Case study:

01 July 2010

A step-wise approach to the quality implementation and sustainable use of the Liverpool Care Pathway in care homes within Northamptonshire

Key points

Northamptonshire NHS Provider Services have developed a step-wise approach to using the Liverpool Care Pathway in care homes with the aim of supporting staff in its use and ensuring it becomes embedded in practice.

The process involves training for most staff in advance of implementation as well as debriefing and ongoing support once in operation. In addition care homes are encouraged to participate in the LCP Reflective Data Cycle to ensure quality is maintained and improved.

In February 2010 14 of the care homes registered with the LCP project reported a total of 27 deaths with 19 having their care supported through the LCP, representing 70% usage.

The process begins with a meeting between the LCP project team and the care home to discuss the implementation process and the commitment required from the home. One condition is that at least 80% of staff must be educated about the LCP before the document can be launched. If this is not met, the launch will be delayed. So far the target of 80% has always been achieved and generally exceeded.

Once the care home has committed to the project it will agree an implementation strategy. A baseline review audit will then be completed and all staff will be informed by letter of what is happening. This will be followed by process mapping for obtaining medication and a review of local practice and policies. A four-week education programme precedes the launch of the LCP with at least 80% of staff expected to attend at least one 1.5 hour session. Sessions are also offered to the multidisciplinary team if required.

Finally, a resource file is created containing all the necessary documentation and information about the LCP.

Once the LCP is in operation staff are offered debrief sessions. The General Practice team, Specialist Palliative Care team and LCP facilitator are also on hand to provide ongoing support. In addition two nurses from the care home will be identified as LCP link nurses and will attend bi-monthly meetings with other link nurses.

The LCP team has developed several strategies to ensure the LCP is sustained. These include facilitated reflective debriefs before the LCP is put into use, embedding the LCP within the home’s clinical governance structure and encouraging staff to participate in the LCP Reflective Data Cycle ( See LCP Reflective Data Cycle case study).

In the future the LCP team plans to formalise the four phases of the LCP implementation to help homes identify which stage they have reached in the process. This will also acknowledge those homes that are truly participating in the project and enable them to capitalise on the development and educational opportunities that the LCP can provide.