Contacts
Contact:
Claire Woodland
Acting Older People's Project Manager
Organisation:
221 Erith Road
Bexleyheath Kent DA7 6EH United Kingdom
Tel:
0208 2986043
Email:
Case study:
11 May 2010
Organisational approach to introducing the Liverpool Care Pathway at a BUPA care home (nursing), Bexley
Key points
- Hospital admissions at the end of life have dropped sharply following the introduction of the LCP at a BUPA home in Bexley
- Staff feel more confident about discussing issues around death and dying and can counter requests for unnecessary treatment
- Some staff still find it difficult to recognise when a resident is dying
The number of residents who were being transferred to hospital to die in a BUPA nursing home in Bexley dropped sharply following the carefully managed introduction of the Liverpool Care Pathway (LCP).
Before the LCP was introduced, 67% of deaths occurred in the home and 32.5% in hospital.
But in the six months following implementation hospital deaths dropped to 21% and in the last six months they fell even further, to just 16%.
The new approach was partly the result of concerns expressed by the local A&E department about the number of residents being transferred from care homes (nursing) who then died within a few hours of admission.
Bexley Care Trust’s older people’s project team, together with the lead cancer nurse from Queen Mary’s Hospital Sidcup, prepared the ground for the change with meetings with the home manager and local GPs.
They also ran workshops for staff, produced resource folders for each unit and visited the home regularly to support the implementation.
Staff now feel confident about discussing issues around dying and the preferred place of care with residents.
They can also use the pathway to discuss spiritual issues more readily
They feel able to counter requests by the families for subcutaneous fluids by showing it is unnecessary and often contra-indicated.
At the same time they are better placed to ensure that those hospital admissions that do occur are appropriate.
Moreover, when a resident’s condition starts to deteriorate, staff can begin preparations earlier and so anticipate what might need to happen to prevent a hospital admission.
Implementation of the pathway has thrown up some challenges.
Staff can find it difficult to recognise when a resident is dying, for instance. Homes will only accept implementation on their own terms and their own pace.
So engaging with the care home manager, local GPs and district nurses at an early stage is vital. It is also crucial to identify a ‘champion’ within the home.
There are now plans to roll out the pathway to another large care home (personal care) in the area.
It has already been successfully implemented in a second BUPA home in the area.
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