The LCP or Liverpool Care Pathway is a British (excluding Wales) care tool covering palliative care options for patients in the final days or hours of life. It was developed to help doctors and nurses provide quality care for the dying patient in the last few hours.In the late 1990s Liverpool university collaborating with Marie Curie developed a pathway for the care of terminally ill cancer patients. Later this was extended to all dying patients. However, press reports and feedback from families indicated that not everyone was getting the high quality care that the public has a right to expect. This led to the Neuberger enquiry which recommended,in July 2013
1. The ending of CQUIN payments for application of the LCP
- To recognise when death is approaching, and when ongoing medical treatment is futile. This is sometimes difficult to do, but the pathway specifies that the team caring for the patient, including at least one senior doctor, should be in agreement that this is the case.
- To assess the patient for common symptoms at the end of life, and to treat these appropriately.
- To communicate effectively with the patient and their friends and family, to ensure that their wishes are respected as far as possible.
- To respect a patient’s spiritual needs.
- To review whether current interventions are in the patient’s best interests, for example continuing with blood testing, intravenous drugs and oxygen therapy.
To be commenced on the Liverpool Care Pathway (LCP), the team caring for a patient must agree:
- The patient is likely to be in the final hours or days of life (acknowledging that this can be difficult to predict).
- Potentially reversbile causes for patient’s condition have been considered.
- Specialist referral, e.g. to specialist palliative care or for a second opinion, have been considered.
- If the physical condition of the patient changes then reconsider if the LCP is appropriate.
This team must include a senior doctor.
Commonly medications are prescribed to alleviate symptoms at th end of life;; often given by a syringe driver.
Pain ,codeine, Paracetamol, morphine.
Nausea , cyclizine, ondansetron
Resp secretions hyoscine
Anxiety midazolam .
Fluids are not withheld at the end of life . Mouth toilet is given to moisten the mouth
however sc. or IV fluids are inapprpriate as they just pool in dependant parts of the body and can give pulmonary oedema. The semi conscious patient is rarely able to swallow fluids and often will aspirate.
Richgeridoc 