Regional updates (April, 2006)
Counties Manukau
The Hospital Palliative Care Team at Middlemore Hospital identified a need within the hospital to improve the standard of care of dying patients and their family/whanau. Having raised these concerns with our DON, and on gaining support from the Clinical Board a twelve month pilot project to implement the LCP into two wards at Middlemore Hospital commenced in April 2005.
To date there have been 15 patients through the pathway and whilst this is much fewer than what we had anticipated, with any change project patience appears to be the most important requirement. Advice gathered from colleagues reinforced the need to go quietly and carefully when endeavouring to introduce the pathway. Currently it appears the nursing staff on the two pilot wards are taking ownership of the pathway and the last 4-5 patients have gone onto the pathway at the initiation of the nursing staff.
As part of my Master of Nursing Thesis I have the opportunity to ask the nurses on the pilot wards and senior nurses involved in implementing the pilot project how they see the early impact of the LCP on the nursing team caring for dying patients.
Jenny Thurston
Clincal nurse specialist palliative care
Middlemore Hospital
JThursto@middlemore.co.nz
Arohanui Hospice
Our journey with the Liverpool care of the dying pathway started late 2004 with a Project Plan that encompassed a pilot of the pathway in aged residential and acute hospital settings linked to a research project to evaluate its impact on the care of the imminently dying in the region.
In partnership with Arohanui Hospice the MidCentral District Health Board have supported the project plan with funding support for a LCP Facilitator role and research project.
The first step was to introduce the pathway into the hospice inpatient unit which was done in December 2004. Is now very much established as part of our normal documentation and post implementation evaluation of both documentation and staff attitudes clearly demonstrated some tangible benefits for implementing the pathway in such a specialist setting.
The next step was the successful recruitment of Amanda Taylor from the UK to work in the role of LCP Facilitator. At present the LCP has been successfully implemented in the first pilot aged residential care facility and the run up to implementation in the second has commenced.
Alongside this good progress is being made with the research project, its navigation through ethics committee and the gathering of the pre implementation data. The research explores the perceptions of health care worker regarding the care of dying patients in Aged Residential Care and the Hospital settings; pre and post implementation of the LCP.
Barry Keane
Director of Clinical Services
Arohanui Hospice
barry.k@arohanuihospice.org.nz
Waikato
In November 2005, I was employed as a Palliative Care Nurse Specialist with a mandate to implement the LCP in Waikato hospital. In December I met with collegues from across New Zealand to learn from their LCP experiences. These meetings were extremely valuable in terms of hearing first-hand accounts of the difficulties and successes associated with this project work. I really appreciated everyone’s willingness to share their resources and knowledge – and their honesty in helping me focus my rose-coloured LCP spectacles!! I have since learnt much about change management processes.
I’m sure it will come as no surprise to experienced pathwayer’s that my initial expectation of having the LCP rolled out by April 2006 has moved to ‘sometime later this year’. To-date, Waikato is registered with Liverpool and have the proforma pre-audits. The hospital-based Palliative Care Team are on board and very supportive. I will be meeting with key stakeholders from the two wards with the highest numbers of inpatient deaths to establish buy-in and encourage ownership of the LCP over the next few months.
We are fortunate that many of the associated policies, procedures and guidelines that inform the goals of the LCP are already in place (Eg: Care of the Deceased/Tupapaku, Management of Syringe Driver’s etc). I look forward to keeping in touch through the newsletter.
Theresa Mackenzie
LCP Project Coordinator
Health Waikato
Phone(07) 839 8691
mackenzt@waikatodhb.govt.nz
Hutt Valley
Te Omanga Hospice has embraced the concept of the Liverpool Care Pathway (LCP) and is registered with the LCP project in the UK. As Palliative Care Nurse Specialist Educator in the Hutt Valley my role supports Aged Care Facilities (ACF) and works collaboratively to improve the delivery of palliative care in the facilities.The concept of the LCP was introduced and some facilities have implemented an adapted version to fit in with their own documentation. Education sessions have been delivered at the hospice and on-site at the facility. End-of-life funding is available for extra staff if required. The LCP has created great interest but difficulties in relation to staff ratios and turnover have affected the implementation in some areas.
A positive effect of the LCP in the Hutt Valley has been a reduction of admissions to Hutt Hospital of patients from ACF in the dying phase.
In consultation with a local Aged Care Facility, Te Omanga has embarked on a research project to “Evaluate the Introduction of the Liverpool Care Pathway for the terminally ill/dying phase in an aged care facility within the New Zealand context”. This research involves a pre and post audit of notes and a focus group to discuss the usefulness of the tool.
The research project has recently been approved by the Central Regional Ethics Committee.
Kate Gellatly
Palliative Care Nurse Specialist Educator
Te Omanga Hospice
Kate.Gellatly@teomanga.org.nz
Hawkes Bay
Hawkes Bay DHB have seen the LCP as being a key component in improving delivery of end of life care throughout the area and we were keen to support this aim. In particular we could see how it might be beneficial in some of the more generalist areas where some of our patients die.
It was decided that before we could promote the LCP as a panacea to solve all problems, we would need to suck it and see for ourselves what it would take to adopt and implement in the specialist area of the hospice. We formed a working part and launched the use of the LCP in December 05.
Adopting this tool has not revolutionised the way that we do end of life care at Cranford Hospice as we already did it very well. It has caused us to standardise what we do and to document the processes by which we decide which treatments and interventions are appropriate.
This has helped to demystify some of the things which we do. It has also provided us with a very comprehensive document which we can use to ensure that consideration of a number of factors are always taken into consideration for all patients no matter what the circumstances at a particular time and no matter which particular combination of staff might be involved in their care.
We have just had our twentieth person on the pathway and are about to do the formal audit to see how the LCP has impacted on documentation. We can hardly wait!
Roger Parr
Cranford Hospice
matron@supportec.org.nz
