Comfort care in burns: The Burn Modified Liverpool Care Pathway (BM-LCP)

Hemington-Gorse, Sarah; Clover, A. James P.; MacDonald, Chelsea; Harriott, J.; Richardson, P.; Philp, Bruce; Shelley, Odhran; Dziewulski, Peter

doi:10.1016/j.burns.2011.03.012

Cited by 21 publications

(44 citation statements)

References 18 publications

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“…9). Hemington-Gorse [81] reported on 32 deaths at St. Andrew’s Centre for Burns in Chelmsford, UK between 1/1/2008 and 12/31/2009. Eleven (34%) were place on comfort care on arrival.…”

Section: Resultsmentioning

confidence: 99%

Harborview Burns – 1974 to 2009

et al. 2012

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BackgroundBurn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974–2009) at the Harborview Burn Center in Seattle, WA, USA.Methods and Findings14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.Conclusions1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.

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“…9). Hemington-Gorse [81] reported on 32 deaths at St. Andrew’s Centre for Burns in Chelmsford, UK between 1/1/2008 and 12/31/2009. Eleven (34%) were place on comfort care on arrival.…”

Section: Resultsmentioning

confidence: 99%

Harborview Burns – 1974 to 2009

et al. 2012

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“…Appropriate use of LCP requires that the responsible physician makes an accurate assessment of their patient as truly dying. In recent years, the procedure has been adopted in the care of other patient groups than cancer patients, such as chronic kidney disease [ 4 ] and burn victims [ 5 ]. LCP received broad support, particularly in the UK and is used in 17 other countries, including Norway.…”

Section: Backgroundsmentioning

confidence: 99%

The Liverpool Care Pathway: discarded in cancer patients but good enough for dying nursing home patients? A systematic review

2017

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BackgroundThe Liverpool Care Pathway (LCP) is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying people with dementia.MethodsThis systematic review is based on a systematic literature search of MEDLINE, CINAHL, EMBASE, and Web of Science.ResultsThe search identified 12 studies, but none describing an evidence-based adaption of LCP to nursing home patients and people with dementia. No studies described the LCP implementation procedure, including strategies for discontinuation of medications, procedures for nutrition and hydration, or the testing of such procedures in nursing homes. No effect studies addressing the assessment and treatment of pain and symptoms that include dying nursing home patients and people with dementia are available.ConclusionLCP has not been adapted to nursing home patients and people with dementia. Current evidence, i.e. studies investigating the validity and reliability in clinically relevant settings, is too limited for the LCP procedure to be recommended for the population at hand. There is a need to develop good practice in palliative medicine, Advance Care Planning, and disease-specific recommendations for people with dementia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-017-0205-x) contains supplementary material, which is available to authorized users.

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“…No specific information was given about the rationale for non-uptake of LCPs at either the ward level or the patient level although five studies22 25 27 33 38 presented possible reasons for LCP exclusion, including unexpected/unpredictable death,25 27 38 low levels of LCP training25 and training schedules that failed to respond to high staff turnover,33 staff shortages33 and patients simply not judged as fulfilling LCP criteria 22 25 38. However this information was not obtained or analysed as part of a systematic collation in each of these five studies, only flagged in the study discussions.…”

Section: Resultsmentioning

confidence: 99%

“…The aim of the Gold Standard Framework is to provide a ‘gold standard’ of end-of-life care for all dying patients, with the LCP the only pathway specifically recommended for use; however, our study suggests that this may be an impossible goal for variable disease trajectories and their impact on LCP eligibility. Despite attempts to develop disease-specific pathways using the LCP as a starting point (eg, the BM-LCP38), these have thus far failed to reach clinical practice in a systematic way. There is an urgent need for prospective studies to evaluate the impact of the LCP on the quality of care for patients with cancer and non-cancer diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Assessing the uptake of the Liverpool Care Pathway for dying patients: a systematic review

Stocker

2013

BMJ Support Palliat Care

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Improving the care of the dying is regarded as a national priority and current guidelines stipulate the need to provide holistic palliative care. Despite this, many dying patients and carers report low levels of comfort and satisfaction with care. Reasons include poor coordination of care, variability in communication and crisis-driven interventions. Integrated care pathways aim to support care coordination and open communication with patients and carers. One example is the Liverpool Care Pathway (LCP). Using the LCP entails assessment of eligibility criteria which requires skills, knowledge and clinical judgement about its timing. This can be problematic, and little is known about actual uptake, characteristics of assessed patients and reasons for inclusion/exclusion. A comprehensive systematic review was conducted for papers published between January 1990 and July 2012 providing information on LCP uptake. 17 papers met inclusion criteria. A total of 18 052 patients were placed on the LCP, in a variety of inpatient and primary care settings, and cancer and non-cancer diagnoses. 47.4% of dying patients identified were placed on the LCP. Although the LCP is widely recommended, it is only used for around half of dying patients. Reasons may include lack of knowledge, high staff turnover and concerns about applicability particularly for unpredictable dying trajectories. The proportion of patients who meet the eligibility criteria and the reasons surrounding low uptake remain unclear. Research is urgently required to further quantify the variable use of the LCP, and to investigate whether alternative approaches should be developed for non-cancer groups.

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Comfort care in burns: The Burn Modified Liverpool Care Pathway (BM-LCP)

Cited by 21 publications

References 18 publications

Harborview Burns – 1974 to 2009

Harborview Burns – 1974 to 2009

The Liverpool Care Pathway: discarded in cancer patients but good enough for dying nursing home patients? A systematic review

Assessing the uptake of the Liverpool Care Pathway for dying patients: a systematic review

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