introduction of liverpool care pathway in hospice setting by louise stebbings
TRANSCRIPT
Introduction of Liverpool Care Pathway in Hospice Setting
By Louise Stebbings
Introduction
Attendance of study day in Liverpool
o Ward manager
o Team leader
o Specialist registrar
Planningo Meeting o How to implement new guidelines into clinical
practiceo Preparation of presentationo Study days arranged for staff of all disciplines
and made compulsory
Education – Staff Training
o 1 hours study sessiono Power point presentationo Discussion forumo All staff given a copy of the pathwayo Opportunity for staff to look at pathway and
discuss any areas of interest or concern
Implementationo A decision was taken by the implementation
group that the pathway would not be implemented until all staff had attended the session
Oppositiono Some initial concern as staff felt it was a
paper exercise as they were already caring for dying patients and delivering a high standard of care
o Advised just a change in documentation and multidisciplinary
Positive
o Some staff had already asked about implementing the pathway and were really keen
o Implemented quite easily into practice due to all staff having attended the mandatory education session
o Staff felt it was user friendly and prompted you to look at all aspects of care for example: religious/spiritual needs and discontinuation of routine medications
Following Implementation
o In 2002 after first 10-15 pathways used it was reviewed and areas of that caused concern were raised
o After this time some areas were reviewed and changed for example the attached symptom management guidelines were taken out as we use the Yorkshire cancer network guidelines
o Some amendments were made to the last page about property and the computer system
Review
o Initially reviewed after first 10-15 used
o Then after 6 months
o Audited after first year of implementation in December 2003 by ward manager and senior health care assistant
Audit
o Audit focused on the documentation and which boxes had been filled in correctly
Results
o 27% of notes had a variance for agitation but
no documentation for what action was taken
o 7% had a variance for pain, respirations,
miturition, mobility, pressure area care, bowel
care and psychological insight with no
documentation
Action Plan From 2003
o Nursing staff to ensure completion of all areas of documentation mainly by documenting what action was taken when a variance occurred
o Nursing staff to ensure they sign and date the front sheet prior to documenting in the pathway
o Verification of death sheet had to be in two different colours depending whether patient on the pathway as people were using the wrong sheet for people not on the pathway
o Clearer identification who should contact social services where necessary as appeared to be being overlooked
Problems
o Issues for some nursing staff with regard to pressure area aspect of the pathway and 12 hourly turning of patients for comfort as opposed to pressure relief
o Some staff argued it was prescriptive and not
holistic
Benefits
o Multidisciplinary documentation
o Easy to implement and use
o Reduction in amount of documentation
o Standardised care for all patients from all disciplines
o Prior to implementation all bereaved people were seen by either ward manger, matron or clinical services manager to receive property and death certificate
o No documentation of this now clearly documented on pathway
Recommendations for Future Audit
o To complete an audit focusing on the variances and how they were managed in practice
o Identify if there is a need for more staff education surrounding symptom control in dying phase
The End