The Liverpool care
pathway was established at the Royal Liverpool University Hospital in
conjunction with the Marie Curie Palliative Care Institute. Palliative care is
a medical treatment designed to make people with terminal illness feel as
comfortable as possible- both physically and emotionally. It can be used to
relieve symptoms but not cure the conditions. The LCP was recommended as a
model of best practise by the department of health, and was therefore been adopted
by many UK hospitals and other health care settings. However there have been
many controversial issues with the pathway, and so Scotland have decided to
phase out this type of treatment.
When used correctly
the LCP was very successful in Scotland and had supported good quality of care
in the last hours and days of life. However it has been recognised that
inappropriate use of the pathway, such as patients being denied rights of food
and water. Furthermore another example is, when patients are not being removed
from the pathway if signs of improvement were shown. Therefore there were high
levels of complaints from relatives, and the high proportion of misuse has led
to the phasing out of the Liverpool Care Pathway in Scotland within the next 12
months.
The review of the LCP
pathway earlier this year recognised this misuse and so the report published on
the use and experiences of the Liverpool care pathway recommends phasing out of
the LCP to be replaced with individual end of life care plans for each patient. The report also provides methods of
improving the care pathway:
1. A general principle that a patient should only be placed on the
LCP or a similar approach by a senior responsible clinician in consultation
with the healthcare team.
2. Unless there is a very good reason, a decision to withdraw or
not to start a life-prolonging treatment should not be taken during any ‘out of
hours’ period.
3. An urgent call for the Nursing and Midwifery Council to issue
guidance on end of life care
4. An end to incentive payments for use of the LCP and similar
approaches
5. A new system-wide approach to improving the quality of care for
the dying
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