The use of the Liverpool Care Pathway in Jersey

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WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY SENATOR S.C. FERGUSON

ANSWER TO BE TABLED ON TUESDAY 20th NOVEMBER 2012

Question

1. What are the controls and procedures used for the Liverpool Care Pathway in Jersey?
2. How long has this procedure been used in Jersey?
3. In how many cases has this procedure been used?
4. Have there been any complaints and, if so, how were these resolved?

Answer

1. The controls and procedures used for the Liverpool Care Pathway in Health and Social Services are those recommended by the Marie Curie Palliative Care Institute in Liverpool.

The approach is endorsed by 22 separate organisations which include several of the Royal Colleges and National Bodies such as : The Royal College of Physicians, The Royal College of General Practitioners, The Royal College of Nursing, The National Care Forum, The British Geriatrics Society, Age UK and The National Council for End of Life Care.

The introduction of the Liverpool Care Pathway within Health and Social Services has been managed through a range of measures to ensure the correct procedures are followed and appropriate controls are in place to monitor its use, which include:

• A training programme for clinical staff, supported by resource packs containing guidance information available in the clinical areas. The training covers 4 main areas which are ( in bold)  communication and the need to discuss and engage with relatives at all times, to support a shared agreement in care, to provide support to relatives, to establish points of contact. To agree and understand advanced care planning, taking into account patient wishes, preferred priorities of care, aiming to support the patient to die in their place of choice.  Medication - to strengthen knowledge and understanding in relation to the main medications used to manage common symptoms such as pain, agitation, nausea and chest secretions and to ensure medication is prescribed so it can be given when needed in order to minimise any possible suffering to the patient. Spirituality, ensuring that the beliefs of the patient are understood by all caring for them and appropriate plans in place. Continuous review, this is an important part of the training to ensure staff understand the fluidity and flexibility of the pathway. That care needs are regularly reviewed and appropriate interventions made to ensure that the patient is comfortable and their symptoms are managed.
• Clinical Guidelines - the Pathway is supported by number of clinical guidelines, which provide clinicians with information to support their decision making, these are available in the clinical areas.

• In addition to this there is guidance to support the decision making process in diagnosing dying and the use of the Liverpool Care Pathway supporting care in the last hours or days of life. These guidelines are part of the Liverpool Care Pathway package.
• Monitoring and Audit - In addition to the above the use of the pathway is monitored and audited.
• Liverpool Care Pathway Facilitator – through funding from Macmillan HSSD have been able to employ a registered nurse to fulfil this role. She works as part of the Palliative Care Team and has led on the introduction of the pathway.

The decision to start a patient on the pathway will be made by the multidisciplinary team caring for the patient, in agreement with the patient's family. The recording of this decision is the responsibility of the most senior doctor available and endorsed by the Consultant who is caring for the patient.

Initial and ongoing assessments of the patient will be done by doctors and nurses caring for the patient (ie more than one professional).

The pathway is intended as a tool to ensure all care needs are considered and appropriately met, regular reviews of the patient by more than one professional supports appropriate use and if clinically appropriate, patients can/do come off the pathway.

2. Health and Social Services have introduced the most current version of the Liverpool Care Pathway during 2012.
3. To date 23 patients have been cared for using the Liverpool Care Pathway within the General Hospital
4. There have been no complaints since its introduction.