• Am J Hosp Palliat Care · Feb 2014

    Clinical Trial

    Implementation of the Liverpool Care Pathway (LCP) for the dying patient in the inpatient hospice setting: development and preliminary assessment of the Italian LCP program.

    • Silvia Di Leo, Laura Bono, Vittoria Romoli, Emily West, Raffaella Ambrosio, Michele Gallucci, Paola Pilastri, Pietro La Ciura, Piero Morino, Massimo Piazza, Danila Valenti, Catia Franceschini, and Massimo Costantini.
    • 1Regional Palliative Care Network, IRCSS AOU S. Martino-IST, Genoa, Italy.
    • Am J Hosp Palliat Care. 2014 Feb 1;31(1):61-8.

    BackgroundThe Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce.AimDeveloping, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting.MethodsThis is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices.ResultsThe LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases.ConclusionsThe LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.

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