MBHT 2011

Fully implemented in the Acute Trust,
Coming soon in the Community!

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National audit of all patients dying on the LCP in acute hospitals between April – June 2011 inclusive
Managed by Marie Curie Palliative Care Institute
Liverpool and Royal College of Physicians
Data is collected locally then collated and published as “National Care of the Dying
Audit”
Feeds into ongoing development of the LCP

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Where is the LCP sited on the intranet and how many ‘clicks’ does it take to navigate to it from the home page?
Where are the symptom control algorithms sited?
What 4 drugs constitute the just-in-case/core drugs in your area?
The patient has needed 1 dose of sedation and 1 dose of antiemetic in 24h. Do they need a syringe driver starting?
What would be a suitable dose of sedation over 24h if required?
What would be a suitable dose of antiemetic over 24 hours if required?
What written information should be provided to the patient’s family when starting the LCP?
A patient’s IVI on the LCP ‘tissues’. What needs to happen next?
A patient on the LCP has laboured breathing. What may help relieve this symptom?

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To navigate to the LCP and symptom control algorithms: Home page>Clinical Services>Palliative care>End of Life Tools (left hand side of page)>Liverpool Care Pathway/Algorithms (4 clicks)
Morphine, midazolam, Cyclizine, Hyoscine hydrobromide
(MBHT & Cumbria), Diamorphine, Midazolam,
Levomepromazine, glycopyrronium (Lancaster Community)
No need for a graseby unless the patient has required 2/3 doses of sedation or antiemetic- just continue with prns
10mg midazolam/24h, Cyclizine 150mg/24h,
Levomepromazine 6.25-12.5mg/24h (this may be given stat as long acting)
Front sheet of LCP 12, additional LCP/Macmillan leaflets if available
Clinical decision on whether they need clinically assisted hydration
Morphine + or – midazolam. Oxygen therapy rarely helps- may be intrusive/uncomfortable, fan

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Dr & nurse to complete initial assessment together
Give front information sheet to family
MDT review at least every 3 days
Don’t keep writing in the medical notes
No need for long narrative on MDT sheet
Don’t use the LCP as a means of stopping obs for patient
Thank-you