing assessments undertaken at least every four hours

  • More explicit and detailed goals on nutrition, hydration and spirituality

  • More succinct information on care after death

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Readers' comments (2)

  • I think this is a good idea. I do feel quite aprehensive about the dying patient. Maybe courses such as this will ease my anxiety.

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  • I agree that all staff caring for people nearing the end of their lives should receive training in this area. To this end the organisation that I work for, a private nursing home group responsible for over 700 care homes, has designed new training to meet this need. The programme is part of a much larger reveiw of the training and educational needs of the staff of all grades and disciplines.

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