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BPJ 36 June 2011

Best Practice Journal

Treatment for the dying patient: The Liverpool Care pathway

This article has been removed as the Liverpool Care Pathway was discontinued in 2014 following a national review in the United Kingdom.

The Liverpool Care Pathway (LCP) is used to manage care in the last days and hours of a person’s life. This model is being increasingly adopted as the gold standard of care for the dying patient. Following training and registration, general practices can use the LCP themselves, or under the umbrella of registered DHBs, hospices, residential care facilities or hospitals. The purpose of the LCP is to standardise and manage the quality of care that a patient receives, and includes guidelines for symptom control, ongoing assessment and care for the family after death.

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Oxycodone use still increasing

Oxycodone is a strong opioid used for the treatment of moderate to severe pain in people for whom morphine is not tolerated or not suitable. Other options after morphine may include fentanyl or methadone, depending on individual patient circumstances. Despite this indication, oxycodone use continues to escalate in New Zealand and it is currently the most frequently prescribed strong opioid. Strong opioids should be used at the lowest effective dose, for the shortest possible time and stepped down as pain resolves. View Article

The fear of enabling; misuse of prescription medicines

Misuse of prescription opioids is increasing worldwide and many doctors are becoming reluctant to prescribe these medicines for fear of contributing to the problem. We present a true account of prescription opioid misuse and lessons that can be learned - do not fear prescribing opioids when use is justified, do not under-treat pain, be vigilant for drug-seeking behaviour. View Article

Vitamin D supplementation: Navigating the debate

Despite the increasing focus on vitamin D levels and claimed associations with many health conditions, there is no evidence to support blanket supplementation of the general population. Vitamin D supplementation should be reserved for those who are at risk of deficiency such as elderly people in residential care, people with darkly pigmented skin and people who receive little direct sunlight e.g. women who are veiled. Vitamin D supplementation at recommended levels is safe, however, there is emerging evidence that sustained, high levels of vitamin D are associated with adverse effects. View Article

Ischaemic cardiovascular disease

The purpose of the PHO Performance Programme is to reduce disparities and improve health outcomes for all people using primary healthcare services in New Zealand. Practices can make simple changes in order to contribute towards their PHO meeting indicator targets, in turn improving health outcomes for their patients. The PHO performance indicator and target for ischaemic cardiovascular disease is for 90% of enrolled patients aged between 30 and 79 years with ischaemic cardiovascular disease, to have been identified and coded within their patient notes. Coding of ischaemic cardiovascular disease enables the development of disease registers, and creates the best opportunity for secondary prevention. View Article

In the aftermath of a catastrophe: The Christchurch earthquake

An interview with Dr Chris Leathart, GP, Christchurch and a member of the bpacnz Clinical Advisory Group. View Article

Introducing the Health Quality & Safety Commission

The aim of the Health Quality & Safety Commission is to work with clinicians and health managers to support and encourage quality and safety improvements, to identify areas where improvements can take place, and to drive change. View Article

News in brief: Dabigatran; Antibiotics and COC; Prescription kitchen

Dabigatran to be listed | Most broad spectrum antibiotics do not affect the combined oral contraceptive | Prescription kitchen View Article

Correspondence: Smoking cessation and serotonin; Breast screening

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