Foreword |
|
xi | |
|
Contributors |
|
xv | |
Introduction |
|
xix | |
|
|
1 What about care pathways? |
|
|
1 | (14) |
|
|
|
|
|
|
1 | (1) |
|
The pathway history and definition |
|
|
2 | (1) |
|
Pathways as concept, model, process, and product |
|
|
3 | (8) |
|
Discussion and challenges for palliative care |
|
|
11 | (4) |
|
2 What is the Liverpool Care Pathway for the Dying Patient (LCP)? |
|
|
15 | (18) |
|
|
|
|
15 | (1) |
|
The LCP Continuous Quality Improvement Programme |
|
|
15 | (1) |
|
Care in the last hours or days of life |
|
|
16 | (1) |
|
Format and outline of the LCP |
|
|
17 | (1) |
|
What is variance reporting? |
|
|
17 | (1) |
|
Innovation and change model |
|
|
18 | (1) |
|
What is organizational governance? |
|
|
18 | (1) |
|
LCP generic version 12 document |
|
|
19 | (1) |
|
Diagnosing dying: the decision to commence the LCP to support care in the last hours or days of life |
|
|
20 | (2) |
|
How should the LCP be completed? |
|
|
22 | (8) |
|
|
30 | (3) |
|
3 Symptom control in care of the dying |
|
|
33 | (30) |
|
|
|
|
How can the Liverpool Care Pathway influence symptom control? |
|
|
33 | (3) |
|
How do you manage pain in the dying patient? |
|
|
36 | (4) |
|
How do you manage agitation in the dying patient? |
|
|
40 | (3) |
|
How do you manage nausea and vomiting in the dying patient? |
|
|
43 | (1) |
|
How do you manage respiratory tract secretions in the dying patient? |
|
|
44 | (1) |
|
How do you manage dyspnoea in the dying patient? |
|
|
45 | (2) |
|
What are the benefits of using a continuous subcutaneous infusion (CSCI) to deliver medication? |
|
|
47 | (4) |
|
Comfort measures in the last hours or days of life |
|
|
51 | (1) |
|
|
52 | (1) |
|
|
53 | (2) |
|
|
55 | (1) |
|
|
56 | (7) |
|
4 Ethical issues in care of the dying |
|
|
63 | (22) |
|
|
|
What is the moral justification for the Liverpool Care Pathway? |
|
|
63 | (1) |
|
How can the Liverpool Care Pathway for the Dying Patient influence ethical decision making? |
|
|
63 | (1) |
|
|
64 | (2) |
|
Withholding and withdrawing interventions and treatments at the end of life |
|
|
66 | (2) |
|
If there is a decision between a treatment that will prolong life and one that will only promote comfort, should the right action always be one that extends life? |
|
|
68 | (1) |
|
Cardiopulmonary resuscitation (CPR) |
|
|
69 | (2) |
|
Issues of hydration and nutrition |
|
|
71 | (2) |
|
|
73 | (1) |
|
Shortening and ending life: the doctrine of double effect and assisted dying |
|
|
74 | (3) |
|
Issues relating to capacity and decision making |
|
|
77 | (8) |
|
5 Communication in care of the dying |
|
|
85 | (22) |
|
|
What are the skills that facilitate communication? |
|
|
87 | (1) |
|
Blocking tactics that can hinder communication |
|
|
87 | (4) |
|
Are the patient and their family aware of the patient's deteriorating condition? |
|
|
91 | (1) |
|
|
91 | (3) |
|
Handling difficult questions |
|
|
94 | (2) |
|
|
96 | (1) |
|
Breaking bad news of a deteriorating condition |
|
|
96 | (2) |
|
Communicating with relatives |
|
|
98 | (1) |
|
Handling feelings and emotions |
|
|
99 | (1) |
|
Communicating with families who want to protect patients from the truth |
|
|
100 | (2) |
|
Cultural issues in communication |
|
|
102 | (1) |
|
The challenge of working with colleagues |
|
|
103 | (4) |
|
6 Spiritual/religious issues in care of the dying |
|
|
107 | (22) |
|
|
How can the Liverpool Care Pathway for the Dying Patient (LCP) influence religious and/or spiritual care? |
|
|
107 | (1) |
|
Is there a research base for spiritual care in palliative care? |
|
|
107 | (2) |
|
|
109 | (1) |
|
|
109 | (1) |
|
What about people who claim to be neither religious nor spiritual? |
|
|
110 | (1) |
|
When should we make the assessment? |
|
|
111 | (1) |
|
How can we assess this aspect of people's lives? |
|
|
111 | (2) |
|
What about the needs of different religious/faith groups |
|
|
113 | (11) |
|
What of the non-religious spiritual needs? |
|
|
124 | (1) |
|
Who should meet the needs assessed? |
|
|
125 | (1) |
|
|
126 | (3) |
|
7 Supporting family and friends as death approaches and afterwards |
|
|
129 | (16) |
|
|
|
129 | (2) |
|
|
131 | (1) |
|
Current risk management strategies |
|
|
132 | (3) |
|
Key considerations alongside risk factors |
|
|
135 | (1) |
|
What is involved in making an assessment? |
|
|
135 | (1) |
|
Preparing the family for the imminent death |
|
|
136 | (1) |
|
|
137 | (1) |
|
|
137 | (1) |
|
|
138 | (1) |
|
Saying goodbye and viewing the deceased |
|
|
139 | (1) |
|
|
140 | (5) |
|
8 Supporting children---as death approaches and afterwards |
|
|
145 | (12) |
|
|
The impact of bereavement upon children |
|
|
145 | (2) |
|
How do we help parents to help their children? |
|
|
147 | (2) |
|
Helping parents to talk to their children |
|
|
149 | (1) |
|
|
150 | (1) |
|
Being present and being involved |
|
|
150 | (1) |
|
|
150 | (1) |
|
|
151 | (1) |
|
|
151 | (1) |
|
Children's understanding of death |
|
|
152 | (1) |
|
|
152 | (1) |
|
Children need support to remember |
|
|
153 | (4) |
|
9 Induction and implementation of the Liverpool Care Pathway for the Dying Patient |
|
|
157 | (16) |
|
|
|
|
|
157 | (1) |
|
|
158 | (1) |
|
|
159 | (2) |
|
|
161 | (4) |
|
|
165 | (5) |
|
|
170 | (1) |
|
|
170 | (3) |
|
10 Dissemination and sustainability strategy for the LCP programme: incorporating a model for national audit for care of the dying |
|
|
173 | (16) |
|
|
|
National clinical audit in context |
|
|
175 | (1) |
|
The impact of national clinical audit |
|
|
175 | (2) |
|
NCDAH: driving up quality in care of the dying as part of a Continuous Quality Improvement Programme |
|
|
177 | (6) |
|
Key performance indicators (KPIs) |
|
|
183 | (3) |
|
LCP version 12 consultation exercise |
|
|
186 | (1) |
|
|
186 | (3) |
|
11 International development of the Liverpool Care Pathway for the Dying Patient (LCP) |
|
|
189 | (18) |
|
|
|
|
LCP International: setting the scene |
|
|
189 | (1) |
|
LCP international activity |
|
|
190 | (1) |
|
Phase 1 Induction---establishing the project and preparing the environment for organizational change |
|
|
191 | (6) |
|
|
197 | (1) |
|
|
198 | (3) |
|
|
201 | (2) |
|
Development of a State/Country/National LCP Office |
|
|
203 | (1) |
|
|
203 | (4) |
Appendix 1 The LCP core documentation and supporting information |
|
207 | (22) |
Appendix 2 Ongoing assessment of the plan of care (non inpatient setting) |
|
229 | (2) |
Appendix 3 Completed pathway |
|
231 | (22) |
Appendix 4 Coping with dying leaflet |
|
253 | (2) |
Index |
|
255 | |