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Dr.JohnEllershaw
MedicalDirector-MarieCurieHospiceLiverpool
Director-MariecuriePalliativeCareInstituteLiverpool
MarieCuriehospice
SpekeRoad
Woolton
LiverpoolL258QA
UK
T：+44（0）1518011490
E：john.ellershaw@mariecurie.org.uk |
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| Criteria to be registered as a Collaborating Centre for the Liverpool Care Pathway Project (LCP)(outside the UK) |
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| Introduction |
Page 3 |
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| Criteria to be registered as a Collaborating Centre outside the U.K |
Page 4 |
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| Appendices |
Page 5-16 |
Appendix1
10 step Implementation / Dissemination Programme |
Page 5-7 |
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Appendix2
Outline of a Bi-Monthly Project Update |
Page 8-11 |
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Appendix3
Translation Guidelines-EORTC |
Page 12-14 |
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Appendix4
PDSA Cycle |
Page 15 |
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Appendix5
LCP Central Team Contact Details References |
Page 16 |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| INTRODUCTION |
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| The Liverpool Care Pathway for the Dying Patient(LCP) has been developed in the U.K to transfer the hospice model of care into other care settings.It is a multi-professional document that provides an evidence-based framework for end of life care. |
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| The LCP provides guidance on the different aspects of care required, including comfort measures, anticipatory prescribing of medicines and discontinuation of inappropriate interventions. |
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| Additional, psychological and spiritual care and family support are included. |
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| The LCP replaces all other documentation in this phase of care and is applicable in hospital, hospice, care home and community settings. |
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| The LCP Central Team is currently working with a number of groups in various countries around The World regarding the development, implementation and dissemination of the Liverpool Care Pathway(LCP). |
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| The criteria below have been evolved following the experience of working with these groups. It is important to formalise the relationship with a collaborating centre to enable the development of an outline project plan for the development and implementation of the LCP in a new country. |
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| The LCP Central Team will be pleased to help and support collaborating centres implement, disseminate and sustain the LCP initiative within their clinical arena. |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| COLLABORATING CENTRE LCP REGISTRATION / IMPLEMENTATION GUIDANCE |
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| 1 |
There is an identified geographical collaborating centre (normally with a University link). |
| 2 |
The collaborating cetre is linked with a national organisation, which recognises the collaborating centre as a focal point for the pilot project with the LCP and subsequent dissemination.(This role may be shared by more than one collaborating centre in any one country). |
| 3 |
A lead clinician in palliative care and a project manager is to be identified at the collaborating centre. |
| 4 |
A project plan is developed and written based on the 10 Step Implementation Programme(See Appendix 1) |
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All parts of the services piloting and implementing the LCP should be registerd with the LCP Central Team in Liverpool UK. |
| 6 |
A Registration Pack will be sent to all Centres registering with The LCP Central Team Liverpool UK. |
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The Lead Clinician in palliative care together with the Project manager need to work in close liaison with the LCP Central Team both in the pilot and implementation phase and in the planning of any dissemination with the appropriate educational resources and training.
A Bi-monthly project planning report to identify progress made and the support needs required from the LCP Central Team U.K. A Project Report proforma is attached(see Appendix 2) |
| 8 |
If the LCP is to be used in a language other than English then a translation process following EORTC guidelines should be followed for translation of the goals. The translation of the prompts can be undertaken at a local level. The translation process should be followed and the final translation back to English should be forwarded to the LCP Central Team for agreement(Guidelines attached-See Appendix 3). |
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The Collaborating Centres have the option of using the LCP logo for their document-guidance for this can be obtained from the LCP Central Team. |
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Analysis will be offered by the LCP Central Team for a retrospective audit(Base Review) of current documentation and analysis of the first 20 pathways will also be analysed. This process is free of charge. |
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The potential for benchmarking(Collation of shared data) of the LCP should be included in the Project Plan and linked with the cross-country comparisons currently being undertaken by the LCP Central Team. |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| Appendix 1 |
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| 10 STEP IMPLEMENTATION PROGRAMME |
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| The key methodology used for this national infrastructure is based on a robust 10 Step implementation programme together with a comprehensive research and evaluation programme. This supports clinically based educational programmes, sustaining interest in the clinical workforce and attention to cultural organisational changes to ensure achievement of objectives and outcomes. |
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| LCP 10 STEP IMPLEMENTATION PROGRAMME |
| 10 STEP PROGRAMME |
PROCESS |
STEP 1
1A. Establish the LCP-gain specialist palliative care support & executive endorsement |
Consider key resource needs Identify key players within organisations / across the Health Economy, Nominate a project lead and or Clinical lead within each clinical area |
| 1B Register with the LCP Central Team |
Contact the LCP Central Team UK for a Collaborating Centre Registration Pack-complete a registration form & return it to the LCP Central Team UK with a letter of endorsement from organisational lead. & wider national agency / governing body endorsement. |
| 1C Education / Spread Mode |
Project Lead to consider educational programme outlining th role & purpose of the LCP and associated documentation-contact the LCP Central Team UK to discuss liaison for study day design & presentation |
STEP 2
Develop the documentation |
Consider clinical guidelines, relatives / carers infomation leaflets, grieving / bereavement leaflets and pilot site(s) |
STEP 3
Retrospective Audit / Base Review |
Contact LCP Central Team UK
Obtain 20 original Base Review Proformas
Review 20 sets of current documentation in accordance with the Base Review Handbook
Send completed proformas to LCP Central Team UK
Analysis and associated report available in 4/52
This process is free of charge
It may be appropriate to undertake more than 1 Base Review across an organisation-for further advice-contact the LCP Central Team UK |
STEP 4
Induction / Education Programme |
LCP Project lead may want to organise study day / programme for a geographical area & work with the palliative Care Service to devise a simple education process locally-this is usually intensive but short term & concentrates on how to use the LCP |
STEP 5
Implementation / Pilot |
Use PDSA Cycle(See Appendix 4)
Pilot over an agreed time frame into a clinical area. There will need to be close liaison with clinical teams for ongoing support, troubleshooting and momentum |
STEP 6
6A Reflective Practice
6B Analysis of first 20 LCP's used |
Palliative care team to work with clinical team to reflect locally on LCP usage
Contact LCP Central Team UK to obtain 20 original LCP Analysis Proformas
Transcribe informaiton from each of your first 20 LCP's onto the proforma using help book provided
Return proformas toLCP Central Team UK
Analysis & Report returned within 4/52 |
STEP 7
Evaluation & Training Needs |
Review educational needs of clinical teams & resource implications of increasing the number of clinical areas using the LCP |
STEP 8
Maintenance / sustaining educational programme |
Consider the needs & resource for sustaining ongoing educational initiatives
Many services have adopted a local key worker approach
Consider analysis / publication of activity in liaison with LCP Central Team UK |
STEP 9
Training the Trainers Programme |
Nominated personnel including the LCP Facilitator to liaise with the LCP Central Team re ongoing support-National Facilitator programme-sustaining educational initiatives within the clinical area
Attendance & participation at annual National / International LCP Conference |
STEP 10
Ongoing Analysis & Feedback |
Some areas liaise with own local Audit / Governance procedures in order to create ongoing analysis of LCP data consider national benchmarking-discuss with LCP Central Team UK |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| APPENDIX 2 |
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| PROJECT REPORT PROFORMA EXAMPLE |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| PROJECT REPORT PROFORMA |
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| UPDATE ON CURRENT POSITION： |
REPORT DATE：
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COLLABORATING CENTRE：
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| KEY ISSUES |
10 step Implementation Programme
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Education Programme
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Key Action Plan for Next 2 Months
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Identify Resource Needs From The LCP Central Team U.K
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Additional Information / Comments
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| APPENDIX 3 |
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| Translation Guidelines-EORTC |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| TRANSLATION GUIDELINES |
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SECTION 1：TRANSLATION PROCEDURE FROM ENGLISH
Cull A, Sprangers M, Bjordal K, Aaronson N, on behalf of the EORTC Quality of Life Study Group 'EORTC Quality of Life Study Group Translation Procedure' July 1998 EORTC, Brussels |
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A. FORWARD TRANSLATION(English->Language x)
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When it has been established whether all of the questionnaire or only some of the items require to be translated, two translators, native speakers of the language of translation(X) who have a high level of fluency in English, will be required. |
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The two translators should independently translate the questionnaire into the required language(X). |
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The translations should then be compared by the person responsible for coordinating the translation process. |
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a) |
Where there is agreement, the translation can be accepted for the provisional forward translation. |
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b) |
where there are differences, the coordinator of the translation process should aim to resolve these by discussion with the translators to yield a provisional forward translation. |
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c) |
Where disagreement is difficult to resolve on a few items, alternative wording may be offered in the provisional forward translation(for resolution through the back translation process). |
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d) |
In the case of multiple or fundamental disagreements, a third independent translator may be invited to arbitrate. This third translator should independently translate the problem sections of the questionnaire before being included in the discussion. The disagreement may be resolved by discussion with the translators or by proposing alternative wording for the back translation(as in c. above). |
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| 4. |
The process should be documented. The coordinator should record the stance of each translator in sufficient detail to explain any difficulties encountered and the rational for the solutions reached. Copies of all interim forward and back translations should be kept for inclusion in the translation report. |
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This process results in a single provisional forward translation(which may offer alternative wording for some items) |
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| The provisional forward translation is then ready for back translation. |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| TRANSLATION GUIDELINES |
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B. BACK TRANSLATION(LANGUAGE X-> ENGLISH)
Cull A, Sprangers M, Bjordal K, Aaronson N, on behalf of the EORTC Quality of Life Study Group 'EORTC Quality of Life Study Group Translation Procedure' July 1998 EORTC, Brussels |
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Two translators, native English speakers with a high level of fluency in language X, will be repuired. |
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The translators should independently translate the relevant sections(of the questionnaire) from the provisional forward translation back into English i.e. without reference to the English original. |
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The English translations should be compared with the original questionnaire by the person coordinating the translation process. |
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a) |
Where there is agreement between a translation and the original those sections of the provisional forward translation may be considered semi-final, i.e. ready for pilot testing. |
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b) |
Where there are differences the coordinator should attempt to resolve these by discussions with the translators. Where agreement can be reached the relevant sections of the provisional translation may then be regarded as semi-final i.e. ready for pilot-testing. |
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c) |
Where agreement still cannot be reached the provisional forward translation may require revision. Revisions may be arrived at by repeating the forward-backward translation process (if necessary incorporating an additional independent translator) until the back translation is sufficiently similar to the original questionnaire. |
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d) |
In the case of persistent difficulty alternative wording of the item(s) in question may be incorporated in the provisional translation used in pilot-testing. The interview used in the pilot test would then be incorporate questions designed to identify the wording which best meets the aims of the translation process (i.e. clear； language of common use； conceptual equivalence to original). |
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The process should be documented. The coordinator should record the stance of each translator in sufficient detail to explain any difficulties encountered and the rationale for the solutions reached. Copies of all interim forward and backward translations as well as the provisional forward translation (which will be used in pilot-testing) and its back translation, should be clearly marked for identification purposes and kept for inclusion in the translation report. |
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| The provisional forward translation can then proceed to pilot-testing |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| APPENDIX 4 |
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| PDSA CYLCE |
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| Process Mapping / The Deming Cycle |
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| The Plan, Do, Study, Act-PDSA method (Deming 1994) is a way to break down changes into manageable "chunks", to test each small part to make sure there is a measurable improvement and no effort is wasted. |
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STEP1-PLAN
・Develop a plan for improving quality |
STEP2-DO
・Execute the plan, first on a small scale |
STEP3-STUDY
・Evaluate / Feedback to confirm / adjust plan |
STEP4-ACT
・Permanent plan / adjust / repeat |
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The PDSA Cycle can test ideas for improvement quickly and easily based on existing ideas, research, theory, review and audit. It encourages starting with small changes, which in time can build into larger improvements in a service through successive quick cycles of change.
If change is seen as being everyone's concern and as an inclusive process then any member of the organisation who seeks to promote best practice can be a change agent and autonomy can be enhanced and not diluted.
Deming W, (1994) The New Economics for Industry, Government, Education. Second Edition. Massachusetts Institute of Technology Centre for Advanced Engineering Study. Cambridge, Massachusetts. |
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| THE LCP Central Team UK recommend use the PDSA Cycle as part of their improvement techniques / change management programme |
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| Criteria to be registered as a Cllaborating Centre fo the Liverpool Care Pathway Project(LCP)(outside the UK) |
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| APPENDIX 5 |
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| Contact Details： |
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| LCP Central Team |
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Dr.JohnEllershaw
Medical Director - Marie Curie Hospice Liverpool
Director - Marie Curie Palliative Care Institute Liverpool
Marie Curie Hospice
Speke Road
Woolton
Liverpool L25 8QA
UK
T：+44 (0) 151 801 1490
E：john.ellershaw@mariecurie.org.uk |
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Deborah Murphy
Directorate manager
National Lead Nurse - LCP
Directorate of Palliative Care
1st Floor Linda McCartney Centre
The Royal Liverpool University Hospitals
Prescot Street
Liverpool L7 8XP
UK
T：+44 (0) 151 706 2273 / 4
E：lcp@mariecurie.org.uk |
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| REFERENCES： |
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| www.lcp-mariecurie.org.uk |
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Ellershaw J E, Wilkinson S Co-editor and Contributor 'Care for the dying： A pathway to excellence' Oxford University Press, April 2003
Cull A, Sprangers M, Bjordal K, Aaronson N, on behalf of the EORTC Quality of Life Study Group 'EORTC Quality of Life Study Group Translation Procedure' July 1998 EORTC, Brussels |
