Monday, 6 February 2017

Metal Nurse: Loss of Liverpool Care Pathway

I've tried not to be too political on this blog, for mostly professional reasons. It has happened at least once. But seeing as this is my blog I thought that this one time (and possibly more often after) I can be. Because this is one topic that really riles me and gets me going. The loss of the Liverpool Care Pathway. I have written previously about how Dying Matters, it is a fundamental part of all good nursing. How we treat the dying patient. How we help the bereaved family. Because how you die stays in people's memory.

For those who don't know. The Liverpool Care Pathway was set up in the late 90's in Liverpool. The aim of it was to provide the best possible care for those who were dying. It provided a framework on how to assess the patients condition, when to continue treatment, when to discontinue treatment and when to provide palliative care. To provide a review of whether further tests and examinations were needed, if artificial hydration should be started when the patient refused diet and/or fluid intake. In other words when to provide comfort care for those in their last hours of living, to provide them with a pain-free, and most importantly, a dignified death. It was a way to provide hospice care in a hospital.

Since 2014 we have not been able to use it. It was completely phased out with the order that each Trust should develop their own pathway, funny considering that the report that the DoH published a document called "More Care, less pathway.". This the Daily Hatreds concluded was victory for the public. Even though the review stated that that LCP was model of good practice, but because of individual mistakes it had to be discontinued. The pathway was excellent, and continually updated. But as usual human beings are fallible. Talking about death and dying is not easy, especially when the family are hellbent on that their relative should live forever. Some people had complained that it was a tick box exercise, which as usual misses the point of these documents. They are there to assist doctors and nurses in providing good care, making sure that all the best care was provided. But as with all good pathways the LCP was proactive, as the patients condition changed for better or for worse, their care and treatment would be re-evaluated. No one stayed on the LCP indefinitely, if someone made a recovery, which does happen because the human body is an amazing thing, then those patients would be re-examined, re-evaluated and and treated accordingly. It was never a "one-size-fits-all". It was a dynamic pathway like all good care pathways are.

All thanks to rags of hate like Daily Mail, Daily Telegraph and Daily Express (The triumvirate of Gentleman's Hate). These papers started reporting that there was a widespread misuse of the LCP, that healthcare professionals were using it as a means of euthanasia, and so on and so forth. The Daily Hate was especially gleeful in publishing false news about doctors withdrawing hydration of neonatal patients.  For a whole year Daily Nazi went on and on about the LCP, stating that families weren't consulted, that patients were put on it without their consent. That patients were put on it to speed up their death. For a whole year the Daily Triumvirate of Gentleman's Hatred continually on a near daily basis misinterpreted proper healthcare decisions, using their misguided (broken) moral compass on how doctors and nurses should do their work and how they should come to their decisions. Contrary to popular belief, the LCP was never misused, just grossly misunderstood.

Quite frankly the only truth was poor communication on the professionals part, which is not unusual. Talking about dying in hospital is often very hard, not just for relatives. But also for those professionals, because you don't want to be seen like you are failing in your job by letting someone die. Good communication is of course key to all good care. This comes with experience and training. It does not come from reading the Daily Triumvirate of Gentleman's Hatred. But the fallout has been such that some relatives seem to think that DNACPR and Advanced Directive are somehow Liverpool Care Pathway remade and should not be considered at all. But since scrapping the LCP we have got better at talking to relatives and patients regarding end of life care has improved, but the availability of said services have not. I know there was much rejoicing when it was scrapped, but when NICE published new guidelines on end of life care. It was all very much a rehash of the LCP, it just can't be called that now. We provided individual care to all patients before and we still do so.

From ICPCN
And the fallout didn't just affect adult nursing, it also affected paediatric nursing. Paediatric Nursing had been trying to develop a similar pathway for years. Seeing as there was the need for one. Palliative care for children is not as well known, generally again this is not a subject that a lot of professionals want to have. They will, but no parent actually wants to hear that there is nothing that the hospital can do for their child and that they would benefit from palliative care, rather than active treatment. The need for a tool for healthcare  professionals to use in order to assist them with making those decisions and the rationale for those decisions was lacking. It's a conversation that neither party wants to have, but both desperately need.

Sometimes further treatment is just inflicting pain on children, with no hope of either cure or reprieve. Extending hope when there is none. Children, like adults, need and deserved tender loving care. And like with adults, how children die stays in the memory of those who live on. But again, thanks to the triumvirate of gentlemans's hatred, the development of said pathway for England(and Wales) was halted almost indefinitely. NICE since have published up guidelines on how manage and plan end of life care for children. Scotland have also been developing an excellent one.

As healthcare professionals we really could do without all the blame and suspicion that is cast on us by paper of Gentlaman's Hatred. It gets in the way of good care when patients and relatives judge our actions based on lies and falsehoods that are propagated by those papers. The readers and writers of said newspapers looked at the loss of the LCP as some sort of victory for the common people, when it was anything but. It was the common people who lost out on a very effective, very good tool that was made for them. It's the common people that lost out. No one goes into healthcare with the thought of making money, they go into it for fulfilment of the job. But it's hard to do the job when writers who don't know anything about healthcare cast doubt and aspersions about your reasoning for being a nurse or a doctor. My job is hard enough as it is, please stop making it harder. I want to care for my patients, not for rumours.
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