1. Introduction of Liverpool Care Pathway in Hospice Setting By Louise Stebbings

2. Introduction Attendance of study day in Liverpool oWard manager oTeam leader oSpecialist registrar

3. Planning oMeeting oHow to implement new guidelines into clinical practice oPreparation of presentation oStudy days arranged for staff of all disciplines and made compulsory

4. Education – Staff Training o1 hours study session oPower point presentation oDiscussion forum oAll staff given a copy of the pathway oOpportunity for staff to look at pathway and discuss any areas of interest or concern

5. Implementation oA decision was taken by the implementation group that the pathway would not be implemented until all staff had attended the session

6. Opposition oSome 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 oAdvised just a change in documentation and multidisciplinary

7. Positive oSome staff had already asked about implementing the pathway and were really keen oImplemented quite easily into practice due to all staff having attended the mandatory education session

8. oStaff 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

9. Following Implementation oIn 2002 after first 10-15 pathways used it was reviewed and areas of that caused concern were raised oAfter 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

10. oSome amendments were made to the last page about property and the computer system

11. Review oInitially reviewed after first 10-15 used oThen after 6 months oAudited after first year of implementation in December 2003 by ward manager and senior health care assistant

12. Audit oAudit focused on the documentation and which boxes had been filled in correctly

13. Results o27% of notes had a variance for agitation but no documentation for what action was taken o7% had a variance for pain, respirations, miturition, mobility, pressure area care, bowel care and psychological insight with no documentation

14. Action Plan From 2003 oNursing staff to ensure completion of all areas of documentation mainly by documenting what action was taken when a variance occurred oNursing staff to ensure they sign and date the front sheet prior to documenting in the pathway

15. oVerification 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 oClearer identification who should contact social services where necessary as appeared to be being overlooked

16. Problems oIssues 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 oSome staff argued it was prescriptive and not holistic

17. Benefits oMultidisciplinary documentation oEasy to implement and use oReduction in amount of documentation oStandardised care for all patients from all disciplines

18. oPrior to implementation all bereaved people were seen by either ward manger, matron or clinical services manager to receive property and death certificate oNo documentation of this now clearly documented on pathway

19. Recommendations for Future Audit oTo complete an audit focusing on the variances and how they were managed in practice oIdentify if there is a need for more staff education surrounding symptom control in dying phase

20. The End