Welsh Collaborative Care Pathway Project; 10 years experience of implementing and maintaining a care pathway for the last days of life

This paper describes the progression over 10 years of a project to implement a care pathway for the last days of life across Wales, leading to a major revision of the pathway in 2010. An initial 38 sites throughout Wales representing hospital, hospice and community settings registered. This has led to a robust end of life care network across the principality. In 2007 an annual audit cycle was established, with outcomes being fed back to the participating sites as well as informing an annual review of the integrated care pathway (ICP). In 2010, there are now over 100 sites using the ICP to deliver high-quality end of life care to patients in Wales. There has been a drop in the number of recorded variances of symptom problems. As a result of widespread adverse publicity, a fundamental re-write of the pathway was carried out. The new pathway was launched at a national conference and all teams provided with new documentation and explanation for the need to change. Within three months, most teams were using the new ICP and individual visits were carried out to those that had difficulty. In conclusion, it is possible to implement, sustain and maintain the use of an ICP for the past days of life over a large and varied geographical area. Major changes can be implemented quickly if sufficient involvement and explanation are carried out. The lessons learnt are transferable to other disciplines seeking to use an ICP.