Implementation of the Liverpool Care Pathway (LCP) for the Dying Patient in the Inpatient Hospice Setting

Leo, Silvia Di; Bono, Laura Cecilia; Romoli, Vittoria; West, Emily; Ambrosio, R; Gallucci, Michele; Pilastri, Paola; Ciura, Pietro La; Morino, Piero; Piazza, Massimo; Valenti, Danila; Franceschini, Catia; Costantini, Massimo

doi:10.1177/1049909113482355

Cited by 10 publications

(8 citation statements)

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“…It is not possible to say on an abstract level that any one type of drug or procedure is appropriate or inappropriate for any given patient, but the observation of data on this scale suggests that the process of care is not fitting the palliative needs of patients. Pathways such as the Liverpool Care Pathway have made steps towards introducing such a philosophy into hospital care, but a stronger evidence base must be built before introducing such initiatives in a widespread way [22,12]. …”

Section: Resultsmentioning

confidence: 99%

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A comparison of drugs and procedures of care in the Italian hospice and hospital settings: the final three days of life for cancer patients

West

Costantini²,

Pasman

2014

BMC Health Serv Res

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BackgroundA palliative approach at the end of life typically involves forgoing certain drugs and procedures and starting others - weighing burden against potential benefit. An assessment of the palliative approach may be undertaken by investigating which drugs and procedures are used in the dying phase, and at what frequencies.MethodsDrugs were classified as potentially (in)appropriate based on expert classification. Procedures were classed as therapeutic or diagnostic. 271 consecutive cancer deaths from across 16 hospital general wards and 5 hospices in Italy gathered data on drugs and procedures in the final three days of life through a standardised form. Differences between the two groups were tested using chi-square testing, and logistic regressions were performed to control for patient characteristics.Results75.0% of patients in hospital received 3 or more potentially inappropriate drugs in their last three days of life, against 42.6% in hospice. Diagnostic procedures were carried out more frequently in hospital. Multivariate logistic regression showed that when data was controlled for patient characteristics, setting had a unique contribution to the differences found in use of drugs and procedures.ConclusionThe data indicates a need for improvement in the hospital setting concerning recognising the need for palliative care, and ensuring a timely introduction of this approach.

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Section: Resultsmentioning

confidence: 99%

“…Studies comparing care given in hospices and hospital are scarce and generally do not include assessment of process of care [11,12]. In this study we therefore aim to assess and compare the palliative approach in hospital and hospice by looking at drugs and procedures administered during the last three days of life.…”

Section: Introductionmentioning

confidence: 99%

A comparison of drugs and procedures of care in the Italian hospice and hospital settings: the final three days of life for cancer patients

West

Costantini²,

Pasman

2014

BMC Health Serv Res

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“…The review of the original LCP programme developed in the UK [18, 28] and the LCP programmes used in Italy [30] and the Netherlands [29] identified three common documents: 1) an LCP document, 2) supportive documentation, and 3) an implementation guide.The LCP documentThe original LCP document was developed in 1997 in the UK and has regularly been updated in accordance with the latest evidence. The latest LCP generic version 12 was launched in December 2009 and can be used in all health care settings where end-of-life care needs to be provided.…”

Section: Resultsmentioning

confidence: 99%

“…The aim of the review was to identify the different components of the LCP programmes, to compare them, and to identify useful components for the development of our care programme for older patients dying in acute elderly wards. Specific reasons have guided the selection of these programmes: the LCP programme from the UK was the one originally developed [18, 28], the Dutch LCP programme uses similar language to that of Flanders [29] and the Italian LCP programme [30] is, to our knowledge, the only LCP programme which has been rigorously evaluated using a controlled trial design [20, 21, 30-33]. …”

Section: Methodsmentioning

confidence: 99%

Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework

et al. 2015

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BackgroundThe effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.MethodsWe conducted a phase 0–1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.ResultsPhase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.ConclusionsBased on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.

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“…Today, it is internationally recognized as a model for support and care in patients at the end-of-life [4] [12], but not without criticism stating it is impossible for nurses and physicians to predict when death is imminent, why the decision to set a patient on the pathway is at worst self-fulfilling [15] [16]. Regardless, the LCP provides evidence-based guidance in relation to various aspects of end-of-life care such as recommended prescription of medication and discontinuation of unnecessary medication, psychological support, spiritual care, and not the least care of families [17] [18]. The LCP discontinues if the patients' condition improves, but resumes if deterioration recurs.…”

Section: Boxmentioning

confidence: 99%

Nurses’ Experiences of Using the Liverpool Care Pathway Plan in Hospitalized Patients with Heart Failure in the End-of-Life Stage: A Qualitative Content Analysis

Hove¹,

Fålun²,

Fridlund³

2016

OJN

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Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients' needs at the last stage of the palliative phase are essential for the nurses' approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses' experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.

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Implementation of the Liverpool Care Pathway (LCP) for the Dying Patient in the Inpatient Hospice Setting

Abstract: The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.

Cited by 10 publications

References 23 publications

A comparison of drugs and procedures of care in the Italian hospice and hospital settings: the final three days of life for cancer patients

A comparison of drugs and procedures of care in the Italian hospice and hospital settings: the final three days of life for cancer patients

Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework

Nurses’ Experiences of Using the Liverpool Care Pathway Plan in Hospitalized Patients with Heart Failure in the End-of-Life Stage: A Qualitative Content Analysis

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