Liverpool Care Pathway for the Dying Patient (LCP) Supporting care in the last hours or days of life
When a person is coming to the end of life it can often be a difficult experience for the individual and their friends and relatives.
The LCP is a pathway or plan which is designed around the individual person and designed to improve the final days and hours of a person's life so they have a dignified and comfortable death.
The LCP uses the best practice from hospices and applies them to a hospital or other clinical setting and is recommended as a best practice model by the Department of Health.
As with any death, no matter how prepared for it a person or their family is, it is a difficult time for everyone involved. There is lots of useful information about the LCP and what it means in practice which will be useful for the relatives of those who are on the pathway
Click here for concensus statement documentation about the LCP
What is the LCP?
- the Marie Curie Palliative Care Institute Liverpool (MCPCIL) Liverpool has pioneered the implementation and dissemination of the LCP Continuous Quality Improvement Programme. This programme is recognised nationally and internationally as leading practice to support care in the last hours or days of life
- the LCP is tailored to the person's individual needs and includes a consideration of their physical, social, spiritual and psychological needs. It requires senior clinical decision making, communication and a management plan and regular reassessment
- the LCP is not a treatment in itself but a framework for good practice - it aims to support but does not replace clinical judgement
- the LCP guides and enables healthcare professionals to focus on care in the last hours or days of life, when a death is expected. However, communication, care and compassion must come from all the healthcare workers caring for an individual patient and their family
When should the LCP be used?
- recognising that someone is in the last few hours or days of life is always complex, it requires a multi-disciplinary team approach and should be led by the most senior doctor ultimately responsible for the patient's care
- the LCP should be considered when there is no appropriate reversible treatment available and the team considers that the patient is in the last hours or days of life
- uncertainty is an integral part of dying. There are occasions when a patient who is thought to be dying lives longer than expected and vice versa. This means that good communication and support for the patient and the relatives and carers is vital
- when it is determined that the patient is dying, all care and treatment must be reviewed; some interventions will be continued, some discontinued, and others started. A referral to the specialist palliative care service or a second opinion should be sought as appropriate
- good comprehensive clear communication is essential and all decisions leading to a change in care delivery should be communicated to the patient where possible and deemed appropriate but always to the relative or carer. This is in accordance with GMC best practice guidance (GMC 2010). The views of all concerned must be listened to, considered and documented.
How is the LCP monitored?
Any organisation that cares for dying people should be able to demonstrate best practice in care of the dying including the last hours or days of life
Each Organisation should ensure:
- it has an End of Life Strategy including the use of a best practice model for care in the last hours or days of life, which is monitored at executive board level
- a named person is employed and responsible for driving up quality for care of the dying in the organisation
- the Specialist Palliative Care Team offers a 7/7 face to face service with an out of hours support line
- the organisation audits care of the dying against the best national benchmark
- all those who care for dying patients are trained to do so
The responsibility for use of the LCP lies with the organisation which is using it. It should be used as part of a continuous quality improvement programme within the governance of the organisation and it must be underpinned by a robust education and training programme.
The LCP, like any other end of life care tool, or an escalation of care tool, is itself the product of a review of good practice and is in place to enable the delivery of safe, standardised, effective patient related outcome measures. The monitoring and governance of any best practice tool or technology is the responsibility of the organisation using it.
For more detailed information about the LCP then click here
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