AMBER Care Bundle

Aim

The AMBER care bundle provides clinical teams a framework to develop a management plan that may include end of life decisions in collaboration with the patient and family for patients whose recovery is uncertain while continuing with treatment in the hope of a recovery. 

Benefits

Early identification of people who may have end of life care needs is the foundation of excellent end of life care. If early identification does not occur then appropriate planning, transfer, interventions and communication with the person and their family cannot take place

The AMBER care bundle:

  • Provides a tool to help clinicians identify people for whom recovery is uncertain and who may have end of life care needs
  • Simplifies key interventions to support best practice
  • Supports staff to start conversations about possible outcomes, including dying and death
  • Gives patients and carers and others close to them time the opportunity to be involved in decision making about their care and preferences for treatment, place of care and dying and to prepare for possible death.

Summary

The AMBER care bundle (Assessment Management Best practice Engagement of patients and carers for patients whose Recovery is uncertain) was developed at the Guy’s and St Thomas’ NHS Foundation Trust in the United Kingdom and localised for use in NSW health care facilities. 

The AMBER care bundle is a simple tool which combines identification questions, four clinical interventions and systematic monitoring that can be applied in adult ward settings. There are four components to the approach:

  1. Talking to the patients and their family to let them know that the healthcare team has concerns about their condition, and to discuss their preferences and wishes
  2. Confirming the current medical plan
  3. Deciding together how the patient will be cared for should their condition get worse
  4. Agreeing the plan with all the clinical team responsible for the patient’s care as well as the patient and family.

The patient’s condition is then monitored closely and reviewed at least daily to record any changes (medical or patient preferences) and address any concerns they or their family have.

Patients whose recovery is uncertain: previously well - recovery expected; recognition of uncertain recovery; recognition of the dying phase. Copyright: Guys and St Thomas NHS Foundation Trust, UK 2013.

Background

The ACI Diagnostic Report to inform the Model for Palliative and End of Life Care Service Provision (2014) examined the cost and utilisation of inpatient services by 37,000 people who died in 2011/12 and were hospitalised in their last year of life. These patients had an average 4 admissions with average LOS of 10 days; had a high proportion of emergency or unplanned admissions; had high level of multiple admissions; and most died in hospital.

The 2012 QSA Self-Assessment identified that the greatest challenges for staff providing end of life care related to staff discomfort  initiating conversations with patients and carers; incomplete documentation; failure to recognise when patients are starting to die; and poor communication between staff and patients and carers.

The Between the Flags program, as well as IIMS reports and Root Cause Analyses, has shown that a common concern is the failure of treating teams to identify patients at risk of dying, and then develop and document appropriate treatment plans and communicate appropriately with patients and carers. Documentation rarely demonstrates that patients and carers have been consulted about their preferred place of care.

What patients receive

  • Patients receive care supported by the AMBER care bundle.
  • This care includes reviewing the patient’s treatment plan or medical plan and involving patients in decisions around their care.
  • They remain suitable for the care bundle while their recovery is uncertain. They are not ’on’ the care bundle.

Partnerships

Other Pillars:

  • HETI
  • NSW Kids and Families
  • Cancer Institute NSW
  • ACI
  • CEC

Other NSW Health:

  • Ambulance Service NSW

Key Dates

Pilot Sites

Program Progress - AMBER care bundle pilot

From October 2013 – June 2014 a pilot study assessed the transferability of the UK AMBER care bundle to acute care settings in the NSW health system. Key findings include that:

  • The AMBER care bundle is transferable to the NSW health system
  • The tool can play a role in improving development of management plans for patients whose recovery is uncertain
  • There is uncertainty in diagnosing dying and lack of willingness to commence end of life discussions when recovery is uncertain;
  • There is a need to recognise how the AMBER care bundle will work with different medical models e.g. GP VMOs
  • There is a lack of clarity and consistency of language relating to end of life;
  • There is a need to define the functioning of the multidisciplinary team and the roles and responsibilities of team members in end of life planning; and
  • There is a lack of standards for documentation of conversations with patients and their families.

Implementing the AMBER care bundle

The simplicity of the AMBER care bundle masks the complexity of change. The speed of implementation in any hospital will depend upon a number of factors, such as the experience and influence of clinical leads and senior executive buy in.

Before you commence implementing the AMBER care bundle it is essential to your success to have the following elements in place.

  1. agreement that there is a problem worth solving
  2. a nominated facility sponsor and support processes established
  3. a nominated ward to commence program
  4. a prepared ward
  5. a governance and evaluation plan

Implementation Sites

The program is being progressively rolled out to interested sites following the pilot.

Southern NSW Local Health DistrictBega District Hospital
Western NSW Local Health DistrictOrange Health Service
Western Sydney Local Health DistrictWestmead Hospital
Blacktown Mount Druitt Hospital (Blacktown Campus)

Evaluation

Each site will have to collect process and outcome data. An evaluation strategy for the statewide program is being developed.

Related Initiatives

The AMBER care bundle works with other programs such as:

Contact

Bernadette King
Program Lead, End of Life Program
bernadette.king@health.nsw.gov.au
02 9269 5522

A/Prof Amanda Walker
Clinical Director, QSA and EOL Programs
amanda.walker@health.nsw.gov.au
02 9269 5596

Page Top | Added: 25 June 2013 | Last modified: 9 November 2015