In the account here, published June 2010, nurses have been 'found out', apparently. Doctors who have colluded with them over the phone, however, appear to have escaped reprimand.
NNPs took verbal orders for medicines from doctors over the phone to save them coming to the ward. They also administered morphine and other opiates intravenously. Neither was allowed under hospital or professional regulations. Grigg-Booth, and at times other NNPs, also prescribed opiates such as pethidine and diamorphine for patients. This was risky and unlawful as they can hasten or cause death.
Yet no one, not a pharmacist, a doctor or a manager, ever questioned what they were doing, so they carried on believing it was all right. They weren't trying to hide anything: clear, open records of the drugs issued on prescription charts, clinical notes and letters exist as far back as 1996. Opportunity after opportunity was missed because some people didn't notice, while others failed to act. Occasional complaints to the divisional manager went nowhere, and evidence of a "club culture" between key staff existed, according to the report. So the board remained unaware, no doubt reassured by the awards and accolades it was winning as its reputation soared. The inquiry found little evidence of the board debating protocols and policies, and external accolades blindly accepted without the healthy suspicion which is crucial for good management. By failing to find out how the New Deal target was being achieved, hospital bosses inadvertently put the needs of the organisation before the needs of patients, the report states.
Sometimes, this practice has been overt, often covert. This practice is, clearly, morally wrong. With the legitimacy granted to it under the LCP protocols, this practice is become widespread and dangerous and should be abandoned.
From Patrick Pullicino, professor of Clinical Neurosciences, University of Kent, Canterbury SIR – As a consultant neurologist practising in the NHS, my first personal contact with the Liverpool Care Pathway (LCP) was when I rounded on my patients one Monday morning and found one of my elderly patients had become deeply unresponsive. I found out that a couple of days previously he had become confused, agitated and difficult to manage because of seizures and pneumonia and the doctor covering together with the nursing staff jointly made a diagnosis that he was “dying”. Despite the fact that none of his problems were fatal, and against the wishes of his family, he was put on the LCP. Against considerable opposition I withdrew the LCP and within two weeks my patient was discharged home to his wife.