Pathway sets new standards (March, 2006)
LCP stands for Liverpool Care of the Dying Pathway, an internationally-recognised “gold standard” of care for the terminally ill in their last days of life. Arohanui Hospice is piloting the implementation of the pathway in this region, as part of a collaboration with the Liverpool centre where it was originally developed. This has led to Amanda’s recruitment from the United Kingdom as the hospice’s LCP Facilitator.
Amanda came to Palmerston North with husband Andrew and children Charlie (8) and Mae (6) in August last year. She’s from the village of Earls Barton, in Northamptonshire. Amanda was working in a similar role in the UK, while also working as a Clinical Nurse Specialist in Palliative Care with patients in the community. Before specialising in palliative care, Amanda was a Charge Nurse in a general hospital and also worked in intensive care.
As well as her nursing qualification, Amanda holds an honours degree in Palliative Care from Oxford Brookes University. She says she was attracted to palliative care “because it’s one area of nursing where you can really use your interpersonal skills.
She stresses that, although hospices specialise in the care of people with life-limiting illness, nevertheless a lot of palliative care is offered outside hospices – in general hospitals, in rest homes, and in people’s own homes by health professionals such as district nurses, general practice teams and hospice community staff. The LCP aims to take the principles of good quality hospice care into these other care settings.
Developed in Liverpool, UK, by internationally-renowned palliative care specialist Dr John Ellershaw in the late 1990s, it is now being used in about 500 centres across the United Kingdom, and has spread to several European countries, and now, New Zealand.
“The pathway is the vehicle that allows us to educate health professionals about communication, symptom control and issues related to palliative care. It guides and prompts them when caring for someone in the last days of their life.” Specific issues addressed by the pathway include symptom control, nursing care in the last days of life, prescribing of appropriate medication, spiritual, cultural and social issues, and communication with the families of patients.
A medication response pack is being developed so, if a patient develops symptoms in the middle of the night, the appropriate medication is available immediately.
“The LCP enables community health professionals to work together – the pharmacies, GPs, District Nurses – everyone involved in someone’s care. Under the LCP programme they all use the same documentation. The paperwork is very precise but also very concise, to enable people to spend the maximum time with the patient. It’s designed to enable health professionals to reflect on their practice and then build and develop it.”
The LCP is only introduced to a non-hospice setting when at least 80 percent of the healthcare professionals have received specialist training in its use. The Brightwater Centre in Palmerston North is the first rest home in New Zealand to implement the plan, under the guidance of Amanda and Arohanui Hospice’s palliative care nurse educator, Bridget Marshall. Approximately 96% of Brightwater staff (including nurses, care assistants and the chaplain) have undergone training.
Amanda says there has been a tremendous amount of enthusiasm for the LCP from Manawatu GPs, District Nurses, pharmacies and rest homes. Other New Zealand centres are also interested in learning more about the pathway, and implementing it in their areas. As a result Arohanui Hospice has launched a nationwide LCP news-letter to create a network of interested hospices, hospitals and health professionals and keep them up to date with developments.
Amanda’s role is to implement the LCP in five pilot sites in Manawatu: three aged care residential centres and two acute wards at Palmerston North Hospital. She is also working alongside the hospice research team to compare care of imminently dying patients before and after the LCP has been introduced. So far, the LCP has been implemented at Brightwater Centre, with the launch at the Horowhenua Masonic Village due next month. Full training and support is provided by hospice staff.
Amanda finds her job very satisfying. “What’s great about working at Arohanui Hospice is that we really do work as a team here. I’ve never worked in an environment where there’s so much support, and being able to tap into and work with so many skilled people is fantastic.”
“Your main tool is yourself and your nursing skills, so your communication with patients and their families is very important,” says Amanda.
