AMBER care bundle...getting started Ready for change? Senior leaders demonstrate support Need for AMBER care bundle is recognised: non-palliative care medical/senior nursing engagement as well as palliative care
AMBER care bundle is viewed as fitting into other important hospital initiatives Effective care for patients in the last days of life Practical support / project support in place 2 Prior to ward implementation Identify roles and responsibilities Who will lead? Clinician engagement all or one? Baseline audit/review sentinel events/complaints what are you trying to change/improve?
Ward level engagement Communication - Ensure benefits to patients & staff are clearly explained as well as commitment required i.e. conversation / documentation Scope the ward Identify ward specific/staff specific issues Education & training requirements/priorities Staff training & development needs Understanding principles and practice AMBER care bundle Raising/receiving a concern Communication skills: difficult conversations both confidence and skills
Daily ACT communication skills 4 Step 1: Introducing AMBER care bundle Meet with senior medical & nursing team Establish program for ward/specialty e.g. working group; governance; awareness campaigns; issues log Involve Palliative Care teams Education sessions Who will undertake education Not a one off process
Formal/informal ward based session e.g. huddles/journey board discussion Communication skills Staff need to understand what it is, its benefits and their roles and responsibilities Set launch dates Step 2: AMBER care bundle in practice Identifying appropriate patients Daily ward rounds Practice using the care bundle until confident Prompt identification of patients e.g. use SPICT trigger tool Completion of documentation, decision making
process & difficult conversations Daily ACT Role modelling conversations/documentation Resources 6 Step 3: Staff using AMBER care bundle Staff identify patients and go through the process Further teaching as needed Clinical leads High visibility on wards Trouble shooting Supporting decision making
Team meetings/huddles to review implementation Is it working? Why? Why not? Do you need to revise input? 7 Step 4: Sustainability The AMBER care bundle needs to become part of every day practice / patient management planning e.g. patient safety checklists; clinical review patients; huddles Monitor progress of ward Audit / data collection Ward based champions Education provision for new staff
8 Implementation success: how will you know? 5 random staff can explain when & how the AMBER care bundle should be used Staff are able to independently identify & manage patients using the AMBER care bundle. Education evaluation Nursing staff: Minimum of 80% have undertaken basic level education on the AMBER care bundle
Medical staff: Basic level of education: 1 senior medical meeting (minimum requirement) junior doctors induction/education sessions 9 Team roles and responsibilities Team roles & responsibilities Defining team roles and responsibilities enables you to identify all tasks, list all roles, resolve overlaps, and fix gaps Group projects proceed more smoothly when
everyone knows what is expected of them In addition to promoting better health outcomes for patients, interdisciplinary collaborative work provides opportunities for informal education across disciplines and enhances skills and knowledge of other professions, as well as a sense of understanding and respect amongst health care professionals (Paquette-Warren et al., 2004). Ultimately it is the responsibility of the team to define the roles and responsibilities for each of the providers on the team Multidisciplinary (MDT) Team & AMBER Nursing Staff Medical team
Can identify patients suitable for AMBER care bundle and discusses with MDT Initiates and documents patient plan of care Leads and/or participates in daily ACT Supports the performance improvement process Can identify patients suitable for
AMBER care bundle and discusses with medical staff /MDT Educate/support patient and family Communicate with other members of the health care team Manages daily ACT review Participate in multidisciplinary rounds, including those that may be specifically focused on management planning Allied health staff
Can identify patients suitable for AMBER care bundle and discusses with medical staff /MDT Collaborate with care team specific to management needs Assist with patient / family education or questions Benefits of MDT team approach Improves care by increasing coordination of services, especially for complex problems i.e. time efficient It encourages team development in the following areas: Shared Mental Model (all team members know the plan for the patient)
Situational Awareness (all team members know what is going on around them) Mutual Support and respect (all team members are supportive of each other and learn to respect each others comments) The opportunity is explicitly provided to focus on and clarify progress, medication, escalation and other issues with all team members Adapted from CEC In Safe Hands program Facilitated Discussion Consider these questions as a Team Do you currently address patient care planning in multidisciplinary rounds?
What works well? What could be improved? Who participates? If you do not do the above, why not? What will it take to implement such rounds? Who will be supportive? Where might resistance be encountered? What are the roles and responsibilities of members of the health care team, as related to developing patient goals of care? Consider these questions as a Team How will you first identify that a newly admitted patient is in the target population
for this project? How will the medical consultant be notified that a potential AMBER care bundle patient has been admitted? What secondary screening criteria will the consultant use to confirm use of the AMBER care bundle intervention with the patient?
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