Case study:

23 January 2009

Implementing the Liverpool Care Pathway on a computer-based Clinical Information System in critical care in Papworth Hospital NHS Trust

Key points

An end of life care facilitator at Papworth Hospital NHS Trust has devised a computer-based care of the dying pathway within critical care.

The facilitator identified which requirements within the LCP goals were already being met on the Clinical Information System (CIS) for each patient. These pages were then linked to other information already entered on the CIS.

The remainder of the LCP has been split into three areas – the admission page where the doctor decides which interventions to keep, reduce or stop; the ongoing observations and comfort scoring page and the care after death page.

One of the biggest challenges has been persuading doctors to access the pages and enter the necessary information. To solve this it was decided that the pathway would be instituted whenever a patient had a DNAR order written up. When the doctor saves the DNAR page the computer automatically opens the pathway pages. There is also an information leaflet for doctors on how to complete the pathway.

The facilitator also visits the critical care area when a patient starts on the pathway to teach staff how to use it.In addition she teaches critical care area staff on an annual statutory and technical study day.

The pathway was implemented in April 2008 and teaching has been taking place since. A small-scale evaluation showed that some areas of the pathway were completed well while others still needed more work. There will be re-evaluation of this aspect in six months’ time.