The Liverpool Care Pathway provides clarity and focus; communication, care, and compassion come from you

Optimizing the experience of care for patients and relatives has historically been viewed as an optional extra rather than a fundamental element of healthcare delivery. The Liverpool Care Pathway for the Dying Patient (LCP) will not in itself provide this optimization, but it should prompt health-care workers to address the issues that will enhance this process. I believe that when we as health-care professionals involved in care in the last hours or days of life are focused on how to improve partnerships with those we serve, and where processes such as the LCP or equivalent are in place to support such partnerships, both the experiences of patients and relatives and health-care outcomes will improve. The LCP is a best-practice model of care that has been adopted across 21 countries to support care in the last hours or days of life. It serves to drive up quality while improving productivity, and uses innovation to drive and embed measurable change in order to make a sustainable difference to the way that we care for dying patients and their relatives (Ellershaw and Wilkinson, 2011). In support of advancing continuous improvement in the UK, the results of the National Care of the Dying Audit – Hospitals (NCDAH) Round 3, which used the LCP as its audit tool, will be published on 1 December 2011 at the LCP Annual Conference at the Royal Society of Medicine, London. It is anticipated that more than 80% of Hospital Trusts in England will have participated in this third-round audit. As the Lead Nurse for the LCP Programme, the past 12 months have been incredibly busy but equally rewarding, and I look forward to the NCDAH results promoting key performance indicators and making recommendations for continuous learning and improvement. However, more than this, it has been an absolute privilege to have had the opportunity to be in contact with so many relatives and carers who have shown great courage in sharing with me their experiences and individual accounts of the recent death of a loved one. Some relatives have shared a negative experience so that they can improve the experience of a death for the next family; many have shared a positive experience to ensure that we continue to learn and drive up quality for care of the dying. The diagnosis of dying is always complex. The clinical decision-making process is challenging, and no single diagnostic tool can determine impend ing death. Good clear communication is pivotal, and the plan of care should be communicated to the patient when possible and appropriate and to the relative or carer without fail. It is clear from the experiences of relatives and carers that when there is a high level of communication and engagement, the last hours or days of life are managed more effectively and with greater care and compassion. In order to better understand and improve the experiences of patients and their relatives during hospitalization, the In s t i tu t e fo r Hea l thca re Improvement (IHI) conducted an indepth review of the research in this area, studied exemplar organizations, and interviewed experts in the field. Their aim was to identify the drivers of exceptional patient and family inpatient hospital experience (Balik et al, 2011). Drivers included strong leadership, winning the hearts and minds of staff, respectful partnerships, and reliable evidence-based care. I believe that the LCP programme aims to achieve all Deborah Murphy is Associate Director, Marie Curie Palliative Care Institute Liverpool, and LCP Lead Nurse of these; however, the LCP is only as good as the person using it. The LCP aims to support but does not replace clinical judgement. Education is key if we are to enhance clinical care. It is an indictment of our health-care system that care of the dying is not currently a core element of education and training for our doctors and nurses. If we are to make a real difference to care of the dying in our society, this is going to have to change. The LCP is not the answer to the challenges we face in care at the end of life, but I believe it is a step in the right direction. The document gives clarity and focus to the plan of care: communication, care, and compassion come from you.