Liverpool Care Pathway For The Dying Patient - Aims

Aims

The pathway was developed to aid members of a multi-disciplinary team in matters relating to continuing medical treatment, discontinuation of treatment and comfort measures during the last days and hours of a patient's life. The Liverpool Care Pathway is organised into sections ensuring that evaluation and care is continuous and consistent.

It was not intended to replace the skill and expertise of health professionals.

In the first stage of the pathway a multi-professional team caring for the patient is supposed to agree that all reversible causes for the patient's conditions have been considered and that the patient is in fact 'dying'. The assessment then makes suggestions for what palliative care options to consider and whether non-essential treatments and medications should be discontinued.

In practice, the implementation of this guideline was found to be lacking. Many decisions are taken in ward settings without the oversight of an experienced doctor of medicine. In almost half of the cases neither patients nor family were informed or consulted that it was decided to place the patient on the LCP.

The programme suggests to provide treatments to manage pain, agitation, respiratory tract secretions, nausea and vomiting, or shortness of breath (dyspnoea) that the patient may experience.

The care was not designed to be a one way street to death, however in 2012 controversy arose indicating that in most case it was and even patients that might have been saved otherwise died because of the LCP. Approximately 3% of patients initially put on the pathway are removed from the pathway when a reassessment indicates they may have a chance of survival, or when relatives have objected, and threatened legal action.