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Implementing the Liverpool Care Pathway in Hospital

Implementing the Liverpool Care Pathway in Hospital. Liz Price Macmillan CNS in palliative care. 2000. Steering group March – base review April – formal teaching & pilot undertaken on haematology & oncology wards Audit on first 20 patients Staff questionnaire. 2001.

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Implementing the Liverpool Care Pathway in Hospital

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  1. Implementing the Liverpool Care Pathway in Hospital Liz Price Macmillan CNS in palliative care

  2. 2000 • Steering group • March – base review • April – formal teaching & pilot undertaken on haematology & oncology wards • Audit on first 20 patients • Staff questionnaire

  3. 2001 • Teaching & implementation began on six Care of Elderly wards in BRI & SLH

  4. 2002 • Audit of 44 patients on oncology ward • Audit of Care of Elderly wards • Teaching & implementation on 3 surgical wards

  5. 2003 • Post pathway analysis undertaken on a random selection of 20 pathways across the Trust • Teaching & implementation on 2 medical wards in BRI

  6. 2004 • Teaching & implementation on 2 further medical wards at SLH • LCP implemented on a total of 15 wards

  7. 2005 • Currently implemented on 11 wards across the Trust • Feasibility pilot undertaken in partnership with hospital clinical governance department to test audit tool.

  8. Over view of audits • Base review reported poor documentation • Findings were standard across specialities • Care of Elderly highlighted the tools versatility 29/33 patients had a diagnosis of non-malignancy.

  9. Positive aspects • Palliation became focus of care • Improved communication • Spiritual & psychological needs were better met • Encouraged multi-disciplinary working • Decreased paperwork • Improved symptom control

  10. Negative aspects • Some nurses struggled to discontinue unnecessary procedures e.g. 2 hourly turns • Poor recording of care after death • Incorrect filing in notes & continuing to document in medical notes • Highlighted need for further education re: symptom control

  11. Plans for 2005 • Snap shot audit of ten patients from each ward using LCP • Continued education & implementation to other areas

  12. Practical challenges • Staff continue to have problems recognising a dying patient • Varying levels of communication skills • Staff forget to use it! • Education • High turnover of medical staff • Ward closures • Audit challenges

  13. Conclusion • Positive & enthusiastic feedback from ward staff • Realisation HPCT cannot undertake role of ongoing auditing • Some challenges can be turned into positives

  14. Practical challenges • Staff continue to have problems recognising a dying patient • Varying levels of communication skills • Staff forget to use it! • Education • High turnover of medical staff • Ward closures • Audit challenges

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