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EDITOR’S COMMENT

'A guidance void is worst outcome for the dying'

  • 4 Comments

The much-maligned Liverpool Care Pathway may still be the most effective means available to help nurses structure the specifics of end-of-life care, according to an expert in clinical ethics in this week’s Nursing Times.

It’s healthy to have this debate now about how much the LCP supported nurses and enabled them to think about how to ensure their patients had a “good death”, but given the respect with which the pathway is viewed by many - both in the UK and internationally - isn’t it strange that this challenge wasn’t verbalised enough earlier?

Once again, the media directed policy from a sensationalist perspective with little understanding of the LCP and support it offers to health professionals, patients and families when used properly. In replacing the LCP the baby was thrown out with the bath water to appease the hacks.

Our article by academic Anthony Wrigley on page 20 states that the LCP offers world-class guidance, but if you read the front pages of the newspapers and you’d probably feel the exact opposite.

“Whatever is true, it’s a shame the media perspective has clouded many people’s views of the guidance”

Whatever is true, it’s a shame the media perspective has clouded many people’s views of the guidance. Nurses can contribute many examples of best practice when using the LCP but instead it was dismissed as a pathway allowing no deviation. Of course, it was misused in some cases, but this is a training and support issue rather than a major flaw in the LCP.

The result of Neuberger’s review - Priorities for Care - shares one thing in common with the LCP - it has not been explained properly or rolled out consistently with formal training. What is lacking is consistency, and a commitment to supporting clinicians.

Confusion reigns supreme over what to do, mixed in with paranoia about implementing any kind of plan for fear of doing the wrong thing. This risks creating a void, the worst possible outcome for dying patients and their relatives.

If staff are following the LCP it is because they want something that specifically helps them to deliver the care they want to, and they need training in how to apply the guidance with compassion.

Months after the LCP was deemed unworkable, concerns have been raised that there is still no viable replacement. Isn’t it time there was? Isn’t it time to commit to getting this right by giving nurses and patients what they actually want and need?

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

  • 4 Comments

Readers' comments (4)

  • LCP gives medics and nurses the right to hasten a patients death and no protection whatsoever.

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  • There was absolutely nothing the matter with the LCP if it was used on appropriate patients. Since its abolition, the care is worse: Doctors are now frightened to prescribe end-of-life medicines waiting until the bitter end for fear of hastening a patients end.

    Before we had a pathway that everyone understood, now all we have is a confused mess.

    Those who were falling over themselves to do away with the LCP are to blame.

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  • Sounds like the copyright holders are pulling out all the stops to get this dreadful document back in use: they make monee from it...If it was so good, and it didnt kill, can you explain:
    a) why the LCPv.11 lacked a consent process, so breached the MCA Code of Conduct from 1st Oct. 2007 onwards? The authors are supposedly 'Professors of Nursing Studies ' ! What an abysmal oversight! And cheers for passing the blame down to the bedside, and all the nurses who used it in good faith, and who risked prosecutions and complaints when they did! What cowards you are, and how lucky you are on a fantastic salary with the Department of Health chums you spend charity money schmoozing.
    b) if you're so knowledgeable, why did LCP v.11 recommend prn diamorphine for everyone, regardless of hydration status or renal status? It was an utterly HORRIBLE DEATH , with delerium added to the burden. Absolutely hideous oversight on your part.
    c) why did LCP v.11 use cyclizine for everyone , even those with cardiac failure? How stupid you are. I can only presume your friendship with Ester Rantzen (who filmed you at liverpool for a documentary after her husband died) has got you 'in' with the Department of Health - it certainly wasn't clinical competency, was it?
    d) why do you persist in using hard-earned charity cash to keep flogging this dead horse?

    We nurse, we don't hasten death - and until you work the hours we do for the wage we do, you really have no right to dictate the way we do these things simply because you light swanning it with showbiz types like Nana Neuberger (a woman who is neither elected, medically or legally qualified, but simply happened to marry up).

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  • PS: the LCP v.11 wasnt deemed 'unworkable', it was deemed 'illegal' - Primary Care Trusts and Marie Curie were liable under the Corporate Manslaughter Act - aren't they lucky the DoH didnt order a public inquiry and gave those responsible time to delete all their incriminating emails:)

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