The Liverpool Care Pathway (LCP)
What is the Liverpool Care Pathway (LCP)?
The Liverpool Care Pathway (LCP) – is a pathway/document that clinical staff put in place when a relative or loved one is nearing the end of their life whether they wish to die at home, in hospital or in a Hospice or Care Home. It outlines the best possible care that is available to assist them.
Information for relatives /carers
The doctors and nurses looking after your relative / friend believe that there has been a change in his or her condition that indicates to them that your relative / friend is dying. The dying process is unique to each person but in most cases, a plan of care can be put in place to support the patient, doctors and nurses, relatives / friend to achieve the best quality of care at the end of life.
Medication / treatment
Medication will be reviewed and any medication that is not helpful at this time maybe stopped and new medication may be prescribed so that if a symptom should occur there would be no delay in responding. It may not be possible to give medication by mouth at this time, so medication may be given by injection or sometimes if needed, by a continuous infusion by a small pump called a Syringe Driver, which will be tailored to individual needs. It may not be appropriate to continue some tests at this time; these may include blood tests or blood pressure and temperature monitoring. The staff should talk to you about maintaining your relative’s / friend’s comfort; this should include discussion regarding position in bed, use of a special mattress and regular mouth care. You may want to be involved in elements of care at this time.
Diminished need for food and drink
Initially, as weakness develops, the effort of eating and drinking may simply have become too much and at this time help with feeding might be appreciated. Your relative/friend will be supported to take food and fluids by mouth for as long as possible. When someone stops eating and drinking it can be hard to accept, even when we know they are dying. It may be a physical sign that they are not going to get better. Your relative/friend may neither want or need food and/or drink and decisions about the use of artificial fluids (a drip)will be made in the best interests of your relative/friends for this moment in time. This decision will be explained to you and reviewed regularly.
Religious / spiritual needs
A key plan of care includes the need for staff to determine the wishes of you and your relative / friend as regards religious or spiritual needs, and what is important to them at this time. You may be asked if you or your relative /friend have a religious tradition or belief and you may want to consider specific support from a chaplain / religious advisor, regarding special needs now or at the time of death or after death. Not everyone who dies has a formal religious tradition, the staff should explore any other values, beliefs, wishes or desires that you or your relative / friend may have at this time.
Facilities
You should be given information with regards to facilities on the ward if your relative / friend is an inpatient, e.g. visiting times, car parking and beverage facilities.
Information / communication
As well as giving information to you about the plan of care the staff will want to check with you that you understand the plan of care. A Coping with Dying leaflet is available if you want more information on what to expect at this time in relation to diminished need for food and drink, changes in breathing and withdrawing from the world. The team looking after your relative / friend will make regular assessments of his or her condition. Please do not hesitate to speak with the doctors or nurses regarding any worries or concerns that you may have with the plan of care in place.
All dying patients irrespective of where they are being cared for and who is caring for them should be receiving their care directly from nurses who are using the Liverpool care pathway. If they are not then relatives should be asking why not.
