AMBER Care Bundle

Hornsby Ku-ring-gai Hospital Palliative Care Service

Published: May 2023

The Hornsby Ku-ring-gai Hospital (HKH) Palliative Care Service is a specialist inpatient consult team that directly supports people admitted to the hospital and provides advice to treating and admitting teams. The palliative care team collaborates with admitting or treating teams to:

  • provide pharmacological and non-pharmacological management of distressing physical and psychological symptoms
  • assist and support with end of life care discussions and care planning (including transfer to a palliative care unit)
  • facilitate referrals to the Northern Sydney Local Health District community palliative care teams for patients being discharged home and requiring further support and case management.

AMBER Care Bundle is used to screen inpatients whose recovery is uncertain

The AMBER Care Bundle is a screening tool used to identify when the patient is deteriorating and their recovery is uncertain. Process followed by the HKH Palliative Care Service is shown below.

Inpatient specialist multidisciplinary palliative care team

Screening and identification of patients whose recovery is uncertain

Shared decision-making and communication with patients and their families

End of life care provided during admission

Systematic approach to assessing and managing patients and care planning

The HKH palliative care team supports the use of the AMBER Care Bundle in the hospital, providing a systematic approach to assist the multidisciplinary team to identify when an inpatient’s recovery is uncertain. AMBER refers to Assessment Management Best Practice Engagement of patients and carers for patients whose Recovery is uncertain.

This bundle enables care planning conversations to be initiated with patients and families earlier and allows them to have a better understanding of their condition. It also promotes ongoing conversations and advance care planning with their community care providers if the person recovers to the point where they can be discharged.

Benefits of using the AMBER Care Bundle

Between 14 July 2020 and April 2021, 165 patients were identified as being suitable for the AMBER Care Bundle. Of these, 49 died in HKH, 16 were transferred to the Neringah Hospital Palliative Care Unit where they subsequently died and 3 died at home. The remaining 116 patients were discharged to their usual place of residence or placed in a Residential Aged Care Facility (RACF). Only 32 patients experienced an inpatient readmission.

“The AMBER care bundle allows all multidisciplinary team members to have a voice and a role in care planning for patients. At HKH, medical teams rotate through inpatient services every 12 weeks, whereas nursing staff and allied health are based permanently on the various wards. As HKH serves an elderly population, nurses and allied health staff will often see the same patient over multiple admissions and are well placed to identify any ongoing functional decline or changes in the care needs of these patients. Medical staff find their input with the AMBER Care Bundle supportive and helpful, and feel it is a useful tool in identifying patients whose recovery may be uncertain.

The AMBER care bundle is empowering for all staff. It helps with decision making and plans.”

Neurology CNC

Useful tips

  • Education for all medical, nursing and allied health staff is key when implementing the AMBER Care Bundle.
  • To promote the use of the bundle and distinguish it from palliative and end of life care, it is useful to identify a local clinical sponsor who is not associated with a specialist palliative care.
  • Use tools within the eMR to document family discussions and goals of care decisions.
  • Advanced trainees are well placed to undertake quality improvement projects, e.g. reviewing the quality of the screening conversation and documentation of a patient’s agreed plan.

Download the full local initiative for AMBER Care Bundle, Hornsby Ku-ring gai Hospital (PDF 843.4 KB)

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