Liverpool Care Pathway for the Dying

1. Liverpool Care Pathway for the Dying Heather Robinson Barwon South Western Region Palliative Care Consortium Manager Thursday 6th August 2009

2. The Liverpool Care Pathway • The Liverpool Care Pathway for the Dying was developed by Prof. John Ellershaw • The LCP focuses on key goals which were found to improve care of the dying • The goals focus on appropriate medications & symptom management, ongoing care, discontinuing inappropriate interventions, communication of care goals, involving family / carers, social & spiritual care, GP involvement and after death care

3. Criteria for use of the LCP • All possible reversible causes for current condition have been considered. • The multi-professional team has agreed that the patient is dying and two of the following may apply: • The patient is bed bound, semi-comatose, no longer able to take tablets, only able to take sips of fluid.

4. Initial Assessment • Diagnosis & Demographics • Physical conditions: a list of possible symptoms with check boxes to establish baseline condition • Goal : Current medication assessed and non essentials discontinued

5. Initial Assessment goals • Goal : PRN S/C medication written up for the following symptoms as per protocol • Pain: Analgesia • Agitation: Sedative • Nausea/Vomiting: Anti-emetic • Dyspnoea: Anxiolytic / Muscle relaxant • Resp Tract Secretions: Anticholinergic

6. Initial Assessment goals • Discontinue inappropriate interventions • Blood tests • Antibiotics • I.V.’s (fluids / medications) • Not for CPR recorded • Enduring Power of Attorney Medical treatment in place. Advanced Care Plan completed

7. Initial Assessment goals • Decision to discontinue inappropriate nursing interventions taken • Syringe driver set up within 4hrs of doctors order • Ability to communicate in English assessed for patient and family • Insight into diagnosis and prognosis assessed for patient and family

8. Initial Assessment goals • Religious / spiritual needs assessed • Identify how family who are not present are to be notified of impending death • G.P. is aware of the patient’s condition • Plan of care explained and discussed with patient and family • Family express an understanding of planned care

9. Care after death • Documentation of death completed • GP Practice notified of patient’s death • Funeral director procedures explained to family • ‘What to do when someone dies’ brochure given to family • ‘Grief and Loss’ brochure given to family

10. Ongoing Care • The patient’s comfort is monitored at each visit and any variance with goals is recorded as is any action completed. • Ongoing care goals include: pain, agitation, respiratory tract secretions, dyspnoea, nausea / vomiting, mouth care, micturition difficulties, medication safety, pressure care, bowel care, care of the family, ongoing spiritual support and psychological support of patient and family.

11. Questions Is there anything you would like to ask? Contact details: Heather Robinson heathrob@barwonhealth.org.au Phone: 52792538