Liverpool Care Pathway (LCP) 
What is known
The Liverpool Care Pathway (LCP) was developed in the UK. it is a clinical pathway to improve care of the dying based on appropriate goals of care [1] and is now widely used in many settings. The original aim of the LCP was to provide an excellent level of care for dying patients wherever they were being cared for, not just in a hospice.

Specific versions of the LCP are available for hospitals, nursing homes, community, and hospices. The LCP documentation replaces the normal clinical record, guiding clinical decision making for the whole team. Once in use within a health care service, the LCP provides data which can be used for auditing quality of care. [2] When the same care pathway is used by a number of different services, it allows the possibility of benchmarking – comparing the outcomes and experiences of end-of-life care between different services.

The LCP has been widely adapted by palliative care services in Australia [3]. There are a number of other end-of-life care pathways which have been developed and evaluated in various settings. [4-7]

There is some research documenting changes in practices where the LCP and other clinical pathways for end-of-life care have been implemented, but no high level evidence regarding their impact is available as yet.

Implications for practice

• Most end-of-life care pathways were initially designed to be used in non-specialist palliative care settings such as acute hospitals
• Implementing end-of-life care pathways requires a major organisational commitment to the goal of improving care of the dying, and may require specific resources and leadership [8-9].

Finding out more
The Marie Curie Palliative Care Institute, Liverpool Care Pathway for the Dying Patient (LCP)

Related CareSearch pages
Audit

References

1. Ellershaw J, Smith C, Overill S, Walker SE, Aldridge J. Care of the dying: setting standards for symptom control in the last 48 hours of life. Journal of Pain & Symptom Management. 2001 Jan;21(1):12-7. 
2. Veerbeek L, van Zuylen L, Gambles M, Swart SJ, van der Heide A, van der Rijt CC, et al. Audit of the Liverpool Care Pathway for the Dying Patient in a Dutch cancer hospital. Journal of Palliative Care. 2006 Winter;22(4):305-8.  no abstract available  
3. Hardy JR, Haberecht J, Maresco-Pennisi D, Yates P. Audit of the care of the dying in a network of hospitals and institutions in Queensland. Internal Medicine Journal. 2007 May;37(5):315-9. 
4. Okon TR, Evans JM, Gomez CF, Blackhall LJ.  Palliative educational outcome with implementation of PEACE tool integrated clinical pathway. Journal of Palliative Medicine. 2004 Apr;7(2):279-95.  
5. Fowell A, Finlay I, Johnstone R, Minto L. An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care. International Journal of Palliative Nursing. 2002 Dec;8(12):566-73.  
6. Bookbinder M, Blank AE, Arney E, Wollner D, Lesage P, McHugh M, et al., Improving end-of-life care: development and pilot-test of a clinical pathway. Journal of Pain & Symptom Management. 2005 Jun;29(6):529-43.  
7. Luhrs CA, Meghani S, Homel P, Drayton M, O’Toole E, Paccione M, et al. Pilot of a pathway to improve the care of imminently dying oncology inpatients in a Veterans Affairs Medical Center. Journal of Pain & Symptom Management. 2005 Jun;29(6):544-51.  
8. Mellor F, Foley T, Connolly M, Mercer V, Spanswick M. Role of a clinical facilitator in introducing an integrated care pathway for the care of the dying. International Journal of Palliative Nursing. 2004 Oct;10(10):497-501. 
9. Taylor AJ, Randall C. Process mapping: enhancing the implementation of the Liverpool Care Pathway. International Journal of Palliative Nursing. 2007 Apr;13(4):163-7. 

This page was created on 22 May 2008 and is due for review in May 2010