Liverpool Care Pathway – An Unsafe Tool

From the BMJ archives -

"The audit... highlights the need for particular consideration for hydration as 1 in 5 patients may be expected to live longer than 3 days."

"...how imminent is imminent?"

Achieving a good death for all

The Imminence of death and the Liverpool Care Pathway    

29 October 2010

In their article 'Achieving a good death for all' Ellershaw and colleagues state that the Liverpool Care Pathway (LCP), or equivalent, is "aimed at improving care of the imminently dying". 1 But how imminent is imminent?

A retrospective review of all deaths (N=188) carried out by one of the authors (MM) in an acute hospital for the months April and August 2010 revealed that 61% of patients were eligible for the LCP. However of all deaths only 78 (41%) patients received care on the LCP. The length of time on the LCP ranged from 1 hour to 31 days (median 23 hours). Of patients on the LCP 20 (26%) were on longer than 72 hours and 10(13%) longer than 5 days.

This audit echoes the point made by Clearkin that prediction of dying -the last 48 hours- is difficult. 2 Some deaths are not predicted and those clinically judged 'imminent' can be prolonged. The audit reinforces the need for meticulous regular monitoring and clinical assessment for each patient placed on the LCP. It highlights the need for particular consideration for hydration as 1 in 5 patients may be expected to live longer than 3 days.

The LCP is in our view a very useful tool which may help achieve a good (or better) death in up to 60% of people in whom death can be anticipated. The imminency for most will be less than 3 days but for a substantial minority it will be considerably longer.

Competing interests: None declared

Edwin J Pugh, Consultant

Mel McEvoy

North Tees and Hartlepool Foundation Trust

Thought Note –

A tool can be considered useful only as far as the parameters are met for its use.

There are too many unknowns for its parameters to be safely met.