How multi-disciplinary teams use the AMBER care bundle
Any member of the clinical multi-disciplinary team can identify patients suitable for the AMBER care bundle using the two questions below.
Stage 1: Identification
If the answer is “Yes” to both questions then the multi-disciplinary team is expected to proceed to the four interventions in the care bundle. As the AMBER care bundle is a multi-disciplinary tool, it involves doctors, nurses and the whole team working together.
Stage 2: Day one interventions
The AMBER care bundle has clear timescales for action. Patients should be involved in decision making throughout, at their own pace and in line with their assessed mental capacity. The timescales for decision making (four hours and 12 hours) were included as a result of feedback from staff as this clear timescale makes it more likely that actions and decisions are completed.
The care bundle includes decisions about cardiopulmonary resuscitation and escalation of care to critical care, but does not exclude these treatments. Some patients on the AMBER care bundle may be both for cardiopulmonary resuscitation and full escalation of treatment.
Some patients respond to active treatment and recover, whilst others do not and care for the last days or hours of life may become appropriate. Therefore, once a patient is identified as suitable for the AMBER care bundle, they will continue to be suitable until they either recover or an individual plan of care for the last days of life is developed. . If a patient is discharged from hospital, key information including information on their preferences should be communicated to relevant members of the community team.
When a patient's care is supported with the AMBER care bundle, both they and those who are important to them (as appropriate) should expect to receive daily contact by staff who assess and "ACT". This is the point at which staff check to see if the patient’s preferences for care have changed.
Stage 3: ACT - Daily monitoring and review
Stage 4: Discontinue the AMBER care bundle if
It is important that the patient's capacity to be involved in decision making is assessed throughout and this follows the principles of the Mental Capacity Act. Staff should follow their hospital's local guidelines and underpinning legal principles..