In 2011/12, 34,446 patients died in NSW Acute Care Facilities. On average, these patients experienced four admissions or more that were greater than ten days per admission, in the 12 months prior to death.
It has been identified that the greatest challenges for staff providing end of life care relate to staff discomfort in initiating conversations with patients and carers; incomplete documentation; failure to recognise when patients are starting to die and then developing and documenting appropriate treatment plans; and poor communication between staff and patients and carers.
Documentation rarely demonstrates that patients and carers have been consulted about their preferred place of care.
The AMBER care bundle is a clinical care bundle developed at the Guy's and St Thomas' NHS Foundation Trust in the United Kingdom. It is a systematic approach for the multi-disciplinary team to follow when clinicians are uncertain whether a patient may recover and are concerned that they may only havea few months to live.
It encourages clinicians, patients and families to continue with treatment, if they wish, in the hope of a recovery, whilst talking openly about preferences and wishes, and putting plans in place in preparing for end of life.
The AMBER care bundle is a simple tool which combines identification questions, clinical interventions and systematic monitoring that can be applied in adult ward settings.
Early identification of people who may have end of life care needs is the foundation for providing safe, high quality end-of-life care. It enables appropriate planning, transfer, interventions and communication with the person and their family.
The CEC's AMBER care bundle is a component of CEC's End of Life program.
AMBER Care Bundle Resources
The following resources are available for facilities:
A pilot study was undertaken during 2013-14, to assess the transferability of the UK AMBER care bundle to the NSW health system. Seven facilities participated in the pilot, four of which were from metropolitan local health districts (LHDs), and three from rural LHDs.
All sites had small numbers of patients commenced on the AMBER care bundle. The pilot was successful in demonstrating that the UK tool could be used in NSW.
The main recommendations from the pilot were that CEC:
- act on the findings and opportunities identified through the pilot phase
- implement the AMBER care bundle across NSW facilities from July 2014
- develop a training and education strategy to support implementation and practice change