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Liverpool Care Pathway for the Dying Patient

Liverpool Care Pathway for the Dying Patient. Liz Penny Ian Fenwick Macmillan GP Facilitators Bradford & Airedale. Basic Bradford & Airedale Stats. Total deaths 4632 Cancer 1177 25% COPD 225 6% Heart failure 80 1.7% Alzheimers 40 Parkinsons 24 MND 21

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Liverpool Care Pathway for the Dying Patient

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  1. Liverpool Care Pathway for the Dying Patient Liz Penny Ian Fenwick Macmillan GP Facilitators Bradford & Airedale

  2. Basic Bradford & Airedale Stats Total deaths 4632 Cancer 1177 25% COPD 225 6% Heart failure 80 1.7% Alzheimers 40 Parkinsons 24 MND 21 Chronic renal failure 9 Multiple sclerosis 9

  3. Place of death Place cancer( % ) all (%) Home 254 (22) 911 (20) Hospice 313 (27) 335 (7) Hospital 445 (38) 2226 (48) NH 108 (9) 862 (19) Comm. Hosp. 41 (3) 131 (3) Unknown 16 (1) 167 (4)

  4. Poor Care of the Dying – Effects on Patient & Family • Patient and family are unaware that death is imminent • Patient loses trust in doctor as their condition continues to deteriorate without acknowledgement • Patient and relatives perceive disagreement in the team and get conflicting messages regarding the patient’s condition • Patient dies with uncontrolled symptoms including pain/agitation leading to a distressing and undignified death

  5. Poor Care of the Dying – Effects on Patient and Family • Patient and family feel dissatisfied with the communication which seems not to be appropriate for the patient’s condition • At death CPR is inappropriately initiated • Cultural and spiritual needs are not met • Outcome - complex bereavement issues, formal complaints regarding care, feelings of failure by staff ,

  6. Background • Royal Liverpool University Hospitals • Palliative Care Team 15% of all deaths • How to promote best practice???

  7. Integrated Care Pathway • Structured plan of care • Multidisciplinary • Incorporates evidence based practice • Defined measurable outcomes • Reduces paperwork • Enables audit

  8. Integrated Care Pathway • Promote best practice • Identify outcomes of care • Empower generic workers • Facilitate documentation • Promote educational role of PCT

  9. Liverpool Care Pathway • Hospitals • Community • Hospice • Nursing homes • Beacon status 2000

  10. Why now? • Supportive & palliative care guidance NICE 2004 “managed systems of care” • Gold Standards Framework GS7 Care of the Dying ● National & local PCT policy

  11. LOCAL IMPLIMENTATION • Nursing Homes facilitator • Macmillan GP facilitator team • End of Life facilitator

  12. NATIONAL PROGRESS • DoH EoLC Programme First Year Progress Report March 2006 ‘ modest improvement ’ • Help the Aged EoLC for Older People March 2006 ‘ lack of appropriate care for older patients ‘

  13. Bradford & Airedale

  14. PALLIATIVE CARE HANDOVER FORM

  15. ANTICIPATORY DRUGS • HALOPERIDOL • MIDAZOLAM • HYOSCINE • DIAMORPHINE

  16. EXAMPLE INJ HALOPERIDOL 5mg / ml 5 X 1ML amps as dir INJ HYOSCINE BUTYLBROMIDE 20mg / ml 5 x 1ml amps as dir INJ MIDAZOLAM 5mg / ml 5 x 2ml as dir INJ DIAMORPHINE 5mg 5 ( five ) x 5mg ( five milligram ) as dir WATER FOR INJECTION 10 X 10mls amps

  17. COST OF ANTICIPATORY DRUGS • HALOPERIDOL £1.55 • MIDAZOLAM £3.63 • HYOSCINE £1.05 • DIAMORPHINE £8.87 • WATER £3.11 TOTAL £18.21

  18. SOURCE OF DRUGS • In LCD cars • Out of Hours Pharmacies

  19. Bradford & Airedale

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