Implementation of the AMBER Care Bundle© began at Aintree University Hospitals NHS Foundation Trust in January 2015. The local population served by the Trust includes some of the most socially deprived communities in the country, with significantly lower than the England average life expectancy and high levels of morbidity. The population profile is also ageing rapidly.

The AMBER Care Bundle© provides a systematic approach to managing the care of hospital patients who have end stage progressive disease and are facing an uncertain recovery from an acute deterioration in their condition. The AMBER care Bundle© has been identified as one of the five key enablers in the Transform Programme to improve End of Life Care in acute hospitals.

Currently 53% of deaths occur in hospital in England. It is estimated that 33% of these deaths could be in the patient’s home. Aintree has included the AMBER Care Bundle in its Avoidable Mortality work programme, as it is recognised that managing clinical uncertainty can result in delayed recognition that a person may be approaching the end of life; this can lead in a failure to address the patient’s preferences, particularly regarding place of care.

If honest and timely conversations are not broached with dying patients then Advance Care Planning cannot take place, preventing inappropriate hospital admissions and interventions.

The hospital also included the AMBER Care Bundle© in its quality strategy as whilst it recognised the value in preventing inappropriate readmissions to the Trust it also recognised the main aim was to improve patient care and experience at end of life.

An opportunity was identified to second an experienced Clinical Nurse Specialist (CNS) from the Palliative Care Team to implement the AMBER Care Bundle © across the Trust. The AMBER Lead Nurse could therefore be ward based to give the opportunity for ad hoc training and advice in end of life care.

The CNS also gains insight into the problems that wards are facing at the frontline. By using an experienced Macmillan CNS it allowed engagement with other departments and teams throughout the Trust such as the Medical Emergency Team, The Business Intelligence Unit and the Mortality Groups for each department. The CNS also attends the Avoidable Mortality Reduction Group and through having up to date, relevant ward experience, she can participate from a ward perspective. The CNS has also been keen to engage with other Trusts which have allowed them to learn as well as to share developments made at Aintree.

Engagement with the National AMBER Care Bundle© Team has been an opportunity to develop and share practice not only on a National level but also an International level with Australia and New Zealand also recognising the benefits that the tool can bring.

Implementing End of Life Tools requires education and experienced support. The right tool, at the right time, in the right place.

For further information please contact Jeanette Renshaw – AMBER Care Bundle Lead Nurse [email protected]

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