The Liverpool Care Pathway (LCP) was an end of life pathway that was “discontinued” in 2013 because it was dangerous.
In fact NHS hospitals now use end of life pathways that have the same flaws as the LCP but they do not have the same name.
The flaws are:
- Patients are started on the pathway because they are diagnosed as “imminently” dying. (This diagnosis is not scientifically possible and so patients diagnosed as dying may not be dying.)
- “Anticipated prescribing” is allowed which means a doctor does not have to sign every increase in dose of sedative medication. This can result in rapid increase in sedation and respiratory suppression.
- When the patient gets too drowsy to drink fluids are discontinued. The patient becomes quickly dehydrated. In some end of life pathways fluids are withdrawn at the start.
- Midazolam a benzodiazepine anti-anxiety medication is often given for “agitation”, but it sedates and can give respiratory suppression. When a patient is sedated they stop drinking and become dehydrated. Also sedation often gives confusion and this can give agitation.
- These medications are usually given by a syringe driver, so if you see a syringe driver always ask why it has been given and what is being given in it.