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The Liverpool Care
Pathway
Dr Kate Tredgett, Consultant in Palliative Medicine
Place of Death
*Data from End of Life Intelligence network
*
Place of death
Swindon Cancer
Patients (%)
Swindon All
Patients (%)
National All
patients 2008-2010
(%)
Home
28
21
20
Hospice
27
8
5
Hospital
34
52
54
Care Home
10
17
18
Total
2279
Quality of End of Life Care
First National Voices Survey of the Bereaved ONS / Dept. Of Health July 2012
Location of Care
Number of Respondents
% Rating Care
Outstanding / Excellent /
Good
Home
3712
82
Hospital
9492
68
Care Home
4357
83
Hospice
1280
87
Research Evidence of LCP Outcomes
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Improves confidence of nurses.
Demonstrates reduced symptom burden.
Improves multi-disciplinary team working.
Improves documentation of care delivery.
Improves anticipatory prescribing of
medications for the 5 key symptoms that may
develop.
Local Support and Governance of the
LCP
Educational Support
• Mandatory e.learning
module
• Biannual study days
• Preceptorship training
• Link nurse training
• Foundation Dr training
• Ward based training
Clinical Governance
• LCP death numbers
monitored
• National Biannual Audit
– Dissemination of findings
– Participation is a Quality
Marker
The LCP document
• Diagnosis of dying
– Audit
• Decision to commence LCP endorsed by most senior clinician 96%
– For 3% of patients the pathway ceases to be appropriate
• Communication
– A full explanation of the current plan of care (LCP) is given to the
patient
– Audit
• 61%
– A full explanation of the current plan of care (LCP) is given to the
relative or carer
– Audit
• 94%
The LCP document
• Withdrawal of treatment.
– Requirement is for interventions to be reviewed
– Requirement if for artificial hydration and nutrition to be
reviewed
Local Picture
LCP use
Year
Number of deaths
supported by LCP
2010
377
2011
427
2012 (up to July)
201
– Median age 83 yrs
– Median 27hrs supported by LCP
Impact of recent publicity
Moving Forward
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Information Development
Continue Education and Support
Participate in next National Audit
Await outcome of Independent Review in
summer
THANK YOU