title: Use of a modified Liverpool care pathway in a tertiary Asian hospital: is there still a role for it?
abstract: BACKGROUND
  In 2007, the Care of the Dying clinical coordinated Pathway (CDP) was adapted from the United Kingdom Liverpool Care Pathway (LCP) and implemented in a tertiary hospital in Singapore to improve care in oncology and subsequently renal patients. With concerns about its use after the Neuberger review, an audit of patients on the CDP was performed to determine if the use of such a pathway should be continued locally.
  
  
  METHODS
  A two-year retrospective audit of CDP use was conducted. Aspects of communication, initiation of CDP, patient monitoring, medications, nutrition, and hydration were assessed.
  
  
  RESULTS
  In the 111 patient records reviewed, there were documented extent of care discussions with 94% of caregivers and 29% of patients before CDP initiation. Of the 88% of CDPs initiated within office hours, 90% fulfilled the inclusion criteria. All patients were monitored at least every eight hours. Seventy-three patients (66%) were prescribed opioids or sedatives and subsequently monitored appropriately, albeit 56% had no documented prior discussion with caregivers regarding medication use. Indications for opioid use were documented for all patients and only one patient had documentation of excessive sedation. Oral feeding and parenteral hydration were continued in 85% and 74% of patients, respectively.
  
  
  CONCLUSIONS
  There was no documented compromise in medication safety, clinical monitoring, and provision of nutrition and hydration for patients on the CDP. However, documentation of important end-of-life decisions and conversations remain poor. Development of an alternative care tool encouraging systematic discussion and documentation of individualized end-of-life care plans should be considered.
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Ong Eng
authors.initials: OE
authors.lastname: Koon
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Shirlyn Neo Hui
authors.initials: SN
authors.lastname: Shan
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Sushma
authors.initials: S
authors.lastname: Shivananda
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Tan Yung
authors.initials: TY
authors.lastname: Ying
authors.affiliation: 2Department of Quality Management, Singapore General Hospital, Singapore.
authors.forename: Arrynoer
authors.initials: A
authors.lastname: Thang
authors.affiliation: 2Department of Quality Management, Singapore General Hospital, Singapore.
authors.forename: Aung Myat
authors.initials: AM
authors.lastname: Kyawt
authors.affiliation: 2Department of Quality Management, Singapore General Hospital, Singapore.
authors.forename: Ulina
authors.initials: U
authors.lastname: Santoso
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Grace Pang Su
authors.initials: GP
authors.lastname: Yin
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Alethea Yee Chung
authors.initials: AY
authors.lastname: Pheng
authors.affiliation: 1Department of Palliative Medicine, National Cancer Centre Singapore.
authors.forename: Patricia Neo Soek
authors.initials: PN
authors.lastname: Hui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D019091:Critical Pathways / Q000592:standards*; D003657:Decision Making; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D013727:Terminal Care / Q000592:standards*; D006113:United Kingdom