AMBER Care Bundle

Problem Statement

The AMBER Care Bundle is a communication tool used for patients who are identified as having an uncertain outcome during their hospital admission. The tool triggers key activities and discussions to occur between health professionals, patients and their families to ensure there is a consistent approach to communication and goals of care.

In 2015, there was a clear mandate for change in the way that clinical teams communicate sensitive concerns around deterioration and risk of death to a patient and their whaanau. The AMBER Care Bundle tool was introduced to provide a systematic approach and support clinicians to have a series of conversations about the goals of treatment, treatment options and any concerns about the patient’s condition, then communicate these conversations to the wider multidisciplinary team.

AMBER stands for:

• A – assessment
• M – management
• B – best practice
• E - engagement with patients and carers of patients whose…
• R – recovery is uncertain.

What are we trying to achieve?

AMBER Care encourages staff, patients and whaanau to continue with treatment in the hope of a recovery, while talking openly about people's wishes and putting plans in place should the worst happen. It is a patient-centric tool that takes into account people’s cultural, spiritual and personal preferences and choice, as well as the clinical elements and treatment decisions.

AMBER Care consists of four elements.

• Talking to the person and their family to let them know that the healthcare team has concerns about their condition, and to establish their preferences and wishes.
• Deciding together how the person will be cared for should their condition get worse.
• Documenting a medical plan.
• Agreeing these plans with all members of the clinical team looking after the person.

The person’s condition is then monitored closely and followed up on a daily basis to record any changes and address any concerns that they or their family may have.

The following graphic demonstrates where the AMBER Care Bundle fits within a patient’s trajectory towards the end of their life.

What have we done?

• Carried out a stocktake analysis of the current state of AMBER Care and how well it is used within wards.
• Reviewed approaches to evaluating the AMBER Care Bundle, such as formal research methodology and clinical audit.
• Developed an alert flag through eVitals, so nurses can identify patients that have been placed on the bundle.
• Delivered a case presentation to the hospital Grand Round. This provided an opportunity to gather views on how AMBER Care is being perceived and used by clinicians, and give an indication of how we can further use the tool in practice.

Been involved with various workstreams that contribute to recognising and delivering care at the end of life to understand how AMBER contributes and aligns with other pieces of work, such as advanced care planning and developing shared goals of care.

What did we find?

The AMBER Care Bundle enables people to be treated with dignity and respect, and to receive consistent information from their healthcare team. It helps people and their carers be fully involved in making decisions and understand what is happening with their care. It also matches CM Health values.

How did we make a difference?

Anecdotally, AMBER has been recognised at a clinical level as having value and improving the quality of patient care, and has been described as ‘the right thing to do’.

Where to from here?

AMBER Care is embedded in those wards that have been using the tool since it began in 2016. However, it has not been possible to roll the tool out further as the Amber Care Facilitator position ended in December 2018.

Wards that have come on board more recently have struggled to use the tool fully.

Next steps will be to:

• appoint a new facilitator, with the scope to work at the frontline to further embed AMBER into the adult inpatient wards, Emergency Department and Medical Assessment Unit
• develop outcome measures for and system-level reporting about AMBER
• continue to be involved with all of the work related to end of life care, to ensure there is alignment and minimise duplication.