Case study:

01 December 2010

Liverpool Care Pathway for dementia patients in the Evington Centre, University Hospitals of Leicester

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Key points

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The palliative care team at Leicester University Hospitals has produced an adapted version of the Liverpool Care Pathway (LCP) for dementia patients with the aim of ensuring they die where they wish and their symptoms are controlled more sensitively.

The initiative started when the team began receiving an increasing number of requests from staff at the Evington Centre, a mental health unit for older people adjoining Leicester General Hospital, to provide advice on support for palliative and dying patients.

Many of the issues revolved around the needs of patients with dementia in their last days and hours. It became clear there was disparity between the skills and knowledge of the mental health nurses who were caring for these patients and the end of life care skills needed to nurse patients in their final days.

It was also clear the generic LCP did not cater for all the needs of people with dementia – or for the staff caring for them. So with help from the Palliative Care Hospital Specialist Team, the Mental Health Trust, the Practice Development Facilitators Team based at LOROS and various health and allied healthcare professionals an adapted version was produced to accommodate some of the specialist needs of dementia patients.

This included a section which indicated the individual’s preferred place of care and place of death. There were also changes relating to specific needs such as communications and spirituality.

In addition changes have been made to the medication and pain control sections of the pathway. The adapted LCP suggests, for instance, that staff might consider controlling pain through pain relief patches rather than administering drugs via a syringe.

At the same time the practice development facilitator team from LOROS has developed a ‘bite-size’ teaching programme, which covers all elements of the LCP, to ensure a holistic approach to the process and documentation.

The local adaptations to the generic LCP version 12 have now been sanctioned as compliant by the Marie Curie Institute for Palliative Care and will as a result be part of the next national audit, expected in May 2011.

The team has recruited around 40 end of life care advisers from Evington Centre as well as the acute hospital who will help spread the message about the LCP to all staff involved in end of life care.

In the last year the number of patients at University Hospitals of Leicester placed on the LCP has almost doubled, from 399 in 2008-9 to 793 in 2009-10. The team has also helped ensure that patients on the LCP can be transferred more seamlessly into the community.

The aim now is to embed the LCP not only in Evington Centre but also in the main hospital where many patients with dementia are still dying.

The project, which has been funded by the East Midlands Workforce Deanery, is due to be completed by April/May 2011.

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