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“Quality care” on Liverpool Care Pathway

Patients on the Liverpool Care Pathway for the Dying Patient (LCP) are receiving high quality care in the last hours and days of life, an audit claims.

The second National Care of the Dying Audit of Hospitals – which covered 155 hospitals and 4,000 patients – suggests that the LCP provides a valuable framework in which clinical judgement can be exercised for the benefit of patients.

However, the findings conflict with the views of a high profile group of consultants who recently wrote to The Telegraph saying that growth in the use of LCP was a “national crisis”.

One of the main aims of the LCP is to support the management of distress caused by agitation and restlessness in dying patients with medication given at an appropriate dose in relation to the severity of the symptom.

The audit shows that, in their last 24 hours, 65% of patients needed no continuous subcutaneous infusion of medication to control distress from agitation or restlessness. Three out of ten had low doses of medication to relieve symptoms delivered by a subcutaneous infusion, with the remaining 4% requiring higher doses. The vast majority of patients were reported to be comfortable, claims the audit.

The authors said: “These findings indicate that dying patients receive good clinical care, tailored to the individual and their distress, when supported by the LCP.”

The number of hospitals using LCP has increase by 31% in the past two years.

This, however, is a cause of concern for Prof Peter Millard, emeritus professor of geriatrics at the University of London, and co-author of The Telegraph letter. He said: “The risk as this is rolled out across the country is that elderly people with chronic conditions like Parkinson’s or respiratory disorders may be dismissed as dying when they could still live for some time.

“Governments have got rid of respite care and geriatric wards, so we’re left with a crisis. The Government has said let’s develop a service to help people die at home – what they should be doing is helping them live. Only when death is unavoidable should you start withdrawing treatment.”

The audit, which was led by the Marie Curie Palliative Care Institute Liverpool (MCPIL) in collaboration with the Royal College of Physicians, does highlight areas for improvement. While communication regarding the plan of care and recognition that the patient had entered the dying phase was generally undertaken with relatives or carers (achieved in 72% and 76% of cases respectively), this could be further improved.

Assessment of spiritual and religious needs and support to patients and their relatives or carers is poor. And more needs to be done on education and training, with only 39% of hospitals having an LCP Facilitator.

Prof John Ellershaw, director of MCPCIL, said: “Hospitals need to recognise that care of the dying is part of their core business. To achieve excellence in the last hours or days of a patient’s life, all health care workers caring for dying patients, and their relatives or carers, should undertake training and education in care of the dying.

“A good death should be the expected not the exception. How we care for dying patients is an indicator of the patient experience across our organisations.”

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