Implementing the Liverpool Care

Pathway in Western Australia -

An innovative approach

to embedding quality improvement

into clinical practice

WA Cancer & Palliative Care Network

Valerie Colgan, Helen Walker and Hayley Arnet

Delivering a Healthy WA

“The responsibility for the use of the LCP generic

document as part of a continuous quality

improvement programme sits within the governance

framework of an organisation and must be

underpinned by a robust education and training

programme”

Deborah Murphy

LCP UK Lead Nurse

25 February 2010

WA Cancer & Palliative Care

Network:

Formed to address state-wide best practice in cancer and palliative care

Palliative care clinicians identified the need for an integrated evidence based care pathway to guide care in the last days and hours of life

• The Liverpool Care Pathway (LCP) was selected as an ideal quality framework for West Australian use

• Palliative Care Network collaborated with Marie Curie Palliative Care Institute Liverpool, linked with the NHS Innovations program.

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The Pilot 2007 - 2008

A Pilot Study was conducted and has informed the implementation process:

• Systematic approach to implementation

• Supported by a centralised group of experts

• Conduct formal research and evaluation of its impact

• Use of the LCP would be tied to quality improvement.

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WA lcp Project

• Conducted in collaboration with:

– Edith Cowan University

– Cancer and Palliative Care

Research & Evaluation Unit at the University of Western Australia

• In three rural West Australian regions

– The Great Southern

– The Midwest

– The South West

• Formal evaluation funded by State Health Research Advisory Council .

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WA Country Health Service Regions

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WA lcp ProjectFlow Chart of Evaluation Study Methods/Data

N = 590 (285 Pre/285 Post)

Death of Patient

Trigger Event

Health Professional Questionnaire

1 Week

Carer Survey or Interview6 Weeks

Audit of Medical RecordAs Available

Baseline

Quality Activity - QI Run

Charts, Monthly Reports

Monthly, Total

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How do we differ?

• Our Training

– Information sessions

– Series of two workshops for Palliative Care Network Nurses (Link nurses)

– Prepared training modules for consistent approach to worksite education

• Our Clinical and Educational Resources

– Clinical Guidelines

Level of evidence documents

Rationale

Symptom Flowcharts

– Ward Resource Manuals

– Palliative Care Network Nurse Manuals

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WA LCP Project – An innovative

approach to use of the LCP……

WA lcp Resources

25 February 2010

25 February 2010

WA LCP Project – An innovative

approach to use of the LCP……

How do we differ?

• Our rigorous use of the Continuous Quality Improvement Program (CQIP)

– Building Teams

– Quality Workshops

– Coaching calls

– Use of Quality Audit Cycle (PDSA)

– Action Planning

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Palliative Care Network Nurses

(PCNN) - Workshops

Exploring the local culture /provision of care in the last days of life

• Clinical practice

• Gaps

• Potential barriers

Describe quality care for the dying - Consider knowledge/skills/resources

Introduce WA lcp - Associated supporting materials and resources

Analysis and review of baseline WA lcp audit results

Draw up Action Plans

Identify and enlist local drivers - Executive sponsors/Steering group members/

Clinicians and specialist palliative care support .

25 February 2010

Workshops – Building Teams

WA lcp Continuous Quality Improvement Program (CQIP)

• QI and Care of the Dying

• Use of Quality Audit Cycle (PDSA)

– Plan

– Do

– Study

– Act

– Rapid Cycle QI• Review QI Method

– Establish Aim

– Select Measures

– Identify Changes

– Action Planning

• Evaluation and Reporting

• Change Management

– Planning for sustainability

– Sharing ideas

– Sharing strategies

– Sharing solutions

• Envision and build teams

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Coaching Calls

Monthly Action Group Meetings –QI/ Clinical/Research

Focus by Video/Teleconferencing

• During the Action Periods (After each workshop)

• Project Staff - Facilitate and Nurture Teams

» Communication - Linking/Networking and Sharing

» Leadership

» Change Management

» Delegation/Shared Workloads

• Critical Thinking/Reflective Practice with WA lcp

25 February 2010

Monthly Progress –

Reports and Action Plans

25 February 2010

Monthly Progress Reports & Action

Plans describe:

• Training

• Reporting – executive sponsor and health service

• QI Activities

– Quality Audit Cycle

– Conducted and planned activities

– Run Charts

– Meeting EQuIP 4 Criteria, NSAP and Standards

– Embedding WA lcp in health service.

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CQIP and EQuIP 4

Criteria:

• 1.1.1 The assessment system ensures current and ongoing needs of the consumer / patient are identified.

• 1.1.2 Care is planned and delivered in partnership with the consumer / patient and when relevant, the carer, to achieve the best possible outcomes.

• 1.1.3 Consumers / patients are informed of the consent process, understand and provide consent for their health care.

• 1.1.4 Care is evaluated by health care providers and when appropriate with the consumer / patient and carer.

• 1.1.6 Systems for ongoing care of the consumer / patient are coordinated and effective.

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CQIP and EQuIP 4Criteria:

• 1.1.7 Systems exist to ensure that the care of dying and deceased consumers / patients is managed with dignity and comfort.

• 1.1.8 The health record ensures comprehensive and accurate information is recorded and used in care delivery.

• 1.4.1 Care and services are planned, developed and delivered based on the best available evidence and in the most effective way.

• 2.1.1 The organisation’s continuous quality improvement system demonstrates its commitment to improving the outcomes of care and service delivery.

• 2.5.1 The organisation’s research program promotes the development of knowledge and its application in the health care setting, protects consumers / patients and manages organisational risks associated with research.

25 February 2010

Next steps with the pathway

• We continue to wok with our rural partners

• Completion of the Post

• Preparation for Metropolitan Rollout in 2010 has

commenced

25 February 2010

Acknowledgements

WA lcp Project Team

Helen Walker

Hayley Arnet

Prof Anne Wilkinson

Asst/Prof Claire Johnson

And our passionate rural partners...

25 February 2010

REFERENCES

• LCP Non-Cancer Briefing Paper. LCP Central Team UK. The Marie Curie Palliative Care Institute Liverpool. December 2007.

• Table of EQuIP 4 Functions, Standards and Criteria Mandatory Criteria. The Australian Council on Healthcare Standards. June 2006.

• Bookbinder M, Blank A, Arney E, Wollner D, Lesage P, McHugh M, Indelicato RA, ANP, Harding S, BCC, Barenboim A, Mirozyev T, Portenoy RK. Improving End-of-Life Care: Development and Pilot-Test of a Clinical Pathway

• John Ellershaw, Maureen Gambles, Tamsin McGlinchey. 2007. Benchmarking: a useful tool for informing and improving care of the dying?

• Fowell A, Finlay I, Johnstone R, Minto L. 2002. An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care. Journal of Int J Palliat Nurs. 8 (12), 566-73

• Veerbeek L, van Zulen L, Swart SJ, van der Mass PJ, de Vogel-Voogte E, van der RijtCCD, van der Heide A. 2008. The effect of the Liverpool Care Pathway for the dying: a multi-centre study. Palliative Medicine, 22: 145-151.

25 February 2010