Implementing the Liverpool Care Pathway in Hospital

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