Saturday, November 30, 2013

Liverpool Care Pathway: Warning for POLST?

Four months have elapsed since the report of the independent review of the Liverpool Care Pathway and the decision to phase out the Pathway over six to 12 months.  Many UK clinicians have already stopped using the LCP.  This is unfortunate since there is no appropriate replacement guidance in place.  

These developments in the UK cause me some worry about end-of-life tools here in the United States.  As I read about the occasional misuse of POLST, I hope that such rare instances do not similarly "bring down" what, for the overwhelming vast majority of patients and residents, has proven to be a very effective way to ensure that the treatment patients get is the treatment patients want.

1 comment:

Patrik Hutzel said...

In a way it doesn't surprise me that many clinicians stopped using the LCP. I have worked with the LCP to varying degrees in an Intensive Care environment. Whilst I think it's a very valuable tool for many Patients approaching their end of life, the degree to which the LCP succeeds in meeting a Patient and their Family's needs in and end-of-life situation often depends on the context and the culture of an Intensive Care Unit and how they apply the written words on the pathway. My concern would not be the misuse of the LCP for POLST and I would be more concerned that the LCP might be "used" for not prolonging a critically ill Patient's life, where life sustaining and life prolonging measures might be indicated and desired, however the culture in a unit or Hospital is more focused on throughput and of treating other cases that might be of more interest for the Intensive Care Unit.
Patrik Hutzel