Thursday, 22 November 2012

Liverpool Care Pathway – Shared Concerns

From the BMJ archives -

"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."


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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