Continuous deep sedation in patients nearing death
Continuous Deep Sedation and LCP concerns 16 April 2008
We share Adrian Treloar’s concerns and comments regarding the LCP (Liverpool Care Pathway) [1] in his Rapid Response to the editorial [2] and paper [3] on Continuous Deep Sedation and have also worried about patients being commenced on the pathway inappropriately.
For some time, we have felt that a Pre-LCP checklist would be appropriate in ensuring that patients did not commence the LCP prematurely and to this end FD devised CELT (Checklist for embarking on End of Life Treatment) [4] which we have piloted at Strathcarron Hospice in Forth Valley in Central Scotland [5].
Essentially CELT is a decision-making framework designed to achieve appropriate transition from active treatment to end-of-life care and to bridge the gap between GSFS (Gold Standard Framework) and the LCP. It highlights the importance of excluding reversible causes of deterioration and can be re-used if there is an improvement following specific treatment, e.g. for hypercalcaemia, and then a further decline.
CELT could provide documented auditable evidence of a logical structured approach to end of life treatment and thus may also be helpful in averting/resolving complaints of either too much or too little treatment at the end of life.
General Practitioners and District Nurses in Forth Valley have found it to be a helpful concept and we are currently discussing routine use of CELT in local acute and community hospitals. We would be happy to provide a copy of the CELT Tool if it was thought to be useful in other settings.
Refs.
2. Scott A Murray, Kirsty Boyd, and Ira Byock Continuous Deep Sedation in patients nearing death BMJ 2008; 336: 781-782
3. Rietjens J, van Delden J, Onwuteaka-Philipsen B, Buiting H, van der Maas P, van der Heide A. Continuous Deep Sedation for patients nearing death in the Netherlands: descriptive study. BMJ 2008 : 10.1136/bmj.39504.531505.25.
4. CELT – A Checklist for Embarking on End of Life Treatment Downs F Strathcarron Hospice 2007
5. Use of the Checklist for Embarking on End of Life Treatment Arnold A, Downs F, Bentley A Poster presentation for 7th Paliative care Congress, Glasgow, April 2008
Competing interests: None declared
Competing interests: None declared
Fiona M Downs, Consultant in Palliative Medicine
Angela Bentley, Michael Cornbleet, and Elizabeth Arnold
Strathcarron Hospice FK6 5HJ
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