Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0-1 study according to the Medical Research Council Framework.

Rebecca Verhofstede,Nele Van Den Noortgate,Joachim Cohen,Tinne Smets,Luc Deliens,Massimo Costantini,Agnes Van Der Heide

doi:10.1186/s12904-015-0025-z

Abstract

BackgroundThe effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. Moreover, the LCP has recently been phased out in the UK hospitals. For that reason, this study aims to develop a new care programme to improve care in the last days of life for older patients dying in acute geriatric wards.MethodsWe conducted a phase 0–1 study according to the Medical Research Council Framework. Phase 0 consisted of a review of existing LCP programmes from the UK, Italy, and the Netherlands, a literature review to identify key factors for a successful LCP implementation and an analysis of the concerns raised in the UK. In phase 1, we developed a care programme for the last days of life for older patients dying in acute geriatric wards based on the results of phase 0. The care programme was reviewed and refined by two nurses and two physicians working in an acute geriatric ward and by two experts from Italy and the Netherlands.ResultsPhase 0 resulted in the identification of nine important components within the LCP programmes, five key factors for a successful LCP implementation and a summary of the LCP concerns raised in the UK. Based on these findings we developed a new care programme consisting of (1) an adapted LCP document or Care Guide for the older patients dying in an acute geriatric ward, (2) supportive documentation, and (3) an implementation guide to assist health care staff in implementing the care programme on the acute geriatric ward.ConclusionsBased on the existing LCP programmes and taking into account the key factors for successful LCP implementation as well as the concerns raised in the UK, we developed a care programme for the last days of life and modelled it to the acute geriatric hospital wards after gaining feedback from health professionals caring for older hospitalized patients.

Highlights

The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting
Phase 0: preclinical phase Review of existing LCP programmes The review of the original LCP programme developed in the United Kingdom (UK) [18, 28] and the LCP programmes used in Italy [30] and the Netherlands [29] identified three common documents: 1) an LCP document, 2) supportive documentation, and 3) an implementation guide
The latest LCP generic version 12 was launched in December 2009 and can be used in all health care settings where end-of-life care needs to be provided

Summary

Introduction

The effects of the Liverpool Care Pathway (LCP) have never been investigated in older patients dying in acute geriatric hospital wards and its content and implementation have never been adapted to this specific setting. The Liverpool Care Pathway (LCP) for the Dying Patient is one such pathway It was developed in 1997 in the United Kingdom (UK) as a multi-professional document that provides a template of care for the final days and hours of life and aims to transfer the hospice model of care to mainstream hospital services [15, 18]. The LCP is based on the principles of palliative care: regular assessment and management of symptoms, comfort measures, effective communication with patients, and their families, and provision of psychological, social, and spiritual/existential support It focuses on the individual physical, psychological, and spiritual needs of the dying patient and their family during the last hours and days of life and provides health care professionals with guidance on the different aspects of care required, including comfort measures, anticipatory prescribing of medications, discontinuation of inappropriate interventions, and the psychological and spiritual/existential support of the patient and family [18]

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