The second National Care of the Dying Audit of Hospitals (NCDAH) led by the Marie Curie Palliative Care Institute Liverpool (MCPCIL) in collaboration with the Clinical Standards Department of the Royal College of Physicians (RCP), supported by Marie Curie Cancer Care & the Department of Health End of Life Care Programme was published on the 14th September 2009.
This National Audit is unique in the world in both size and scope collecting data from 155 Hospitals across all SHA’s, representing nearly three quarters of hospitals in England and in parallel a pilot audit undertaken in Northern Ireland hospitals. The audit includes 3893 Patients whose care was delivered supported by the Liverpool Care Pathway for the Dying Patient (LCP).
Aims of the Project
- To drive up the quality of care in the last hours / days of life
- To undertake a prospective audit of the goals of care included on the LCP and gather data from up to 30 consecutive deaths in each of the participating hospitals between 1st October 2008 and 31st December 2008.
- To provide participating organisations with data comparing their individual performance with that of the whole sample.
- To enable participants to share best practice at 3 regional workshops.
- To inform the consultation exercise commenced in 2007 to develop Version 12 of the LCP
What is the LCP?
The LCP provides a useful template to guide the delivery of care for the dying to complement the skill and expertise of the practitioner using it. Once commenced the goals of care prompt staff to consider the continued need for invasive procedures and whether current medications really are conferring benefit. It has 1 aim and that is to improve the quality of care given in the last hours / days of life.
The use of the LCP does not preclude use of antibiotics or artificial nutrition or hydration but it does ask the professional to consider an appropriate decision for that moment in time and the health professional is asked to document the reason for decisions made.
Using the LCP in any environment requires regular assessment and involves continuous reflection, challenge, critical decision-making and clinical skill underpinned by a robust educational programme. There is a systematic 10 step implementation process within a 4 phased service improvement model to support the use of the LCP.
Findings from the audit together with widespread consultation will inform further development of Version 12 of the LCP which is currently out for consultation and will be launched on 25th November 2009. A current draft of Version 12 can be viewed on the Marie Curie Palliative Care Institute website.
National Audit Round 2 - 2009
The audit results are as impressive as those of the first audit, published in 2007. This shows that standards of patient care remain high, and underlines the value of the LCP in providing a framework in which clinical judgement can be exercised for the benefit of individual patients.
Dr Jonathan Potter, Clinical Director, Clinical Effectiveness and Evaluation Unit,
“The second round of the national audit of care of the dying demonstrates that, where the Liverpool Care Pathway for the dying patient (LCP) is used, people are receiving high quality clinical care in the last hours and days of life.”
Professor John Ellershaw, Director, Marie Curie Palliative Care Institute Liverpool said:
“Hospitals need to recognise that care of the dying is part of their core business. To achieve excellence in the last hours / days of a patient’s life, all health care workers caring for dying patients and their relatives / carers should undertake training and education in care of the dying. A good death should be the expected not the exception! “
“How we care for dying patients is an indicator of the patient experience across our organisations. “
Reports
The generic report can be viewed via the link below:
For Further Information
For further information about the audit please contact:
Maureen Gambles
Audit Coordinator
Research & Development Lead
Marie Curie Palliative Care Institute Liverpool
c/o Directorate of Specialist Palliative Care,
1st Floor, Linda McCartney Centre,
Royal Liverpool University Hospitals NHS Trust,
Prescot Street,
Liverpool, L7 8XP
Tel: 00 44 151 706 2274
Email: Maureen.gambles@liverpool.ac.uk
For further information about the LCP, please contact:
Deborah Murphy
Associate Director MCPCIL
National Lead Nurse - LCP
(address as above)
Tel: 0044 151 706 2274
Email: lcp.enquiries@rlbuht.nhs.uk