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Liverpool Care Pathway for the Dying Patient

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Bradford & Airedale. PALLIATIVE CARE. HANDOVER FORM. ANTICIPATORY ... TOTAL 18.21. SOURCE OF DRUGS. In LCD cars. Out of Hours Pharmacies. Bradford & Airedale ... – PowerPoint PPT presentation

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Title: Liverpool Care Pathway for the Dying Patient


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Liverpool Care Pathway for the Dying Patient
  • Liz Penny
  • Ian Fenwick
  • Macmillan GP Facilitators
  • Bradford Airedale

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Basic Bradford Airedale Stats
  • Total deaths 4632
  • Cancer 1177 25
  • COPD 225 6
  • Heart failure 80 1.7
  • Alzheimers 40
  • Parkinsons 24
  • MND 21
  • Chronic renal failure 9
  • Multiple sclerosis 9

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Place of death
  • Place cancer( ) all ()
  • Home 254 (22) 911 (20)
  • Hospice 313 (27) 335 (7)
  • Hospital 445 (38) 2226 (48)
  • NH 108 (9) 862 (19)
  • Comm. Hosp. 41 (3) 131 (3)
  • Unknown 16 (1) 167 (4)

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Poor Care of the Dying Effects on Patient
Family
  • Patient and family are unaware that death is
    imminent
  • Patient loses trust in doctor as their condition
    continues to deteriorate without acknowledgement
  • Patient and relatives perceive disagreement in
    the team and get conflicting messages regarding
    the patients condition
  • Patient dies with uncontrolled symptoms including
    pain/agitation leading to a distressing and
    undignified death

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Poor Care of the Dying Effects on Patient and
Family
  • Patient and family feel dissatisfied with the
    communication which seems not to be appropriate
    for the patients condition
  • At death CPR is inappropriately initiated
  • Cultural and spiritual needs are not met
  • Outcome - complex bereavement
    issues, formal complaints
    regarding care, feelings of failure by staff
  • ,

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Background
  • Royal Liverpool University Hospitals
  • Palliative Care Team 15 of all deaths
  • How to promote best practice???

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Integrated Care Pathway
  • Structured plan of care
  • Multidisciplinary
  • Incorporates evidence based practice
  • Defined measurable outcomes
  • Reduces paperwork
  • Enables audit

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Integrated Care Pathway
  • Promote best practice
  • Identify outcomes of care
  • Empower generic workers
  • Facilitate documentation
  • Promote educational role of PCT

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Liverpool Care Pathway
  • Hospitals
  • Community
  • Hospice
  • Nursing homes
  • Beacon status 2000

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Why now?
  • Supportive palliative care guidance NICE 2004
  • managed systems of care
  • Gold Standards Framework
  • GS7 Care of the Dying
  • ? National local PCT policy

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LOCAL IMPLIMENTATION
  • Nursing Homes facilitator
  • Macmillan GP facilitator team
  • End of Life facilitator

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NATIONAL PROGRESS
  • DoH EoLC Programme
  • First Year Progress Report March 2006
  • modest improvement
  • Help the Aged
  • EoLC for Older People March 2006
  • lack of appropriate care for older
    patients

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Bradford Airedale
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PALLIATIVE CARE HANDOVER FORM
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ANTICIPATORY DRUGS
  • HALOPERIDOL
  • MIDAZOLAM
  • HYOSCINE
  • DIAMORPHINE

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EXAMPLE
INJ HALOPERIDOL 5mg / ml 5 X 1ML amps as dir INJ
HYOSCINE BUTYLBROMIDE 20mg / ml 5 x 1ml amps as
dir INJ MIDAZOLAM 5mg / ml 5 x 2ml as dir INJ
DIAMORPHINE 5mg 5 ( five ) x 5mg ( five
milligram ) as dir WATER FOR INJECTION 10 X
10mls amps
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COST OF ANTICIPATORY DRUGS
  • HALOPERIDOL 1.55
  • MIDAZOLAM 3.63
  • HYOSCINE 1.05
  • DIAMORPHINE 8.87
  • WATER 3.11
  • TOTAL 18.21

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SOURCE OF DRUGS
  • In LCD cars
  • Out of Hours Pharmacies

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Bradford Airedale
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