Palliative care

Fact sheet 11 Liverpool Care Pathway
The Liverpool Care Pathway is an integrated pathway tool which can be used during the last 72 / 48 hours of life. It provides guidance on the different aspects of care required, including comfort measures, anticipatory prescribing and discontinuation of inappropriate interventions.
There are three sections to the tool Diagnosing dying, Ongoing assessment and Care after death
Key elements
A multidisciplinary team approach
Initial assessment of patients condition and comfort
Communication with the patient, family and significant others
Identification of religious and spiritual needs
Agreed plan of care
Anticipatory prescribing
Symptom control Pain, agitation, nausea and vomiting, respiratory secretions, breathlessness.
Agree and cease unnecessary interventions
Ongoing assessment, recording and amendment to plan if required
Care after death inform GP
Provide appropriate information to family

ACP Guidelines SCHP
ACP is an aspect of care planning which can only be undertaken by a person who has capacity to decide.The outcomes of ACP might include one or more of:
• Advanced statement to inform subsequent best interest discussions (PPC preferred priorities of care document)
• Advanced decision to refuse treatment. (ADRT) A more specific, legally binding document
• Appointment of LPA (lasting power of attorney)

A few things to remember:
ACP is voluntary
ACP can only involve people who have capacity
There should be no pressure on the patient from the family, carer or healthcare professional to participate in ACP
Not everyone will be comfortable in talking about ACP
There is evidence that ACP discussions on admission to a care home may cause distress, but can be successful once a person has had time to settle and if staff are appropriately trained
ACP should be considered followinCare planning (usually ceiling of treatment discussion in our patient population) to be undertaken by appropriately trained clinicians, currently Julie and GPs. We must ensure that all GPs are willing and trained in ceiling of treatment discussions.
Formal assessment of capacity documentation by the clinicians doing ACP/CP before discussions

Handover (ooh)

Hacking-medschool/handover-prescribing

icid.salisbury.nhs.uk Palliative Care Handover Form for OOH Service

yac palliative care.co.uk ooh service

goldstandardsframework.org.uk OOHs

Nurses Verbal Handovers (a bit poor)	SNCSG Pearson 2006http://www.ukna.org/
H	Have essential information ready before uou begin . Include:
A	Any changes in patients/family situation
N	normal parameters that have eviated
D	Doctors rounds – changes in treatment /management plans
O	Objective Data vital signs + relevant subjective data
V	Viscous statements – avoid personal opinions / gossip
E	education – what has been said to patient/family
R	relevant and priority care for next shift

Hospices

http://endoflife.northwestern.edu/more_about/hospice_care.cfm

http://www.helpthehospices.org.uk/about-us/in-the-uk

http://www.direct.gov.uk/en/CaringForSomeone/CaringAndSupportServices/DG_10035718

Macmillan nurses

Macmillan.org.uk

Macmillan Nurses

Mariecurie.org.uk

Oncology emergencies

http://www.bmj.com/content/315/7121/1525.full

Oncological Emergencies

palliative.org Spinal Cord Compression

Hypercalcaemia in oncology

http://hacking-medschool.com/high-calcium

http://216.55.99.51/clinical/palliativecare/palliativec1257.html

http://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/HealthProfessional/page5

Spinal Cord Compression

NICE CG75 Metastatic spinal cord compression Nov 200

QRG

SVC Obstruction

Due to mets in mediastinal lymph nodescausing compression or invasion of SVC. Patient presents with congestion, oedema,and prominent distended veins over upper limb chest wall neck or face.

http://www.patient.co.uk/doctor/SVC-Obstruction.htm

SVCO Medscape

http://youtu.be/iDdOgweo2tI

Neutropaenia / Pancytopaenia / Sepsis in Radio/Chemotherapy

http://emedicine.medscape.com/article/199003-overview

http://www.bmj.com/content/341/bmj.c6981.full

Major haemorrhage

http://book.pallcare.info

gp-palliativecare.co.uk haemorrhage

Bony Mets

http://www.bmj.com/content/337/bmj.a2041.full

Prescribing in palliative care

palliative drugs.com

WHO Analgesic Ladder

hacking-medschool.com/pain-scales

WHO Analgesic Ladder

3 step approach for pain relief. Inexpensive and effective in 80-90%.
STEP 1 Non Opiod aspirin paracetamol NSAID
STEP 2 Weak Opiod for mild to moderte pain eg codeine
STEP 3 Strong Opiod Strong Opioid for moderate to severe pain eg morphine

Oral preps are preferred at all stages.
Analgesics should be given regular intervals (3-6 hourly) not on demand
Adjuvants eg anxiolytics should be considered at any step
No top dose but if morphine exceeds eg 300mg/24hr or if side effects reconsider cause of pain +/seek specialist advice.

Cancer Pain Tutorial Dr Mahibur Rahman