Liverpool Care Pathway: A National Scandal: Liverpool Care Pathway

Shaun Lintern's twitterview with UK nurses which took place yesterday on NurChat is here...

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The point to make that is so oft dismissed, simply because it is too shocking to consider is this -

The Liverpool Care Pathway has, for the past few years, been used to manage patients 'diagnosed' as dying but not necessarily 'dying'. The LCP has not only been misused; it has also been misapplied. The former is misadventure or manslaughter. The latter is murder.

This is NurChat -

The full transcript of the online debate that took place on Twitter and contained the hashtag #NurChat is at NurChat20/08/13 – The Liverpool Care Pathway.

Copied here is some of the conversation which includes tweets without the hashtag and won't be in the transcript above...

‏@NurChat

"Let's get going....How do you feel about the recomendation the LCP should be abolished? #NurChat"

‏@LeggeAngie

"@NurChat Sad. I think used properly, the LCP is a great way of caring for the dying. Wished my Aunt had been placed on it. #NurChat"

‏@matthewvanloo

"@NurChat Poor decision driven by media #NurChat"

‏@RebeccaLouiseUK

"@matthewvanloo @NurChat totally agree! Media have totally taken it out of context #NurChat"

‏@ShaunLintern

"Yes Gov review recommended the LCP be abolished but in reality the care plans suggested may end up being the LCP in all but name#NurChat"

‏@gina_L_M

"@NurChat very anxious and sad. I think it will leave inexperienced hospital staff with even fewer resources and less support #Nurchat"

‏@matthewvanloo

"@gina_L_M @NurChat That was the problem the LCP tried to address, a tool that gives junior staff confidence in their decisions#NurChat"

‏@DonnaNewcross

"@matthewvanloo @gina_L_M That's exactly why I found it useful. Especially newly qualified Dr's with little experience #nurchat"

‏@matthewvanloo

"@DonnaNewcross @gina_L_M While we talk about senior staff involved in EOL care, the reality is it falls to junior medics often#NurChat"

‏@cllrfay

"@NurChat sad, I liked LCP found it helpful in explaining to family & ensuring consistency of care #nurchat"

‏@JFr4ser

"The LCP is a document, nothing more or less. It's founding principles will continue until time dilutes memory #nurchat"

‏@cathtayloruclan

"Problem with any pathway is there's temptation for practitioners to avoid creativity & stick to plan. Rules out individual care #NurChat"

‏@ShaunLintern

"The problem with the LCP was with poor implementation in sadly too many places. But LCP itself was not a problem. #NurChat"

‏@mybike321

"@ShaunLintern it shouldn't have been poorly implemented as there is a standard checklist to work through #lcp #NurChat"

‏@ShaunLintern

"@mybike321 But it was. And there can be no denial of that. But that is an issue with those individuals rather than the LCP. #NurChat"

‏@swayoung01

"@NurChat poor decision and not evidence based but we need now to ensure that it's "replacement" does the best for our PTs#Nurchat"

‏@ShaunLintern

"But Gov review was right to highlight the fact LCP did not have evidence base behind it. But neither do the replacement care plans#NurChat"

‏@JFr4ser

"It's very easy in hospital to continue to treat reversible things at EoL when harms (pain/distress) out-way the benefit. LCP needed#nurchat"

‏@RebeccaLouiseUK

"-ve it can sometimes reduce individual care planning. +ve it gives focus and confidence to nurses #nurchat"

‏@cathtayloruclan

"It's not just staff it should give confidence too though. Pts & families too but media have destroyed that now #nurchat"

‏@MsNaughtyCheese

"@NurChat i've seen it used wonderfully in Intensive Care & been involved in a fascinating study #NurChat"

‏@MsNaughtyCheese

"@NurChat team discussing well with family, involving palliative care/pain team & individualising the care plan #NurChat"

‏@ShaunLintern

"Yes media was hysterical over LCP but the review did identify some worrying behaviour. All NHS staff should think hard about that.#NurChat"

‏@cllrfay

"@NurChat I received training on LCP was able to ask if unsure and felt confident using it, all a bit uncertain again now :-/ #nurchat"

‏@mybike321

"@NurChat we received a days training on #lcp #NurChat"

‏@mybike321

"@NurChat I think it was sufficient enough, have now worked with it since 2007"

‏@SKasaven

"@NurChat I've seen LCP used very professionally on older MH wards, good support from palliative care team giving training/advice#NurChat"

‏@ShaunLintern

"Training in some places was poor for staff using the LCP. Review found some examples of just an hour and OK to miss it. #NurChat"

‏@MsNaughtyCheese

"How did the LCP become "gold standard" if not evidence based? #NurChat"

‏@ShaunLintern

"@NurChat @MsNaughtyCheese It became adopted as best practice following the use of similar methods in Marie Curie Hospices.#NurChat"

‏@JFr4ser

"@NurChat @MsNaughtyCheese Because opiates in death have been accepted for centuries plus some presumed physiology"

‏@MsNaughtyCheese

"@JFr4ser @NurChat accepted & presumed? Thats not evidence base, agree evidence (& sense) for each part but not the whole?#NurChat"

‏@ShaunLintern

"Many of poor care issues raised with LCP review mirror what I heard at #MidStaffs inquiry. It was about wider issues at play in NHS#NurChat"

‏@bobjbrown

"@shaunlintern I don't see the link between #MidStaffs and the #LCP - the first was about neglect and poor standards the second communication"

‏@ShaunLintern

"@bobjbrown Read the review. They found lots of similar issues and actually sited #MidStaffs many times in report."

‏@bobjbrown

"@ShaunLintern have done - #LCP poor care issues were media hyped, with the many benefits and good examples diluted and public confused."

‏@DrShirleyLock

"I wonder if public perceptions about death and lack of understanding of the dying process played a part in the outcry? #Nurchat"

‏@ShazzaHudson

"@DrShirleyLock Without question. The biggest concern of families was 'dying of thirst' little understanding of normal dying process#nurchat"

‏@ShaunLintern

"A question from me...now we know there were issues with LCP, was the media right to highlight it, even if it went OTT? #NurChat"

‏@matthewvanloo

"@ShaunLintern Its a shame the problems were highlighted through the media, and these problems were not highlighted at local levels#NurChat"

‏@TildaMc

"@ShaunLintern Doubt DM stories were all true .Call me paranoid but have little faith in British printed media. So no #NurChat"

‏@ShaunLintern

"@TildaMc But what about the findings of the Gov review? Found lots of very poor practice and behaviour. #NurChat"

‏@DonnaNewcross

"@ShaunLintern Yes I believe so but in a more constructive way. Get rid of the scaremongering headlines like pathway to death#nurchat"

‏@ShaunLintern

"@DonnaNewcross Yes I think the same. Media could have acted more responsibly but still the issues needed highlighting. #NurChat"

‏@gina_L_M

"@ShaunLintern yes, it was right to report on the issues as raised by families affected. Poor care nexcusable at any phase of life#NurChat"

‏@nedwards_1

"@ShaunLintern They started OTT. They tarred all use of the LCP with the same brush. They failed to highlight the real issues. Total fail"

‏@ShazzaHudson

"@ShaunLintern No, should have been highlighted to professional bodies. Enormous damage has been done. Families fear good pall care #nurchat"

‏@acorns47

"Is anyone working with a modified ICP? #nurchat"

‏@ShazzaHudson

"@acorns47 Always have locally, extended beyond 48 hrs to weeks/months using same principles #nurchat"

‏@matthewvanloo

"Should specialists in EoL care be involved with all patients in the palliative stage of their illness? #NurChat"

‏@ShazzaHudson

"@matthewvanloo Not enough resource for ALL dying pts. It's why tools were established to guide all professionals in best practice#nurchat"

‏@david_dwlewis

"What I do disagree with is the paper exercise of it though - filling in without fully checking the patient #NurChat"

____________________________________________

Copied here, in the public interest, is the full transcript published by Nurchat at the link above -

NurChat transcript – The Liverpool Care Pathway

Please read from the bottom for full chronological order.

Shaun Lintern ‏@ShaunLintern 1m
If you want some guidance on how to care for people here is latest from NHS England after the LCP review: http://www.ncpc.org.uk/sites/default/files/Guidance_for_doctors_and_nurses%20_Liverpool_Care_Pathway.pdf … #NurChat

Gerry Bennison ‏@AlresfordBear 2m
@JogreenJo @NurChat Depends whether or not they are upheld

#NurChat

NurChat ‏@NurChat 2m
@princessandtoad

David Lewis ‏@david_dwlewis 2m
@NurChat @ShaunLintern I would hope not!

NurChat ‏@NurChat 2m
Thank you everyone for joining #NurChat and sharing your experience & knowledge. Please feel free to carry on #NurChatting

Sharon Hudson ‏@ShazzaHudson 2m
@acorns47 Always have locally, extended beyond 48 hrs to weeks/months using same principles #nurchat

Angela Legge ‏@LeggeAngie 2m
@david_dwlewis That’s an issue with all tools. They need to be treated as an aide for working with the patient – not tick box #NurChat

Donna Mullikin RN ‏@DonnaNewcross 2m
@ShaunLintern No but it will be harder to empower junior Dr’s to change treatment without it #nurchat

kim pascoe ‏@acorns47 2m
@cathtayloruclan @DonnaNewcross @ShazzaHudson but who is checking up on it? #nurchat

tilda mc crimmon ‏@TildaMc 3m
@LeggeAngie @MsNaughtyCheese @ShazzaHudson @JFr4ser Think most teams shouldn’t need specialist except in exceptional cases #nurchat

NurChat ‏@NurChat 3m
RT @ShaunLintern: Will you change the way you care for people at the end of their life without the LCP? #NurChat

David Lewis ‏@david_dwlewis 3m
What I do disagree with is the paper exercise of it though – filling in without fully checking the patient #NurChat

Sharon Hudson ‏@ShazzaHudson 3m
@NurChat Communication, advance planning, collaboration, spiritual and psychological support, individualised symptom management #nurchat

Shaun Lintern ‏@ShaunLintern 3m
@cathtayloruclan @nedwards_1 It is what worries me too #NurChat

Kelly Owen ‏@Kelly_M_Owen 3m
@pinksparklegirl @ShaunLintern @acorns47 yes, I think so too.. #nurchat

rebecca ‏@MsNaughtyCheese 4m
@mybike321 @katemasters67 @DonnaNewcross sorry I meant things like continuing treatment etc tough for pt & team? #NurChat

littlemissminion ‏@princessandtoad 4m
@NurChat #NurChat we all know it will just be renamed and modified slightly and reused… Just like everything else in #nhs

gina_LM ‏@gina_L_M 4m
@NurChat yes but not because of the pathway, every family is different so my practice is different every time #NurChat

Dr ShirleyLockeridge ‏@DrShirleyLock 4m
@matthewvanloo I wonder this particularly people with dementia where things like pain assessment are more complex #Nurchat

Gerry Bennison ‏@AlresfordBear 4m
@gina_L_M And shaping for political gain

#nurchat

Jo green ‏@JogreenJo 4m
The principles surely remain the same, lcp or no lcp document #nurchat

kim pascoe ‏@acorns47 5m
@MsNaughtyCheese @ShaunLintern its only unrealistic if nurses not trained experiencd empowerd & no urgent back up #nurchat

Shaun Lintern ‏@ShaunLintern 5m
Will you change the way you care for people at the end of their life without the LCP? #NurChat

rebecca ‏@MsNaughtyCheese 5m
.@DrShirleyLock I think so we just don’t talk about it, but also sign that LCP was not used to talk about dying wishes as should #NurChat

tilda mc crimmon ‏@TildaMc 5m
@matthewvanloo @ShaunLintern Agree if areas of poor practise unlikely to only be with LCP. #nurchat

Newcross Health ‏@NewcrossHealth 5m
RT @nurchat: Lastly…Will you change the way you care for people EOL without the LCP? #NurChat ?

Sharon Hudson ‏@ShazzaHudson 5m
@ShaunLintern No, should have been highlighted to professional bodies. Enormous damage has been done. Families fear good pall care #nurchat

Matthew Van Loo ‏@matthewvanloo 5m
Should specialists in EoL care be involved with all patients in the palliative stage of their illness? #NurChat

Donna Mullikin RN ‏@DonnaNewcross 6m
@david_dwlewis Neither do I. I believe it plays a fantastic tool in end of life care #NurChat when used appropriately

kim pascoe ‏@acorns47 6m
@cathtayloruclan @DonnaNewcross @ShazzaHudson After all hoohaa you’d have thought m’ment be on our backs to ensure care done well #nurchat

Shaun Lintern ‏@ShaunLintern 6m
The LCP and the problems identified in its use came back to lots of the things seen at #MidStaffs. Need to think bigger picture. #NurChat

NurChat ‏@NurChat 6m
Lastly…Will you change the way you care for people EOL without the LCP? #NurChat ?

Cath Taylor ‏@cathtayloruclan 7m
@ShaunLintern @DonnaNewcross you didn’t implement it correctly is fundamentally wrong. #nurchat

tilda mc crimmon ‏@TildaMc 7m
@MsNaughtyCheese @acorns47 @ShaunLintern It costs just as much in Scotland don’t need finacial rewards/penalties. #NurChat

Ian Ireland ‏@IanIreland 7m
@Fran52notout @NurChat Thank you

Angela Legge ‏@LeggeAngie 7m
@MsNaughtyCheese @ShazzaHudson @JFr4ser Pain control is a specialist area of its own. #NurChat

Fran S ‏@Fran52notout 7m
@IanIreland @NurChat Well said #NurChat

Shaun Lintern ‏@ShaunLintern 7m
@nedwards_1 I agree Nigel. The issue was not the LCP itself but the individual behaviours of some drs and nurses. #NurChat

kim pascoe ‏@acorns47 7m
@JFr4ser Yes, cant wait till monday am. Need immediate assessment to ensure symptoms minimised n e’rybody supported #nurchat

Andrea Evans ‏@Andie_E 8m
@NurChat The freedom for the dying patient to eat and drink whatever they like – risks accepted. #whatshouldbekeptfromLCP

rebecca ‏@MsNaughtyCheese 8m
@ShazzaHudson @JFr4ser @LeggeAngie pain can change, worson/improve etc, as with all LCP aspects need regular review & flexibility #NurChat

Linda Buchan ‏@lybuchan 8m
@NurChat Collaboration of all the care team and inclusion of patients and relatives where possible. Good symptomatic relief

Donna Mullikin RN ‏@DonnaNewcross 8m
@cathtayloruclan @acorns47 @ShazzaHudson Pathway not to blame just the individual

#nurchat

Matthew Van Loo ‏@matthewvanloo 8m
@ShaunLintern @TildaMc Changing the pathway won’t address this. The cause for this behaviour needs to be indentified & addressed #NurChat

kevin dodsworth ‏@mybike321 8m
@MsNaughtyCheese @katemasters67 @donnanewcross every case I’ve been involved in has been tough #lcp #NurChat

David Lewis ‏@david_dwlewis 8m
@ShaunLintern @NurChat individual care plans and treat everyone as a person are surely different issues though?

littlemissminion ‏@princessandtoad 8m
@NurChat #NurChat it used correctly and people not be afraid to use it….

gina_LM ‏@gina_L_M 8m
@NurChat emphasis on communication at all stages and a focus on getting the basics right for that pt and family #NurChat

Shaun Lintern ‏@ShaunLintern 8m
@DonnaNewcross Yes I think the same. Media could have acted more responsibly but still the issues needed highlighting. #NurChat

Sharon Hudson ‏@ShazzaHudson 8m
@DrShirleyLock Without question. The biggest concern of families was ‘dying of thirst’ little understanding of normal dying process #nurchat

Jools ‏@juliejo52553859 9m
Dying should be openly talked about especially with those at end stage of their disease #NurChat

tilda mc crimmon ‏@TildaMc 9m
@DonnaNewcross @david_dwlewis Yes , supports good care. #NurChat .

NurChat ‏@NurChat 9m
@cathtayloruclan Good question! #nurchat

Ian Ireland ‏@IanIreland 10m
@NurChat Common sense! #NurChat

kim pascoe ‏@acorns47 10m
Is anyone working with a modified ICP? #nurchat

Donna Mullikin RN ‏@DonnaNewcross 10m
@JFr4ser @acorns47 yes all members of MDT #nurchat

Gail Mcadam ‏@mcadam_gail 10m
Papers sometimes reflect on negatives but surely there was some positives #nurchat

Jools ‏@juliejo52553859 10m
@DrShirleyLock I agree that there is not enough awareness especially with people surviving longer with end stage illnesses. #NurChat

Rae Webster ‏@tcbtttc 10m
@Kelly_M_Owen @ShaunLintern @Pathway2Death @NHS_HCA Well ours was for the discussion…#nurchat

Shaun Lintern ‏@ShaunLintern 10m
@TildaMc But what about the findings of the Gov review? Found lots of very poor practice and behaviour. #NurChat

Joanne Fraser ‏@JFr4ser 10m
@DrShirleyLock Without a doubt. Plus it’s use in non-cancer EoL where appreciation of time-limiting diagnosis is less #Nurchat

gina_LM ‏@gina_L_M 10m
@ShaunLintern yes, it was right to report on the issues as raised by families affected. Poor care nexcusable at any phase of life #NurChat

NurChat ‏@NurChat 10m
What initiatives would you like to see used from the LCP in the future and why? #NurChat

Donna Mullikin RN ‏@DonnaNewcross 11m
@ShaunLintern Yes I believe so but in a more constructive way. Get rid of the scaremongering headlines like pathway to death #nurchat

Cath Taylor ‏@cathtayloruclan 11m
@acorns47 @DonnaNewcross @ShazzaHudson might have issues but reinforces accountability no?! #nurchat

tilda mc crimmon ‏@TildaMc 11m
@ShaunLintern Doubt DM stories were all true .Call me paranoid but have little faith in British printed media. So no #NurChat

Shaun Lintern ‏@ShaunLintern 11m
@juliejo52553859 @NurChat Do you mind telling us where that is? #NurChat Are there more like this? #worrying

Matthew Van Loo ‏@matthewvanloo 11m
@ShaunLintern Its a shame the problems were highlighted through the media, and these problems were not highlighted at local levels #NurChat

Sharon Hudson ‏@ShazzaHudson 11m
@MsNaughtyCheese @JFr4ser @LeggeAngie Pts at EOL should have been on an appropriate analgesic regime before EOL. LCP a guide only #nurchat

kim pascoe ‏@acorns47 12m
@DonnaNewcross @ShazzaHudson So sillyness is that no LCP now but whos checking process/documentation now? Apart from RN that is. #nurchat

Shaun Lintern ‏@ShaunLintern 12m
@david_dwlewis @NurChat The Review calls for locally developed individual care plans for each patient. #NurChat

Donna Mullikin RN ‏@DonnaNewcross 12m
@david_dwlewis Goes without saying. Do we need a framework to tell us what to do though for end of life care? #nurchat

rebecca ‏@MsNaughtyCheese 12m
@mybike321 @katemasters67 @DonnaNewcross really? Any cases where this was tough for the patient or team? #NurChat

gina_LM ‏@gina_L_M 12m
@DrShirleyLock undoubtedly, it’s a huge part of my role in EoL care in the hospice to educate families about what is happening #NurChat

Cath Taylor ‏@cathtayloruclan 13m
We who are experienced nurses are we hanging onto our perception of our best practice? Are there viable up to date alternatives? #NurChat

Joanne Fraser ‏@JFr4ser 13m
@DonnaNewcross @acorns47 Argument they are de-skilling across the board, particularly jnr drs. Must be wary of such effect #Nurchat

Nichola Baker ‏@nicb188 13m
@NurChat @alisonleary1 Does the LCP hype reflect societies fear of dying? It all comes back to communication and education #NurChat

Shaun Lintern ‏@ShaunLintern 13m
A question from me…now we know there were issues with LCP, was the media right to highlight it, even if it went OTT? #NurChat

tilda mc crimmon ‏@TildaMc 13m
@juliejo52553859 @NurChat Being reviewed in Scotland . #nurchat

David Lewis ‏@david_dwlewis 13m
Every Nurse should have care and compassion for their patients anyway – that’s an NMC standard #NurChat

Dr ShirleyLockeridge ‏@DrShirleyLock 14m
I wonder if public perceptions about death and lack of understanding of the dying process played a part in the outcry? #Nurchat

tilda mc crimmon ‏@TildaMc 14m
@MsNaughtyCheese @acorns47 @ShaunLintern Why in England id financial motive so strong? #nurchat

Fran S ‏@Fran52notout 14m
@acorns47 @ShaunLintern @MsNaughtyCheese I agree and clinicians incentive always to be what is best for client as first priority #NurChat

rebecca ‏@MsNaughtyCheese 14m
@ShazzaHudson @JFr4ser @LeggeAngie many analgesics & routes for the many types of pain, shouldn’t limit focus to morphine #NurChat

Kelly Owen ‏@Kelly_M_Owen 14m
@pinksparklegirl @ShaunLintern @acorns47 I agree,I know my patients and know what they need LCP should still be used as framework #nurchat

Jools ‏@juliejo52553859 14m
@NurChat yes it’s removed. No alternative #NurChat

Sharon Hudson ‏@ShazzaHudson 15m
@NurChat Was at Pall Care Conference that day, huge discomfort at knee jerk decisions and abandonment. Chief Execs make decisions for safety

rebecca ‏@MsNaughtyCheese 15m
@ShazzaHudson @JFr4ser @LeggeAngie i’ve seen it exacerbate asthmatic patient & that was horrible for the family #NurChat

Donna Mullikin RN ‏@DonnaNewcross 15m
@JFr4ser @acorns47 Very true sadly. Deskilled a lot of nurses #nurchat

kevin dodsworth ‏@mybike321 15m
@katemasters67 @donnanewcross @msnaughtycheese the #lcp would not be commenced without family/carer discussion having taken place #NurChat

Joanne Fraser ‏@JFr4ser 15m
@MsNaughtyCheese @LeggeAngie Im aware of all of that but ultimately at very EoL the basics are usually most cost-effective #Nurchat

Shaun Lintern ‏@ShaunLintern 15m
@acorns47 @MsNaughtyCheese But how, in a finance driven NHS, do you spread what you believe is good practice? #NurChat

David Lewis ‏@david_dwlewis 15m
What is the alternative to LCP? #NurChat

NurChat ‏@NurChat 15m
Has the LCP already been removed in your area of work? What are you using as an alternative? #NurChat

Mrs S ‏@moodomsmum 15m
@NewcrossHealth @mcadam_gail surely in £ strapped NHS more cost effect to tweak,improve, & train than abolish & start again #nurchat

rebecca ‏@MsNaughtyCheese 16m
@acorns47 @ShaunLintern why shouldn’t hospitals be rewarded for correctly using best practice? Money could be spent on training? #NurChat

Matthew Van Loo ‏@matthewvanloo 16m
@ShaunLintern @NurChat @alisonleary1 leading to variations in care > postcode lottery #NurChat

Cath Taylor ‏@cathtayloruclan 16m
@Kelly_M_Owen but that’s not a LCP problem, that’s anissue of poor comm skills contributing to poor decision making #nurchat

kim pascoe ‏@acorns47 17m
@JFr4ser @NurChat Totally agree with this . Deskilled RNS all round #nurchat

Emma Taylor ‏@pinksparklegirl 17m
@Kelly_M_Owen @NurChat @ShaunLintern @acorns47 the principles of care shouldn’t be any different though #NurChat

gina_LM ‏@gina_L_M 17m
@mcadam_gail they don’t make good stories and families (rightly) will pursue avenues more aggressively in cases of poor care #NurChat

Donna Mullikin RN ‏@DonnaNewcross 17m
@mcadam_gail Good stories don’t sell papers

#nurchat

David Lewis ‏@david_dwlewis 17m
Personally I don’t think good nurse differs in the care provided – LCP or not #NurChat

Kelly Owen ‏@Kelly_M_Owen 17m
@pinksparklegirl @NurChat @ShaunLintern @acorns47 I’m finding this too.. Meanwhile dying patients still need us! #nurchat

Shaun Lintern ‏@ShaunLintern 18m
@NurChat @alisonleary1 I suspect in truth each trust will develop their own mini-LCP effectively. #NurChat

Linda Buchan ‏@lybuchan 18m
@NurChat @alisonleary1 I don’t think we nurses made our voices heard enough. It had problems, we could’ve worked on them.

Donna Mullikin RN ‏@DonnaNewcross 18m
@acorns47 @ShazzaHudson That us what is scary now. If no guidelines in use #nurchat

Matthew Van Loo ‏@matthewvanloo 18m
@NurChat @alisonleary1 Yes. Daily Wail et al driven hype with little substance. #NurChat

Cath Taylor ‏@cathtayloruclan 18m
@DonnaNewcross @ShaunLintern does that say more about what clinicians think about how they’re perceived than doing right thing?! #nurchat

Shaun Lintern ‏@ShaunLintern 18m
@NurChat @alisonleary1 Review said it should be abolished to make way for individual care plans. Focus on the individual patient. #NurChat

kim pascoe ‏@acorns47 18m
@ShaunLintern @MsNaughtyCheese Simple solution is to get rid of incentives #nurchat

Gail Mcadam ‏@mcadam_gail 19m
What happened to the times it has been used properly and worked #nurchat

rebecca ‏@MsNaughtyCheese 19m
@JFr4ser @LeggeAngie huge world of analgesia out there to choose from though as many types of pain #NurChat

Kelly Owen ‏@Kelly_M_Owen 19m
In almost half of cases neither patients nor family were informed or consulted that it was decided to place the patient on the LCP.#nurchat

Shaun Lintern ‏@ShaunLintern 19m
@gina_L_M @acorns47 @MsNaughtyCheese @mybike321 Yep the review agreed with you. #NurChat

kim pascoe ‏@acorns47 19m
@ShazzaHudson @NurChat Nurses left with no guidelines . Stupidity which will bite someone on the btm #nurchat

gina_LM ‏@gina_L_M 19m
@AlresfordBear yes as with all communication both side are open to interpretation and contextual issues #NurChat

NurChat ‏@NurChat 20m
Q from @alisonleary1 Why has the LCP been abolished? How has EBP been overturned by the media? #NurChat

Shaun Lintern ‏@ShaunLintern 20m
@MsNaughtyCheese @acorns47 Unrealistic and unlikely you could evidence that in every case. #NurChat

Donna Mullikin RN ‏@DonnaNewcross 20m
@pinksparklegirl @ShaunLintern @acorns47 Interesting #nurchat

Kelly Owen ‏@Kelly_M_Owen 20m
@ShaunLintern @tcbtttc @Pathway2Death @NHS_HCA It should not differ.. Commissioner/postcode/trust.. Although I’m sure it does! #nurchat

tilda mc crimmon ‏@TildaMc 21m
@ShazzaHudson @NurChat @acorns47 Yep could have been good news story about people recovering following good care #nurchat

Shaun Lintern ‏@ShaunLintern 21m
@NurChat @acorns47 This is the danger of throwing it open to local process. Some will be good some will be bad. #NurChat

gina_LM ‏@gina_L_M 21m
@ShaunLintern @acorns47 @MsNaughtyCheese @mybike321 is the biggest cause of issues in general I’d wager #NurChat

Mrs S ‏@moodomsmum 21m
@NurChat did review find differences in +ve/-ve experiences in different specialities or areas with increased frequency of use

Emma Taylor ‏@pinksparklegirl 21m
@NurChat @ShaunLintern @acorns47 once it was made public we had no option, no consultant would touch it #NurChat

Gerry Bennison ‏@AlresfordBear 22m
@gina_L_M Depends on the how the individual is considered by the interpreting individual #NurChat

rebecca ‏@MsNaughtyCheese 22m
.@acorns47 @ShaunLintern could the payment system be altered so that clinicians must prove they used it well/appropriately? #NurChat

tilda mc crimmon ‏@TildaMc 22m
@ShazzaHudson @matthewvanloo @JFr4ser Would disagree as do not have to consider addiction/abuse ability to work #nurchat

Donna Mullikin RN ‏@DonnaNewcross 22m
@mybike321 @MsNaughtyCheese No neither have I. But does this come down to the persons training? #nurchat

Joanne Fraser ‏@JFr4ser 22m
@acorns47 @NurChat Probably because we created a specialist nurse culture and eroded basic level of competence (in many things not just EoL)

Jo green ‏@JogreenJo 22m
@WeNurses we used a modified version but I now write my careplan to relect the principles of the lcp #nurchat

Sheila kasaven ‏@SKasaven 22m
@NurChat @acorns47 have to sensible &still use principles of LCP + good support, shared care when required &responsible clinician #NurChat

Shaun Lintern ‏@ShaunLintern 22m
.@acorns47 @MsNaughtyCheese @mybike321 Communication or lack of with families was biggest cause of issues over LCP. #NurChat

gina_LM ‏@gina_L_M 23m
@AlresfordBear discussion with pt (if poss) & family is integral to all the LCP documentation/guidance I’ve seen #NurChat

Sharon Hudson ‏@ShazzaHudson 23m
@ShaunLintern @NurChat @MsNaughtyCheese The same model.

Angela Legge ‏@LeggeAngie 23m
@AlresfordBear Great! My Aunt didn’t make it onto LCP. She died in hospital – but wanted to die at home #NurChat

rebecca ‏@MsNaughtyCheese 23m
@NewcrossHealth @bennettschris5 my experience too, we also individualise the framework & revise the tool from feedback regularly #NurChat

Sharon Hudson ‏@ShazzaHudson 23m
@NurChat @acorns47 Because of public perception. Fear of litigation. The Daily Mail has a lot to answer for #nurchat

kevin dodsworth ‏@mybike321 23m
@MsNaughtyCheese never had any relatives disagree #NurChat

Joanne Fraser ‏@JFr4ser 24m
@MsNaughtyCheese @LeggeAngie I might be way off but reasons 4 selecting alternative(more expensive)newer opiate don’t apply in EoL #NurChat

Gail Mcadam ‏@mcadam_gail 24m
I have worked with a gp in the past who discussed end of life care with relatives and patient to see what they want#nurchat

Gerry Bennison ‏@AlresfordBear 24m
@DonnaNewcross Indeed

#nurchat

Kelly Owen ‏@Kelly_M_Owen 24m
@JFr4ser @ShaunLintern Such differences must not continue,patients deserve,compassionate,dignified death no matter where they live #nurchat

Angela Legge ‏@LeggeAngie 24m
@AlresfordBear Would have liked #LCP to have point about where to die – possibility of helping to arrange transport for this #NurChat

kevin dodsworth ‏@mybike321 24m
@ShaunLintern @msnaughtycheese yes they were involved in the decision making process #NurChat

kim pascoe ‏@acorns47 24m
@ShaunLintern @MsNaughtyCheese @mybike321 excellent point. Not relatives decision as such. Need lots of communication #nurchat

tilda mc crimmon ‏@TildaMc 25m
#nurchat Hi Tilda here. Use LCP after ausit and training.see is as precise documentation tool which supports good care .Not a prescription

Sharon Hudson ‏@ShazzaHudson 25m
@matthewvanloo @JFr4ser Lots of evidence of comparison between analgesia in Pall Care- pain control doesn’t change at EOL #nurchat

Shaun Lintern ‏@ShaunLintern 25m
Many of poor care issues raised with LCP review mirror what I heard at #MidStaffs inquiry. It was about wider issues at play in NHS #NurChat

Donna Mullikin RN ‏@DonnaNewcross 25m
@AlresfordBear That all depends on who is using it #nurchat

Rae Webster ‏@tcbtttc 25m
@ShaunLintern @Pathway2Death @NHS_HCA @Kelly_M_Owen The CQUIN was for having an end of life discussion NOT for putting pts on LCP #nurchat

Jools ‏@juliejo52553859 25m
Training was poor and the EOL degree module has opened my eyes.The LCP is a sad loss #NurChat

kim pascoe ‏@acorns47 25m
@LeggeAngie @NurChat meant going on course not the end. Need to have key skills & exp, no short cut to this. Compassion integral #Nurchat

Shaun Lintern ‏@ShaunLintern 25m
@NurChat @MsNaughtyCheese It became adopted as best practice following the use of similar methods in Marie Curie Hospices. #NurChat

Gerry Bennison ‏@AlresfordBear 26m
#nurchat How can the LCP be a care pathway when it often bears no reference to the individual and their choice for their end

rebecca ‏@MsNaughtyCheese 26m
@JFr4ser @NurChat accepted & presumed? Thats not evidence base, agree evidence (& sense) for each part but not the whole? #NurChat

Newcross Health ‏@NewcrossHealth 26m
RT @mcadam_gail: Why don’t they invest in training to use it properly? #nurchat

NurChat ‏@NurChat 26m
Q from @acorns47 Why has there been knee jerk reaction? – trusts abandoning LCP, nothing to replace? #NurChat

Donna Mullikin RN ‏@DonnaNewcross 26m
@sexyvicchic83 And you were expected to use the pathway without any training ? #nurchat

SJ ‏@YeWeeStoater 26m
Lurking on #nurchat tonight I have been reflecting on #Scotland’s #EOL care strategy via @online_his http://www.healthcareimprovementscotland.org/our_work/patient_experience/palliative_care/palliative_care_indicators.aspx … THX @NurChat

Shaun Lintern ‏@ShaunLintern 27m
@MsNaughtyCheese @mybike321 Surely you mean relative consultation. They can’t give consent. It remains a medical decision. #NurChat

Linda Buchan ‏@lybuchan 27m
@DonnaNewcross @NurChat Yes I agree, we still use the training we were given as a team as we did before, during and after LCP

Dawn Talbot ‏@dawntalbot1961 27m
@MsNaughtyCheese @SiobhanAdam Need something that is open and transparent. With better training and communication to relatives.#Nurchat

Joanne Fraser ‏@JFr4ser 27m
@NurChat @MsNaughtyCheese Because opiates in death have been accepted for centuries plus some presumed physiology

NurChat ‏@NurChat 27m
@JogreenJo Good point. How long? Competency sign off? #nurchat

Matthew Van Loo ‏@matthewvanloo 27m
@JFr4ser @MsNaughtyCheese @LeggeAngie An RCT not giving analgesia would not get past ethics #NurChat

Victoria Wilson-Lang ‏@sexyvicchic83 28m
@NurChat never had any official training #nurchat

Newcross Health ‏@NewcrossHealth 28m
RT @lybuchan: I continue to provide end of life care by individually care planning and involving relatives and patients as much… #nurchat

Jo green ‏@JogreenJo 28m
@WeNurses I personally like the lcp, it gives structure but think ppl should be given more training in care for the dying patient #nurchat

Kelly Owen ‏@Kelly_M_Owen 28m
@MsNaughtyCheese @NurChat #LCP can be used to prompt staff to provide the holistic care needed in Patients who are EOL #nurchat

rebecca ‏@MsNaughtyCheese 29m
@mybike321 what happens when the relatives disagree? #NurChat

Gail Mcadam ‏@mcadam_gail 29m
Why don’t they invest in training to use it properly#nurchat

Fran S ‏@Fran52notout 29m
@ShaunLintern @NHS_HCA @Kelly_M_Owen I worry that my CQUIN targets relate more to numbers than quality but I focus on quality #NurChat

Joanne Fraser ‏@JFr4ser 29m
@MsNaughtyCheese @LeggeAngie Im not sure there’s ever been an RCT that divided the dying into those on opiates vs those not #nurchat

Angela Legge ‏@LeggeAngie 29m
@acorns47 @NurChat I’ve always thought #compassion was the most important requirement for #LCP #NurChat

gina_LM ‏@gina_L_M 29m
@NewcrossHealth @moodomsmum good practice! One to one training best, as with implementation with pts #NurChat

Linda Buchan ‏@lybuchan 29m
@NurChat I continue to provide end of life care by individually care planning and involving relatives and patients as much as possible.

rebecca ‏@MsNaughtyCheese 30m
@SiobhanAdam but only if it is used as it was intended, lack of understanding & this communication has ruined it #NurChat

Kelly Owen ‏@Kelly_M_Owen 30m
@matthewvanloo @ShaunLintern CQUIN, with local NHS commissioners pay trusts for meeting targets to “reward excellence” in care. #nurchat

Rebekah Roshan ‏@Bex2079 30m
@NurChat My experience of using LPC has always been very positive, one of the best examples of collaborative working #NurChat

kim pascoe ‏@acorns47 30m
@NurChat Yes training given, but not replacement for experienced nurse. Need both. Do nurses get less experience now? #nurchat

Shaun Lintern ‏@ShaunLintern 30m
@NurChat Even greater risk of fragmented care. Good places will do it well. Bad will do it bad only now no national standard #NurChat

Donna Mullikin RN ‏@DonnaNewcross 31m
@NurChat Uncertainty? I would still take certain aspects from it, as I used them before the LCP was here #NurChat but would rather have LCP

Newcross Health ‏@NewcrossHealth 31m
RT @moodomsmum: as RTP nurse had no training on it. Had a patient placed on it during placement and was thoroughly taught by mentor #nurchat

rebecca ‏@MsNaughtyCheese 32m
@Kelly_M_Owen @NurChat do you think the LCP helps or hinders you in this? #NurChat

Kelly Owen ‏@Kelly_M_Owen 32m
@ShaunLintern @NHS_HCA funds to be used as a means of providing sufficient resources for good quality and compassionate care #nurchat

Mrs S ‏@moodomsmum 32m
@NurChat as a RTP nurse had no training on it. Had a patient placed on it during placement and was thoroughly taught by mentor.

Sharon Hudson ‏@ShazzaHudson 32m
@gina_L_M @pinksparklegirl @ShaunLintern @LeggeAngie Brilliant, that’s how we need to do it, alongside practice #nurchat

Shaun Lintern ‏@ShaunLintern 32m
@matthewvanloo @NHS_HCA @Kelly_M_Owen CQUIN payments are agreed between commissioners and providers. Meant to spread best practice. #NurChat

Joanne Fraser ‏@JFr4ser 33m
@ShazzaHudson @LeggeAngie was it? Just based on recognised best practice principles? Who was deprived 2 see if death better on LCP #nurchat

Kelly Owen ‏@Kelly_M_Owen 33m
@ShaunLintern @NHS_HCA payment for each patient implemented on the LCP, or equivalent approach, looks like an incentive to do so #nurchat

NurChat ‏@NurChat 33m
Good question @MsNaughtyCheese: How did the LCP become “gold standard” if not evidence based? #NurChat

Angela Legge ‏@LeggeAngie 33m
@ShaunLintern So it needed clear training with competency assessment? #NurChat

kevin dodsworth ‏@mybike321 33m
@NurChat I think it was sufficient enough, have now worked with it since 2007

NurChat ‏@NurChat 33m
How does the abolishment of the LCP leave those in need of end of life care? #NurChat

Shaun Lintern ‏@ShaunLintern 33m
Medical students receive a woeful amount of training which @kesleeman has highlighted. We need to do more to address this. #NurChat

rebecca ‏@MsNaughtyCheese 34m
How did the LCP become “gold standard” if not evidence based? #NurChat

Shaun Lintern ‏@ShaunLintern 34m
Training in some places was poor for staff using the LCP. Review found some examples of just an hour and OK to miss it. #NurChat

gina_LM ‏@gina_L_M 34m
@pinksparklegirl @ShaunLintern @LeggeAngie I’ve gone to wards myself to assess pts and meet staff, they don’t need time away #NurChat

Matthew Van Loo ‏@matthewvanloo 34m
@ShaunLintern @NHS_HCA @Kelly_M_Owen How did these incentives work? #NurChat

rebecca ‏@MsNaughtyCheese 35m
@JFr4ser @LeggeAngie I thought evidence base for each part but not the framework as a whole? #NurChat

Angela Legge ‏@LeggeAngie 35m
@pinksparklegirl @gina_L_M @ShaunLintern This is a real problem at the moment #NurChat

Linda Buchan ‏@lybuchan 35m
@NurChat I fwlt some medics could have done more training on it at times. Some weren’t so sure about it

Shaun Lintern ‏@ShaunLintern 36m
@NHS_HCA @Kelly_M_Owen I’m afraid there were incentives under the CQUIN payments system which rewards trusts for taking things up. #NurChat

kim pascoe ‏@acorns47 36m
@MsNaughtyCheese @JFr4ser or going back to review within 4 hours #nurchat

Emma Taylor ‏@pinksparklegirl 36m
@gina_L_M @ShaunLintern @LeggeAngie is part of the problem the usual inability to release staff from wards for training? #NurChat

Mrs S ‏@moodomsmum 36m
@Kelly_M_Owen @NurChat @ShaunLintern – wholeheartedly agree with this comment

rebecca ‏@MsNaughtyCheese 36m
@RebeccaLouiseUK don’t forget its a tool for the whole MDT! #NurChat

Sharon Hudson ‏@ShazzaHudson 36m
@JFr4ser Very much. That’ s an element of the recommendations. Less able to accurately prognosticate #lcp #nurchat

Matthew Van Loo ‏@matthewvanloo 36m
@ShaunLintern @NurChat Speaking to rels is a start,but it doesn’t understand patient experience. The rel has nothing for comparison #NurChat

NurChat ‏@NurChat 37m
@mybike321 Did you feel that was sufficient ?#nurchat

kim pascoe ‏@acorns47 37m
@ShaunLintern Any incentivised strategy will attract people who are motivated by the incentive too #Nurchat

Jools ‏@juliejo52553859 37m
@NurChat very little training. I got to grips with it just as it was given poor press and then no one wanted to use it

Newcross Health ‏@NewcrossHealth 37m
RT @bennettschris5: my trust provides continual training in our version of lcp and we have a link nurse that provides ward updates. #nurchat

Joanne Fraser ‏@JFr4ser 37m
@LeggeAngie Not me, that’s one of the criticisms of it – that it wasn’t evidence-based. In my mind difficult to make EoLC so… #Nurchat

NurChat ‏@NurChat 37m
@Kelly_M_Owen In the mean time? #nurchat

Shaun Lintern ‏@ShaunLintern 38m
@Kelly_M_Owen I can see the argument for incentivising best practice but public perception is negative. #NurChat

rebecca ‏@MsNaughtyCheese 38m
@LeggeAngie @NurChat I think discontinuing treatment & focus on early EOLC can be what scares family if not communicated well #NurChat

Angela Legge ‏@LeggeAngie 38m
@gina_L_M @pinksparklegirl @ShaunLintern So frustrating! This is definitely the way things should be #NurChat

Sheila kasaven ‏@SKasaven 38m
@NurChat I’ve seen LCP used very professionally on older MH wards, good support from palliative care team giving training/advice #NurChat

Sharon Hudson ‏@ShazzaHudson 38m
@LeggeAngie @JFr4ser It was evidenced based and thoroughly audited which is why it was recommended to be used across sectors #lcp #nurchat

Benno ‏@bennettschris5 38m
@NurChat my trust provides continual training in our version of the lcp and we have a link nurse that provides ward updates.

kevin dodsworth ‏@mybike321 39m
@NurChat we received a days training on #lcp #NurChat

gina_LM ‏@gina_L_M 39m
@LeggeAngie @pinksparklegirl @ShaunLintern we have a 24hour advice line. It’s been open a year. It has never rung. #NurChat

Fay Howard ‏@cllrfay 39m
@NurChat I received training on LCP was able to ask if unsure and felt confident using it, all a bit uncertain again now :-/ #nurchat

Kelly Owen ‏@Kelly_M_Owen 39m
@NurChat we are about to receive updates.. “More care less pathway” #nurchat

rebecca ‏@MsNaughtyCheese 39m
@NurChat team discussing well with family, involving palliative care/pain team & individualising the care plan #NurChat

Linda Buchan ‏@lybuchan 39m
@NurChat Yes all staff nurse on my ward received training and also palliative care training. I was confident using it

Angela Legge ‏@LeggeAngie 39m
@MsNaughtyCheese @cathtayloruclan Would need to be tied in with Deanery competencies #NurChat

Shaun Lintern ‏@ShaunLintern 39m
@matthewvanloo @NurChat A very difficult study but it could be done. Relatives can be a good judge I believe #NurChat

Joanne Fraser ‏@JFr4ser 40m
< for time-limiting illness, acute decline, lack of escalation all happening in very short timespan?? #nurchat

Donna Mullikin RN ‏@DonnaNewcross 40m
@gina_L_M @pinksparklegirl @ShaunLintern That is shocking! #nurchat

rebecca ‏@MsNaughtyCheese 40m
@LeggeAngie @cathtayloruclan yes definitely, have seen competencies & training in nursing done well but ?medics #NurChat

Emma Taylor ‏@pinksparklegirl 40m
@gina_L_M @ShaunLintern yes lots of resources out there but uptake generally poor #NurChat

Chris Jones ‏@ChrisJ999 40m
@DebHazeldine @ShaunLintern @NurChat of course discussing it is good but as it's over maybe look towards the future not past.

NurChat ‏@NurChat 40m
Did you recieve training on the use of the LCP? Did you feel confident using the pathway? #NurChat

Sharon Hudson ‏@ShazzaHudson 40m
@ShaunLintern It is fit for person in the right environment, with the right training and intention e.g. Hospice. #lcp #nurchat

Joanne Fraser ‏@JFr4ser 40m
How much is LCP difficulty related to death from non-cancer disease? Hospice care applied in acute healthcare, less appreciation > #nurchat

Kelly Owen ‏@Kelly_M_Owen 40m
@ShaunLintern financial incentives must cease in relation to any approach to care of the dying. #nurchat

Donna Mullikin RN ‏@DonnaNewcross 41m
@matthewvanloo @NurChat as a nurse I was furious. It was unnecessary pain. If they followed the LCP it wouldn’t have happened #nurchat

Angela Legge ‏@LeggeAngie 41m
@gina_L_M @pinksparklegirl @ShaunLintern Training for NHS staff? How wonderful #NurChat

Matthew Van Loo ‏@matthewvanloo 41m
@ShaunLintern @NurChat How do we get evidence? Difficult area for trials – cannot do RCTs, cannot speak with patients #NurChat

Chris Rousell ‏@NHS_HCA 41m
#NurChat I think the LCP has become the scapegoat for poor care. The highway code isn’t to blame for poor driving.

Shaun Lintern ‏@ShaunLintern 41m
For those who may not know my interest in LCP began when my Nan died on it in April last year receiving exemplary care @UHNS_NHS #NurChat

gina_LM ‏@gina_L_M 41m
@pinksparklegirl @ShaunLintern as a local hospice we offer advice and training for free. Very rarely taken up sadly. #NurChat

Angela Legge ‏@LeggeAngie 41m
@JFr4ser Are you saying guidance wasn’t evidence-based? #NurChat

kevin dodsworth ‏@mybike321 41m
@ShaunLintern in the trust I work for its a team decision and with relatives agreement #NurChat

rebecca ‏@MsNaughtyCheese 42m
@acorns47 @JFr4ser I agree & think that can be part of the problem – clinicians not realising they can deviate eg NG feeding #NurChat

Matthew Van Loo ‏@matthewvanloo 42m
@DonnaNewcross @NurChat Sorry to hear that. This is a lack of confidence which I feel individual care pathways will make worse #NurChat

NurChat ‏@NurChat 42m
@MsNaughtyCheese Can you elaborate? #nurchat

Linda Buchan ‏@lybuchan 42m
@ShaunLintern @Kelly_M_Owen @NurChat I agree that was an issue

Kelly Owen ‏@Kelly_M_Owen 42m
@ShaunLintern @NurChat lost autonomy! Thought process! #nurchat

Angela Legge ‏@LeggeAngie 42m
@ShaunLintern Agree – would have benefitted from in depth investigation into issues #NurChat

gina_LM ‏@gina_L_M 42m
@JFr4ser @matthewvanloo @DonnaNewcross yes I am spoiled by staffing in hospice not available in NHS. Better supervision #NurChat

Siobhan A ‏@SiobhanAdam 43m
#NurChat However the #LCP to me promotes a patients right to make decisions about their care in their final days.

rebecca ‏@MsNaughtyCheese 43m
.@NurChat but I do agree reassesment & training is an issue #NurChat

Shaun Lintern ‏@ShaunLintern 43m
Yes media was hysterical over LCP but the review did identify some worrying behaviour. All NHS staff should think hard about that. #NurChat

rebecca ‏@MsNaughtyCheese 43m
.@NurChat i’ve seen it used wonderfully in Intensive Care & been involved in a fascinating study #NurChat

Shaun Lintern ‏@ShaunLintern 43m
@matthewvanloo @NurChat I think the lack of evidence base and the toxic nature of the name mean this could be an opportunity. #NurChat

Siobhan A ‏@SiobhanAdam 43m
#NurChat May be difficult to save because it has become less about effective implementation and more about healthcare professional vs media.

Donna Mullikin RN ‏@DonnaNewcross 43m
@NurChat My – is when my mum was dying they refused to start LCP as out of hours. Instead had regular injections of morphine #NurChat

Sheila kasaven ‏@SKasaven 43m
@LeggeAngie @cathtayloruclan agree with competency tools to support LCP rather than removing #NurChat

Kelly Owen ‏@Kelly_M_Owen 43m
@NurChat I am a qualified & autonomous nurse, I know my patients. I can and do prescribe care to meet their needs. #nurchat #LCP

Linda Buchan ‏@lybuchan 43m
@RebeccaLouiseUK @NurChat I agree, however most nurses do look at the individual and encourage others to do so as well

Matthew Van Loo ‏@matthewvanloo 44m
@JFr4ser @DonnaNewcross @gina_L_M unfortunatly often without senior supervision #NurChat

Emma Taylor ‏@pinksparklegirl 44m
@ShaunLintern it seemed that hospitals weren’t prepared to invest in training and implementation then wonder why it could go wrong #NurChat

Rebecca Lobb ‏@RebeccaLouiseUK 44m
@Kelly_M_Owen @NurChat agree with you there! #nurchat

Angela Legge ‏@LeggeAngie 44m
@MsNaughtyCheese @NurChat I think there would have been more concentration on comfort and less on treatment earlier. #NurChat

Shaun Lintern ‏@ShaunLintern 44m
@mybike321 But it was. And there can be no denial of that. But that is an issue with those individuals rather than the LCP. #NurChat

Jools ‏@juliejo52553859 45m
There was never enough training for all specialities using it. It’s a great loss as it was a fantastic way of caring at EOL #NurChat

Joanne Fraser ‏@JFr4ser 45m
@matthewvanloo @DonnaNewcross @gina_L_M Not across the board. But jnrs need to be involved so they become proficient too. #NurChat

Shaun Lintern ‏@ShaunLintern 45m
@Kelly_M_Owen @NurChat I think that is possible where things started to go wrong. In some places it became a tick box. #NurChat

rebecca ‏@MsNaughtyCheese 45m
@LeggeAngie @NurChat can I ask how different you think you’re exoerience would have been? #NurChat

Cath Taylor ‏@cathtayloruclan 45m
It’s not just staff it should give confidence too though. Pts & families too but media have destroyed that now #nurchat

Kelly Owen ‏@Kelly_M_Owen 45m
@NurChat Generally well utilised but often lacks reassessment #nurchat

Angela Legge ‏@LeggeAngie 45m
@JFr4ser Hi – could you expand on issue with analgesia? #NurChat

Shaun Lintern ‏@ShaunLintern 46m
@pinksparklegirl More than a few. There was a significant minority sadly and media right to highlight that. But not pathway itself #NurChat

gina_LM ‏@gina_L_M 46m
@matthewvanloo @DonnaNewcross yes it may though I have found it also falls on senior nurses & the pathway was also useful for them #NurChat

Gail Mcadam ‏@mcadam_gail 46m
@SandraWeston8 hi Sandra welcome 2 nurchat #nurchat

Joanne Fraser ‏@JFr4ser 46m
Evidence base difficult to accrue in EoLC. Withholding analgesia recognised as needed for longer than formal medicine unethical #nurchat

Donna Mullikin RN ‏@DonnaNewcross 47m
@matthewvanloo @DonnaNewcross @gina_L_M Precisely, then they are accountable #nurchat

Rebecca Lobb ‏@RebeccaLouiseUK 47m
-ve it can sometimes reduce individual care planning. +ve it gives focus and confidence to nurses #nurchat

kevin dodsworth ‏@mybike321 47m
@ShaunLintern it shouldn’t have been poorly implemented as there is a standard checklist to work through #lcp #NurChat

Angela Legge ‏@LeggeAngie 47m
@cathtayloruclan Do we need a competency for tools such as this? Would that have been a better approach for the LCP? #NurChat

Linda Buchan ‏@lybuchan 47m
@NurChat I think there was some issues regarding poor training and implementation, but these could have been resolved

Matthew Van Loo ‏@matthewvanloo 48m
@DonnaNewcross @gina_L_M While we talk about senior staff involved in EOL care, the reality is it falls to junior medics often #NurChat

Shaun Lintern ‏@ShaunLintern 48m
When I attended Govt review and listened to the bad stories the complaints werent about LCP as such but about poor care generally. #NurChat

Kelly Owen ‏@Kelly_M_Owen 48m
@ShaunLintern @ShaunLintern @NurChat It was not intended to replace the skill and expertise of health professionals. #nurchat

Gianluca Catania ‏@GianlucaCatania 48m
@matthewvanloo @NurChat @gina_L_M Quality of dying will be impaired

Cath Taylor ‏@cathtayloruclan 48m
@LeggeAngie agree completely. Junior staff in particular need guidance & support #NurChat

Emma Taylor ‏@pinksparklegirl 49m
@ShaunLintern someone described it as scrapping the highway code because of a few bad drivers #NurChat

kim pascoe ‏@acorns47 49m
@JFr4ser it is a framework thats all #Nurchat

Linda Buchan ‏@lybuchan 49m
@NurChat I am very sorry The LCP has been abolished. It was a good care plan

Rebecca Lobb ‏@RebeccaLouiseUK 49m
@SandraWeston8 welcome! #NurChat

NurChat ‏@NurChat 49m
What has been your experience of the LCP? What are the +/- #NurChat

gina_LM ‏@gina_L_M 49m
@matthewvanloo @NurChat exactly, not necessarily junior staff either. I’ve met many experienced staff who are fearful of EoL #NurChat

Joanne Fraser ‏@JFr4ser 49m
It’s very easy in hospital to continue to treat reversible things at EoL when harms (pain/distress) out-way the benefit. LCP needed #nurchat

Shaun Lintern ‏@ShaunLintern 49m
But Gov review was right to highlight the fact LCP did not have evidence base behind it. But neither do the replacement care plans #NurChat

kim pascoe ‏@acorns47 49m
@ShaunLintern @Kelly_M_Owen @NurChat @wenurses Hi all #nurchat

Matthew Van Loo ‏@matthewvanloo 49m
Very one sided so far, is anyone in agreement with the abolishment of the LCP? #NurChat

Angela Legge ‏@LeggeAngie 49m
@SandraWeston8 Welcome to Twitter! You’ll pick it up quickly enough! #NurChat

Donna Mullikin RN ‏@DonnaNewcross 50m
@matthewvanloo @gina_L_M That’s exactly why I found it useful. Especially newly qualified Dr’s with little experience #nurchat

Gail Mcadam ‏@mcadam_gail 50m
@DrShirleyLock I agree #nurchat

Chris Sykes ‏@NHSChrisSykes 50m
@NurChat it is always good to review processes. The LCP has been around a long time.

Stu Young ‏@swayoung01 50m
@NurChat poor decision and not evidence based but we need now to ensure that it’s “replacement” does the best for our PTs #Nurchat

Shaun Lintern ‏@ShaunLintern 50m
The problem with the LCP was with poor implementation in sadly too many places. But LCP itself was not a problem. #NurChat

Sandra Weston ‏@SandraWeston8 50m
Hello sorry im late, trying to work out how to use twitter. Thank god for daughters #nurchat

Angela Legge ‏@LeggeAngie 50m
@cathtayloruclan That can happen with many such tools. We need to think creatively about that risk #NurChat

Rebecca Lobb ‏@RebeccaLouiseUK 51m
@cllrfay @NurChat same. It was something useful to help explain a very sad time! #NurChat

Cath Taylor ‏@cathtayloruclan 51m
Problem with any pathway is there’s temptation for practitioners to avoid creativity & stick to plan. Rules out individual care #NurChat

Dawn Talbot ‏@dawntalbot1961 51m
Something had to be done as people being placed on it without discussing with the family.#NurChat

Donna Mullikin RN ‏@DonnaNewcross 51m
@gina_L_M Agree. It’s a useful tool if used correctly #nurchat

Angela Legge ‏@LeggeAngie 51m
@DrShirleyLock That’s a good way of putting it. #NurChat

Matthew Van Loo ‏@matthewvanloo 51m
@gina_L_M @NurChat That was the problem the LCP tried to address, a tool that gives junior staff confidence in their decisions #NurChat

Shaun Lintern ‏@ShaunLintern 51m
@Kelly_M_Owen @NurChat That is a good point Kelly. Could be a worse situation that what we had before. #NurChat

Rebecca Lobb ‏@RebeccaLouiseUK 52m
@matthewvanloo @NurChat totally agree! Media have totally taken it out of context #NurChat

kevin dodsworth ‏@mybike321 52m
@NurChat @shaunlintern good evening #NurChat

Stu Young ‏@swayoung01 52m
@ShaunLintern @NurChat dedication indeed (@nursingtimesed pls note even with “man flu” he works)

Joanne Fraser ‏@JFr4ser 52m
The LCP is a document, nothing more or less. It’s founding principles will continue until time dilutes memory #nurchat

Fay Howard ‏@cllrfay 52m
@NurChat sad, I liked LCP found it helpful in explaining to family & ensuring consistency of care #nurchat

Dr ShirleyLockeridge ‏@DrShirleyLock 52m
very sad, thought it was really person centred #Nurchat

gina_LM ‏@gina_L_M 52m
@NurChat very anxious and sad. I think it will leave inexperienced hospital staff with even fewer resources and less support #Nurchat

Shaun Lintern ‏@ShaunLintern 52m
Yes Gov review recommended the LCP be abolished but in reality the care plans suggested may end up being the LCP in all but name #NurChat

Helen scrimshire ‏@HScrimshire 53m
@ShaunLintern @NurChat don’t expect sympathy !

Kelly Owen ‏@Kelly_M_Owen 53m
@NurChat worried at the lack of guidance now #nurchat

Joanne Fraser ‏@JFr4ser 53m
@ShaunLintern @NurChat From still a pre-dominantly female profession? Eh, no! #NurChat

Matthew Van Loo ‏@matthewvanloo 53m
@NurChat Poor decision driven by media #NurChat

Rebecca Lobb ‏@RebeccaLouiseUK 53m
I’m personally quite shocked. I don’t agree #nurchat

Angela Legge ‏@LeggeAngie 53m
@NurChat Sad. I think used properly, the LCP is a great way of caring for the dying. Wished my Aunt had been placed on it. #NurChat

NurChat ‏@NurChat 54m
@ShaunLintern Lots of special brownie points for you Shaun

#NurChat

NurChat ‏@NurChat 54m
Let’s get going….How do you feel about the recomendation the LCP should be abolished? #NurChat

Shaun Lintern ‏@ShaunLintern 54m
Can I have special #NurChat brownie points for turning up with #manflu? @NurChat

Angela Legge ‏@LeggeAngie 55m
@ShaunLintern @swayoung01 @NurChat Oh you poor thing! #NurChat

Cath Taylor ‏@cathtayloruclan 55m
I’m just checking in to watch discussion as usually miss it but was interested in LCP! #NurChat

gina_LM ‏@gina_L_M 55m
@ShaunLintern @LeggeAngie @mcadam_gail better than splitting attention with holby city though? #Nurchat

Shaun Lintern ‏@ShaunLintern 56m
@swayoung01 @NurChat Very glad to be here Stu. And for the record I am here with the #manflu Dedication! #NurChat

Rebecca Lobb ‏@RebeccaLouiseUK 56m
Good evening, been a while I’ve taken part #nurchat

Shaun Lintern ‏@ShaunLintern 57m
@LeggeAngie @mcadam_gail *pulls face* I won’t say a word! #NurChat

Donna Mullikin RN ‏@DonnaNewcross 57m
Evening #NurChat Donna here

Joanne Fraser ‏@JFr4ser 57m
Hello. Might not manage full hour, will see #nurchat

Cath Taylor ‏@cathtayloruclan 57m
Evening! #NurChat

Stu Young ‏@swayoung01 57m
@NurChat Goodeveing and welcome to @ShaunLintern #NurChat

Kelly Owen ‏@Kelly_M_Owen 57m
Hello!!! #nurchat

Dr ShirleyLockeridge ‏@DrShirleyLock 58m
Hello #Nurchat

Dawn Talbot ‏@dawntalbot1961 58m
Hello #NurChat

Angela Legge ‏@LeggeAngie 58m
@mcadam_gail Hope you can forgive me if I’m watching #GBBO at the same time (sheepish) #NurChat

Gail Mcadam ‏@mcadam_gail 59m
@LeggeAngie hi angela#nurchat

Matthew Van Loo ‏@matthewvanloo 59m
@NurChat Good evening #NurChat

rebecca ‏@MsNaughtyCheese 59m
@NurChat *waves hello* #NurChat

Mrs S ‏@moodomsmum 59m
Hi #nurchat

gina_LM ‏@gina_L_M 59m
@NurChat hi! #Nurchat

Shaun Lintern ‏@ShaunLintern 59m
Hello everyone in tonight’s #NurChat. Be gentle with me!

NurChat ‏@NurChat 1h
Tonight we are delighted to have @ShaunLintern along for the ride. He is happy to answer any specific questions that people have #NurChat

Angela Legge ‏@LeggeAngie 1h
@NurChat Hello #Wave #Nurchat

NurChat ‏@NurChat 1h
Good evening everyone and welcome to #NurChat Tonight’s topic is’ the Liverpool Care Pathway’. If you are out there please say Hi!

Newcross Health ‏@NewcrossHealth 1h
RT @nurchat: If you want to join in #NurChat tonight at 8pm re: LCP Please add #NurChat to all of your tweets so we can all enjoy them

NurChat ‏@NurChat 1h
If you want to join in #NurChat tonight at 8pm re: LCP Please add #NurChat to all of your tweets so we can all enjoy them

NurChat ‏@NurChat 1h
As always here is a link to the advice from the NMC re: social media use before tonights #NurChat http://bit.ly/QzXXvX

Liverpool Care Pathway: A National Scandal

Wednesday 21 August 2013

Liverpool Care Pathway - The Twitterview

NurChat transcript – The Liverpool Care Pathway

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