| Remove prognostication from eligibility criteria |
Health professionals highlighted the difficulty of predicting whether patients were going to die during their current hospital admission. Consequently, many were reluctant to make decisions on patients’ suitability for the AMBER care bundle based on their risk of death and instead focused on identifying situations of clinical uncertainty to inform their decisions. Additionally, health professionals suggested that simplification of the eligibility criteria to concentrate solely on ‘clinical uncertainty’ rather than ‘deterioration’ and ‘risk of dying’ would not only ensure that a wider group of patients would be identified and benefit from the AMBER care bundle, but it would mean that staff would not be required to use the ambiguity of prognostication as a decision-making tool. |
| Removal of daily review stickers |
Health professionals saw little value in the requirement of placing a yellow ‘A’ sticker delineating ‘AMBER’ on patients’ clinical notes to prompt staff to think about their situation. In practice, this task associated with the intervention was rarely completed. Health professionals therefore recommended that the sticker should be disposed with. |
| Daily review of the patient’s situation of clinical uncertainty |
Health professionals suggested that reviewing patients’ clinical uncertainty within the clinical team was not required daily since patients’ situations did not tend to change between recovery and deterioration that often. Further, some health professionals perceived that the requirement to revisit conversations on a daily basis were distressing for patients and family members. Staff therefore recommended that it would be more valuable and efficient to review patients’ clinical situations only where there was evidence of a more profound change in their situation. |
| Daily re-engagement with patients and/or family |
Paradoxically, patients and particularly relatives suggested that staff should provide a brief practical update to the patient and family each day regarding their general overall care. Aware of workload pressure of staff, patients and relatives suggested that these did not need to be lengthy discussions. Instead, they should be brief, covering any notable events that occurred throughout the previous day and provide a general update regarding their care. It was suggested that these brief updates could be undertaken by nurses and other ward staff who were present more often on the wards. |
