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Liverpool Care Pathway. Central Norfolk Specialist Palliative Care Team Presentation to Watton medical practice 18 th February 2008 Elizabeth Stallwood . Background. The modern hospice movement was established in response to the poor quality of care of the dying patient

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liverpool care pathway

Liverpool Care Pathway

Central Norfolk Specialist Palliative Care Team

Presentation to

Watton medical practice

18th February 2008

Elizabeth Stallwood

  • The modern hospice movement was established in response to the poor quality of care of the dying patient
  • The hospice model of care is now generally regarded as the ‘gold standard’ for the dying patient
  • A major challenge is to transfer best practice from a hospice setting to other care settings
  • The Liverpool Care Pathway (LCP) for the Dying Patient is a multi-professional document that provides a template for client centred best practice and facilitates appropriate standards of record keeping (see Essence of Care, DOH, 2003)
  • The LCP is now seen as best practice for end of life and is a major government initiative with PPC and GSF. It is expected to be used for all patients who are dying.
  • The process of evaluation for any organisation can begin with a retrospective audit of 20 case notes (Base Review) to establish current documentation of care. This forms part of a national audit programme
  • The development of the LCP has led to measurable outcomes of care
3 sections of the lcp all care is now directed at comfort and dignity
3 sections of the LCPAll care is now directed at comfort and dignity


  • 1.Initial assessment: medical and nursing
  • 2.Ongoing daily assessment
  • after death

Goals encompass the following: -

  • Physical : Medications and comfort care
  • Psychological: Resolution of tensions
  • Religious / spiritual: peaceful outcome.
  • Social: All family understand the care.

Section 1:Initial assessment 1.Diagnosis of dying:unable to take tablets, bed-bound, semi-conscious, only able to take sips of fluid.2.Drug review3.Anticipatory prescribing4. Nursing review

approaching death
Approaching death

Multiple organ failure

Metabolic disorder

Organic brain failure

Gradual shutdown of body function


Goal 1 Current MEDICATION assessed and non- essentials discontinued

Patient not taking oral medications

nb Insulin (see protocol)

Dexamethasone (separate driver)

Anti convulsants – midazolam 20mgs

medication review 1
Medication review 1

Goal 2 a AS REQUIRED subcutaneous drugs written up according to protocol

2.1 Pain

2.2 Nausea and vomiting

2.3 Agitation

2.4 Respiratory tract secretions

2.5 Dyspnea

nb remember any anticipated emergency drugs.

Goal 2b Anticipatory drugs for syringe driver prescribed for all the above symptoms with ranges for increasing the drug

medical review 2
Medical review 2

Goal 3: DISCONTINUE inappropriate interventions

3.1 Blood tests

3.2 Antibiotics

3.3 IV/ S/C fluids or drugs (A/B)

3.4 Not for CPR ( GSF/PPC/ACP)

Doctors signature…………………………………………………………

nursing interventions
Nursing interventions

Goal 3a Discontinue inappropriate nursing interventions

Goal 3b Syringe driver set up within 4 hours of Doctor’s order

psychological insight religious spiritual
Psychological/Insight & Religious/Spiritual

Goal 4 Ability to communicate in English assessed as adequate:

4.1 Patient

4.2 Family/other

Goal 5Insight into condition assessed:

Aware of diagnosis

5a1 Patient

5b2 Family/other

Recognition of dying:

5b1 Patient

5b2 Family/other

Goal 6 Religious and spiritual needs are assessed

6.1 Patient

6.2 Family /other


Goal 7 How family/other to be informed of patients impending death, any special people OOHs.

Goal 8 Bereavement : anticipate those at risk

Family/other given information, ie what to do after death hospice leaflets

Goal 9 Ensure General practitioner is aware of patient’s condition

Goal 10 Plan of care explained to:

10.1 Patient

10.2 Family

Goal 11 Family/other understanding of care plan


Section 2: Assessment and Ongoing Care a Daily review of symptoms and conditionb Note a varience if not meeting the goal

assessment and ongoing care
Assessment and Ongoing Care

Are Goals are met on

  • Pain, agitation, respiratory tract secretions, nausea and vomiting
  • Mouth care, micturition, medication given safely and accurately, syringe driver checked (where appropriate), bowels assessed
section 3 care after death
Section 3:Care After Death

Goal 12 GP practise contacted re: patients death

Goal 13 Procedure for laying out followed

Goal 14 Procedure following death discussed -to include OOHs.

Goal 15 Family/other given information on procedures


Goal 17 Necessary documentation and advice is given to the appropriate person

Goal 18 Bereavement leaflet given


The Liverpool Care Pathway for the Dying prompts the following KEY FUNCTIONS:

  • DIAGNOSIS of dying
  • ANTICIPATION and PLANNING of the appropriate care
  • DISCUSSION with patients and relatives about the care (sometimes difficult conversations + DNAR)
  • METICULOUS practice at this precious time