palliative care 2a

Question 1

The Amber Care

Bundle

Answer 1

 Designed to prompt medical teams to have conversations with patients
and their carers when recovery uncertain
May still be being actively treated - not waiting until the patient is
dying

Question 2

Four components to the approach: The Amber Care

Bundle

Answer 2

Talk to patient and family re concerns about their condition, and
discuss preferences and wishes
 Confirm the current management plan
 Identify how the patient will be cared for should their condition get
worse
 Agree plan with MDT as well as the patient and family.

Question 3

Amber meaning

Answer 3

Assessment
Management
Best Practice
Engagement of patients/carers for patients
Recovery is uncertain

Question 4

How we die in NSW – the case for change

Answer 4

 Report* examined cost & utilisation of 37,000 people
who died in 2011/12 and were hospitalised in their last
year of life

Question 5

Where it fits

Answer 5

well
uncertain recovery
last days

Question 6

well

Answer 6

Previously well recovery expected

Question 7

uncertain recovery

Answer 7

Recognition of uncertain recovery

Question 8

last days

Answer 8

recognition of the dying phase

Question 9

Stage 1 – Identifying the patient

Answer 9

1. Is the patient deteriorating, clinically unstable and
   with limited reversibility? and
2. Is the patient at risk of dying during this episode of
   care despite treatment?
   yes to both - amber care

Question 10

Clinical Assessment -

Answer 10

Is the patient’s condition serious
enough that even with active treatment there is
uncertainty that they will recover?

Question 11

Review the patient’s admission notes

Answer 11

 History (co morbidities);
 recent admissions;
 physical examination;
 medications

Question 12

Supportive & Palliative Care Indicators Tool

Answer 12

Readily identifiable indicators of deteriorating health commonly present in
advanced conditions
 Promotes early supportive palliative care in parallel with optimal management
of any underlying conditions as part of routine clinical practice
 Evidence-based clinical indicators of all the major advanced, life-limiting
conditions and multi-morbidity

Question 13

Stage 2 - Day 1 Interventions

Answer 13

Within 12 hours of patient identification
 patient/carer discussion documented in medical record
 patient’s preferred place of care documented
 medical plan documented in progress notes
 escalation decision documented for clinical reviews and rapid response
team
 resuscitation plan completed

Question 14

Stage 3 - Daily monitor/review ‘ACT’

Answer 14

During daily ward remember to act
is your patient still amber
are there medical changes
Have you talked with the patient/ carer about the management plan

Question 15

Daily ACT

Answer 15

Daily acts should be clear and concise, completion should be done either nurse, doctor,patient

Question 16

Stage 4 - Cessation Details

Answer 16

 Reason for AMBER cessation documented
 AMBER cessation discussed with GP/LMO
 Document patient wishes/outcomes of discussion on
discharge summary
 Last days of life plan commenced (if applicable)

Question 17

Amber care stops if

Answer 17

Patient recovers
last days of life plan is commenced
patient dies
pt transfer/ discharge to an area amber is not used