Guidelines for looking after people at the end of life
I’ve heard of something called the Liverpool Care Pathway. Can you tell me what it is?
Care pathways are plans for how someone should be cared for when they have a particular medical condition or set of symptoms. Doctors, nurses and other health professionals record the care that they give in the care pathway document. So their notes are all together, in the same place, and everyone involved knows what is going on.
- Are focused on the patient and their family
- Are based on evidence
- Set standards for how things should be done
- Involve the patient and their carers
- Involve all professionals caring for the patient and their family
Experts in each medical condition agree the care pathway for their area. They use their expertise, as well as nationally and locally agreed guidelines. The team of experts who agree the pathway includes people from many different professions involved in caring for people with each particular condition.
Care pathways describe the patient’s journey and help make sure patients get the care they need along the way. They aim to predict possible problems that the person may have, and hopefully prevent them. Care pathways include
- An assessment of the person’s needs
- The care that they have
- An expected outcome or goal from having that care
An example of this is if someone is in pain, they are prescribed an agreed painkiller for that pain and the expected outcome is that they aren’t in pain anymore.
Professionals also use care pathways as a way of
- Educating and teaching other professionals
- Developing care for people with each condition
- Checking that people are getting the care they need
It is the only document that the professionals use to record the care they give.
The Liverpool Care Pathway (LCP) is a care pathway for people who are dying. It covers all aspects of care including
- Keeping the patient comfortable by controlling their symptoms
- When to prescribe certain drugs to prevent symptoms before they start
- When to discontinue some treatments or aspects of care
- Psychological and spiritual support
- Support for the family
The idea behind the LCP is to care for people who are dying in the same way, wherever they are. People may be cared for in a hospice, at home, in hospital or in a care home. Local professionals develop the pathway to include local guidelines. Although much of the care will be similar wherever you live, there may be slight differences between areas.
The pathway includes
- A detailed assessment by a health care professional to work out what you need
- A plan of your care, including likely symptoms you may develop and how to prevent them if possible
The LCP means that you should have clear information about the care you need and who will give it.
Pathways improve communication between health professionals as well. If the nurse looking after you changes, your new nurse will be able to read your pathway and know exactly what you need. And any changes to your plan of care will be recorded in the pathway, with the reason why it has changed.
One of the key recommendations of the National Institute for Health and Clinical Evidence (NICE) guidance for supportive and palliative care is that professionals should identify and address the needs of people who are dying. NICE recommends that one way to do this is through a model of care. They suggest that for the last days of life this should be either the LCP or the Welsh Integrated pathway. The Welsh Integrated Pathway is a guideline developed in Wales that is very similar to the LCP.
You may be asked some questions about the symptoms you have and how you want to be cared for. Your family will be included as they will also need help and support.
The assessment will include information about your spiritual beliefs and about what you and your family understand about your illness. It will also include information about what you want to happen when you die. It helps to make sure you and your family get what you want, and all the professionals caring for you know what you need.
We have a section about dying with cancer, which has lots of helpful information.
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