Wednesday, 17 July 2013

Liverpool Care Pathway - They Do Not Have The Paperwork

When the evidence has been buried with the patients...
There isn't much left to go on.

The Review points out that:
1.30 The reports of incomplete and wrongly completed forms that the Review received are of grave concern, reminding the Review panel of a key finding of the Mid Staffordshire Public Inquiry – insufficient openness, transparency and candour.
The Review Panel strongly supports Robert Francis QC’s call for a duty of candour, and recommends that clinicians be reminded by their registration bodies that the deliberate falsification of any document or clinical record, in order to deflect future criticism of a failure of care, is contrary to GMC28 and NMC guidelines and therefore a disciplinary matter.
This is The Telegraph 

They really intend to review every patient placed on the Liverpool Care Pathway?

Every year 130,000 patients are placed on the LCP. The paperwork isn't always there and, where it is, it is mostly slapdash or incomplete. This is not evidence-based medicine. But this is what they have to go on.

This is GLA Conservatives –

This report, Unheard Voices: The Liverpool Care Pathway, exposes a lack of clear, reliable and publically accessible information over how the Liverpool Care Pathway (an end of life care pathway) is applied in hospitals.
Data from 21 London health trusts uncovered by Andrew Boff, Leader of the GLA Conservatives, shows:

38% of trusts (8) could not say how many patients were on the LCP

81% of trusts (17) could not provide the number of patients who were removed from the LCP and/or survived

81% of trusts (17) could not give the longest and shortest periods that patients were on the LCP
38% of trusts (8) could not provide any of the requested information on patients on the pathway
Andrew Boff, Leader of the GLA Conservatives, Londonwide Assembly Member and author of the report said:
"It is a scandal that we could not find basic information on the some of the most vulnerable people, those over 65 years of age, on the Liverpool Care Pathway. We are talking about straightforward figures that should be readily available in the public domain - the number of deaths on the LCP, the length of time that patients are cared for on it, and the number of patients that are removed from it. Trusts should be required to record this information regularly, clearly and concisely, and the clinical commissioning groups should make sure that they do this.
The report recommends that independent advocates be made standardly available to patients without friends or family to represent them when they are in hospital, and when decisions are being made about whether they should be placed on the LCP.
They really intend to review every patient placed on the Liverpool Care Pathway!

These are the killing wards. Where the paperwork is complete it has been done tick-box fashion, so of course it looks alright, but how many of these were actually 'dying'? 'Evidence', 'evidence', 'evidence', but the evidence is not the reality.

No, they will use representative samples in the same manner Ellershaw did to paint black as white and wrong as right as in this BMJ submission intended to 'prove' there is no ‘blanket’ policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

- BMJ 
Conclusion Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no ‘blanket’ policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP

The study used datasets from the National Care Audits of the Dying using LCP version 11. Hospitals were permitted to submit selected data from 'up to 30' adult patients, the dose received in the last 24 hours of life and the last dose received for agitation and restlessness.
  • No data is given on drugs supplied alongside that prescribed for the symptoms mentioned. Has morphine already started; does it continue?
  • Was the patient already unconscious...?
  • This is selected data from 0.04% of the total number of patients on LCP.
  • This is a study based on biased data.
  • Messrs. Ellershaw et al are allocated funding for this feeble research and actually get away with it.
  • 'Evidence' such as this was submitted to the 'review'.

This does not bode well.

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