Better Care For The Dying

[naomi24]

The controversial Liverpool Care Pathway is to be axed in favour of individual treatment plans. Good idea? I think so.

http://www.telegraph.co.uk/news/politics/10177308/Liverpool-Care-Pathway-to-be-axed-in-favour-of-individual-treatment-plans.html

[mushroom25]

the idea for the plan was good and well-intentioned, but as implemented was often too inflexible, and could lead the ruthless to see it as a legal means of euthenasia. Individual care plans agreed with the family has got to be the way forward.

[pixie373]

There always have been individual treatment plans. The Liverpool Care Pathway was supposed to have been part of that for those rightly or wrongly assessed. It should never have been used in the first place, Imo. People naturally stop eating when they're close to the end and then stop drinking as their bodies cannot make use if the nutrients. Giving higher doses of medication which may hasten death always has and always will happen. Also, a very individual decision.

[woofgang]

The Liverpool care pathway has been horribly misused by some people. The individual treatment plans will have to cover the same things and will be open to the same misuse ie the wrong treatment will be planned and enacted for a person.
Used PROPERLY the care pathway can be very helpful in ensuring as gentle and peaceful and end as is possible for people who are going that way anyway.

for people who haven't seen it, here is an example of the actual document.

[woofgang]

link http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_(Example).pdf

[anneasquith]

ye gods, the nhs cant get it right even when it comes to care of the dying. god help us all :(

[Old_Geezer]

Not working in the 'industry' it is difficult to know what the best thing to do is in such circumstances; but I have reservations about a system that explains to the patient that they are about to kill them off for their own good, and do not seem to be requesting the patient's permission. Or if the patient is unable to express a rational view, the permission of the family who would act on the patient's behalf. I would be concerned it is a rational for saving the cost of continual treatment.

[boxtops]

when I worked in hospices it was regularly used - that seems an appropriate place for it, since the patient was terminal and the staff were specialist trained to know when someone was near the end. I'm not sure that it should be axed across the board, but it's obviousl been misinterpreted and misused in some settings. Individual care plans should always be the norm, anyway.

[woofgang]

OG, it doesn't kill people off. have a look at the paperwork I posted. There is supposed to be discussion and agreement with the patient or their representative. changing this form for another form will not stop people acting improperly if they are going to.

[LazyGun]

I would echo woofgangs sentiments. Whatever replaces the Liverpool Care Pathway will have to cover exactly the same issues. It has become synonymous with bad even sinister practice because far too often it has not been used as it should have been.

[pixie373]

I disagree. I can't open woofgang's link, but can see Naomi's. It mentions food and fluid being withheld. That does kill people off, no matter how healthy they are to start with. I am not aware of that being allowed before.

[Rosetta]

thank you or posting the paperwork woofgang. The process is a bit too formulaeic and tickbox imo, and I would quess LCP has come unstuck because practitioners have not included family enough in the decisions or process. I am uncomfortable with the hydration issue, surely patients shouldn't be allowed to become dehydrated.
Individual treatment plans should be a better way, though the same problems may still arise. As always it will be down to the skill, commitment and empathy of the staff helping the patient and family at this difficult time

[emmie]

very good idea, if it actually come about. my relative was supposed to be supported by care in the community, change care, for no care...
lets hope changes are made, as for Liverpool care pathway, sounds like an undertakers.

[boxtops]

It's not, em, if initiated properly. It's intended to avoid unnecessary interventions if someone is in the last stages.

[emmie]

then i had better take another look, quite frankly water should not be withheld from a person, if they are dying they are dying, there is no need to make them suffer any more than necessary. And they shouldn't put DNR notices on people's beds when the person and family don't request it.

[emmie]

the Macmillan nurse wouldn't have stopped my other half's water, even if it was just to wet the lips and mouth, that would not be right..

[Old_Geezer]

I did look as far as the example flow. There was no agreement I saw. Remove medication, one kills the individual off.

[pixie373]

I agree, em. There were already protocols in place for DNR. Anybody can refuse further treatment at any time. Medications can be used palliatively, increased or stopped. Nothing has changed there. Nobody should ever have food or fluids withdrawn. If they stop taking them themselves, that is different

[EcclesCake]

The front page of The Telegraph states that Liverpool Pathway will be replaced with an 'individual treatment plan agreed with families'.

I have no particular issue with the LCP but I would have been much happier knowing that that was how my Mother's exit was being managed.

It was never talked through or explained to me, I only understood her end of life care some considerable time after her death.

[pixie373]

As far as i know, there has always been individual treatment care put together by patient, family, doctors and other relevant people. It's nothing new.

[woofgang]

pixie, in good care, whatever you call it, food and drink is not withheld.
if you google Liverpool care pathway documentation, you should find one that you can read. NOWHERE does it advocate withholding food or drink. The medications that are stopped are the unnecessary ones. Where helpful ones are still given, a drip is set up so that they can be continue to be given even after the patient will not or cannot take them orally. They can also be given fluid through a drip (specifically mentioned) but if eg the heart or kidneys are failing then that fluid will make the patient less comfortable as it will sit in the tissue, causing swelling and breathlessness. In this case, the mouth should be moistened as often as the patient appears to need it. If the patient wants either food or drink thatey should always always be given it.
Whatever the new setup is called, it will still have to address the same issues and best practice which the actual pathway does cover, will remain unchanged. Please please go and read what the actual document says and not what the newspapers say that it says.
I agree about discussion and discussing DNR. My husband was fortunate in having very good end of life care, the only problem was a lack of resource.