117 Hospital @Home and the Amber Care Bundle: Introducing the Concept of Uncertainty of Survival to Improve Advance Care Planning. (16th March 2021)

• Record Type: Journal Article
• Authors: MacDougall, A; Costa, S; Seymour, E; Yielding, R; Schiff, R
• Is Part Of: Age and ageing. Volume 50(2021)Supplement 1
• Page Start: i12
• Page End: i42
• Publication Date: 2021-03-16
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afab030.78
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Introduction: GSTT@home is a hospital@home providing multi-disciplinary acute care in peoples' homes throughout Lambeth and Southwark. AMBER is an internationally recognised care bundle to improve care for hospital inpatients where survival is uncertain. The bundle prompts recognition of survival uncertainty, communication and advance care planning (ACP)- principles relevant to many hospital@home patients. This quality improvement project aimed to embed these principles into GSTT@home by adapting AMBER to this community setting. Methods: Cycle 1 Plan- Determine whether @home patients might benefit from principles of AMBER. Do and Study- Audit patients >80 years that died within a 3-month period after @home admission (January–June 2018); one in 10 patients died (10.9%), median age 82 and median CFS 8. Act- Inpatient AMBER bundle adapted for @home setting to systemically identify and prompt ACP. Cycle 2 Plan and Do- AMBER@Home bundle formally introduced and piloted with @home, education using posters and lanyard cards. Study: Audit use of AMBER@Home for patients >80 years who died within three months of discharge from @home (August–October 2019). Act- AMBER@Home incorporated into daily handover document. Cycle 3 Plan and Do- Further education embedded AMBER@Home, increased consultant and GP support. Study- Use of AMBER@Home re-audited as above for November 2019–January 2020. Conclusions: Using AMBER@Home appears to have changed practice without the AMBER bundle being formally used. Throughout 3 audit cycles there was a steady increase in ACP. Future planned interventions include appointing a frailty nurse to @home team to further embed AMBER@Home, distributing lanyard cards more often and using "Coordinate My Care" to improve accessibility to ACP decisions including PEACE.