implementing the liverpool care pathway in …...implementing the liverpool care pathway in western...
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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.
.25 February 2010
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
25 February 2010
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
25 February 2010
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
25 February 2010
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.
25 February 2010
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.
25 February 2010
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