Thursday, 12 February 2015

Liverpool Care Pathway - On The Final Stretch

So casual do we watch another die? So casual is become our estimate of life?

Coldly, calculatedly, we place a value judgement on what is a life worth living. Then, what else might we expect in this Monty Python world when ‘Stand by’ takes on a whole new, quite literal, dimension of meaning?

The Mail headlines -

In the aftermath of the Mid Staffs killing wards, they rolled out the '6 Cs'...

Caring people used to become doctors and nurses because they cared. "Better training" will not teach people who do not care to care.

Nurture may instill; nature will reveal…

Compassion is something you may learn but it may not be taught.

They waited long enough until they thought it was safe to act. Culture and attitudes have been doctored and groomed. It seems they can now get away with anything, even referring to a dementia sufferer as 'Mickey Mouse'...
Liverpool Care Pathway - Hard At Their Purpose
Ensure that naloxone injection, an antidote to opiate-induced respiratory depression, is available in all clinical locations where diamorphine and morphine injections are stored or administered.
Not one of the 'just in case' boxes deployed to Care Homes and for use in patient's own homes, apparently, contains the antidote. The purpose is to push and, when push comes to shove, shove they will.

Further reading -
Liverpool Care Pathway - The Rationing Of Available Resources
There is now a first (999) and second class (111) emergency number. Time, which is always the crucial factor in any emergency, is being wasted expecting someone who may not, and most likely does not, possess that knowledge to determine how much of an emergency is an emergency to make that crucial decision.

The box-ticking, target-hitting 999 response service has been running for some years...

And even a skilled paramedic may miss something that should be blue-lighted...
Liverpool Care Pathway - 111, EPaCCs And The 999 Downgrade
And the first class 999 service has, itself, been further downgraded.

It has become practice to make these priority assessments and to downgrade response. Vulnerable groups are being groomed to downgrade their own response expectations. Attitude has been subtly skewed.

Once upon a time, doctors would go that extra mile to preserve life. That is the whole principle of First Aid and why First Aiders become First Aiders: to rush in to the rescue, to be there and be able to attend to a dire need. Life and the preservation of life was always first and foremost in mind. That has all been turned on its head.

When every heartbeat counts, do you check what's on the EPaCCs or do you just plunge in and try and save that life?
Liverpool Care Pathway - ‘Hands On’ Life CafĂ©
The victim in the Mail report was a 47 year old man, not immediately someone to be placed in a group to receive a downgraded response. The court determined that the gentleman would not have survived his heart attack, however, and so the paramedic, among five hospital staff arrested, received only a suspended sentence for failing to execute his duty of care. The manslaughter charge was dropped.
CCTV caught Matt Geary as, hands in his pockets, he took a quick look at the desperately ill patient.
But instead of trying to save his life and taking him to the accident and emergency department only yards away, he callously left.
The paramedic "took a quick look" the report says. This was clearly an assessment that there was only a small chance of a successful response to CPR. This paramedic was actually following the Lakhani Recommendations...
Liverpool Care Pathway - The Cost Of Living
Is there evidence of a DNACPR advance directive or order being in place?

Is the person elderly or frail as described in the Lakhani Recommendations...?

To comply with a ‘Last Wishes’ document and to maintain dignity; to retain the dignity of this dignified person, is it best to...

Let them go? Is it better to stand back and just watch them die?

This is the world we live in...

This is what we have come to and we are almost there. We're on the final stretch.

Additional reading -
Liverpool Care Pathway - From “Nightingale To Nightmare” 

Liverpool Care Pathway - The Prequel 

Liverpool Care Pathway - The Bee Wee Consultation

Liverpool Care Pathway - The Rationing Of Available Resources

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