Care pathway concerns must be challenged

[naomi24]

For Em, and anyone else rightly worried about this practice.

http://www.telegraph....ed-says-minister.html

[ethandron]

Yes naoimi, I know what the care pathway is and that is exactly what I was referring to.

[naomi24]

Really? I misunderstood you then.

[seadogg]

According to one of my girls, who is involved, its also about looking over ones shoulder as there a rapacious families out there with an eye on litigation if they can fabricate a case.

[naomi24]

Seadogg, I'm wondering if that adds weight to the evidence that this system does not offer the best care. If patients are treated as they should be treated, the chances of successful litigation must be pretty remote - so why do staff feel they need to look over their shoulders?

[ummmm]

I watched something yesterday but only caught some of it so can't post a link to it. According to the lady being interviewed her mother was put on the pathway. The family refused and fed/watered her themselves. She recovered.

Are they putting people on the pathway too soon?

If they are that's extremely sad. I know when my Dad was on his death bed he fought to stay alive until he seen all his siblings.

[naomi24]

Ummmm, I saw that. Can't remember where though.

[ummmm]

I've been googling. No luck though. Other people have claimed the same.

[Prudie]

I saw that story in the DM earlier this week. I can only say my mother was a totally independent intelligent driving 89 year who'd pass easily for 70. Monday she was fine and out and about, Tues in a coma from bacterial meningitis, Thursday put on the pathway, Sunday dead. A consultant even was crass enough to say near the end 'oh I didn't know she was still able to drive etc'

[NOX]

I'm sorry but this is a terrible thing by and large. If people are so ill, terminally so, then it should be their decision to end their life proactively not allow some team to make the decision for them ( as in Prudie's mother's cvase) and essentially starve and dehydrate someone to death.
Whilst Macmillan are a pretty worthwhile organisation their quote "food and drink aren’t necessary as their body no longer needs them" is an absolutely ludicrous statement, as chronic dehydration leads to amongst other things extreme pain, disorientation and panic- lovely way to go.
I would kill before anyone in my family was allowed on this monstrous route out of life.

[LazyGun]

Obviously the death of a family member or relative is going to be an emotive issue.

The purpose of the Liverpool Care Pathway was to develop best practice guidelines for the most dignified treatment in the final, irreversible phase of treatment in patients who had been deemed terminal.In such circumstances, nutrition or hydration is not wanted by the patient, and to insist on offering it deemed intrusive and undignified.That is not to say that hydration should be automatically withdrawn - a care team meeting should take that into account and offer IV hydration etc where appropriate.

Much of the recent concern have centred around the adoption of this care pathway into the general hospital environment - for the best of intentions, in an effort to offer the same level of dignity and best practice as offered in the hospices. This was also the reason for offering cash incentives as an inducement to health trusts to adopt the pathway.

Patients in a general hosptial environment will differ from those in a hospice environment however.Nursing and medical staff on a busy general hospital ward may well have less training, time and experience to determine whether a patient is actually in the terminal,irreversible phase of their illness and that lack of training, experience and time will have contributed to some patients incorrectly being placed on the pathway.

Another, persistent issue that the Health Service urgently needs to address is the often abysmally poor and often insensitive communication between healthcare professionals and patients and/or relatives and carers- This applies across the board, in all areas of healthcare, but is obviously especially important here.

And in hindsight, it was possibly not the wisest idea to offer cash incentives in an area that was fraught with so many potential landmines.

I have included some references which detail what exactly the care pathway is - it may help people better understand the purpose and the stages of the pathway itself.


http://www.mcpcil.org...CP-Briefing-Paper.pdf

http://www.liv.ac.uk/...n_FINAL_(Example).pdf

[emmie]

i am worried as you know, seeing this sort of thing in action. I would hope that you don't have to see off your loved ones in such distress as being denied food or water, you wouldn't or shouldn't treat a dog like that.

[emmie]

what upsets me the most is if the person isn't terminally ill, as we have seen from some of these reports from relatives, the medical profession should hang it's head in shame if so.

[Euphemia]

Well, as a cancer patient with no way back, I shall welcome the easing of my exit in any way, short of "a chap on the heid". What is paramount is the best for my family. At the moment I am receiving excellent care from the hospital, my GP and my Marie Curie specialist nurse who are ensuring that for the moment my life quality is good with little or, as the case currently, no pain.

[pdq1]

I'd never believe constitutional murder would happen in a country like England!

[pdq1]

'institutional murder' would be a better phrase

[boxtops]

re an early post - the Liverpool Care Pathway's not new, they were using it in the hospice when I worked there in the mid-1990s.

[naomi24]

Boxy, it's changed since then. That's what this is all about.