End of life care in the acute hospital settingBMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5048 (Published 01 December 2009) Cite this as: BMJ 2009;339:b5048
- Polly Edmonds, consultant in palliative medicine1,
- Rachel Burman, consultant in palliative medicine1,
- Wendy Prentice, consultant in palliative medicine1
- 1King’s College Hospital NHS Foundation Trust, London SE5 9RS
Most deaths occur in hospital, yet effective management of dying patients in this environment is challenging. The Liverpool care pathway was developed as a framework to guide practice and extend the excellence of hospice care into hospital, where there was evidence of poor quality care.1 2
An updated version (version 12) of this care pathway was ratified on 2 December 2009. A recent media debate during the consultation period raised criticisms that the pathway is prescriptive and inevitably leads to the patient’s death; it also highlighted concerns about inappropriate sedation and dehydration. The debate has produced welcome political and professional interest in the care of the dying.
The Liverpool care pathway offers a framework that helps non-specialists manage the dying process, with the aim of ensuring a minimum standard of care for people who are dying. If correctly used it should not hasten a patient’s death. Research from the United Kingdom and international data show that the pathway reduces symptom burden, improves multidisciplinary working, and increases anticipatory prescribing for key symptoms that may develop in the last hours or days of life. It also improves nurses’ confidence in caring for the dying.3 4 5 Two national audits have benchmarked data …