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Saturday, 14 September 2013

Putting pathways into perspective

Once again I'm exercising the slow blog style; of late the concerns about care pathways have been in the thoughts of many, particularly in end of life care.
The recent report on the Liverpool care of the dying pathway, (LCP)  'More Care: less pathway...' by a group chaired by Baroness Julia Neuberger has led to much soul searching  particularly amongst those who had time to learn how to use the LCP correctly. 

Proper use of the LCP tool (its just one tool - not a whole toolkit) left people at the end of life (who are be believed to be within approximately 72 hours of dying, as far as professional judgement can be accurate) freed from unnecessary treatments and interventions; it enabled all those involved to have an understanding of what was happening, with a mutually agreed approach towards letting the death happen whilst keeping comfort, dignity and respect for the dying person at the forefront of the care that needed to be delivered.
The report speaks of evidence of good practice yet it reaches the conclusion that the LCP should be left behind as, in the name of the LCP, much poor care of the dying had taken place. I believe it likely that the poor care would have taken place anyway as there would have to be a culture of accepting poor care, to allow misuse of a tool such as the LCP.

Healthcare professionals do need to be careful about terms such as care pathway; it is all too easy to take a professional short cut when faced with pressures of work. In the last week research undertaken by Dr Kristian Pollock  highlights the effects busy-ness for care staff has on their ability to interact with the dying person on hospital wards.
So this got me thinking about pathways; whilst taking a train journey a few days ago I listed pathways I could think of:

  • Stepping stones
  • Gravel
  • Wooden deck
  • Grass
  • Slabs
  • Bricks
  • Mud
  • Tarmac
We have nearly all these in our garden; some very short, not easy or pleasant  to use; others take us on a longer route past lavender and herbs; have better views, and are much easier on the feet. So what's my point?

We should carefully consider facilitating choices for the dying person, beginning with a personalised approach to planning for their end of life. A care pathway that does not allow for deviation from the route is limiting. It's a bit like going round a stately home following the arrows  under the beady eyes of the custodians. Had healthcare workers fallen into that way of thinking with the LCP? Only one way to travel, no matter how welcome or not you may be; ignoring vital information and potential options for alternatives because the 'pathway' is well fixed.

Lets get out the maps, and look at the routes we can travel with the dying person toward their death. We will need to be flexible; prepared to risk going "off piste"; getting dirty and even lost. The important thing will be not to leave those who are dying thinking they are alone. 
Be creative and passionate about what you are doing; take them into your relationship with the dying person while they explore the pathway(s) to take.





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