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P7 Red Envelope Scheme
  1. Shirley Young and
  2. Deb Hickey
  1. St Luke’s Hospice, Basildon, UK


Ambulance crews reported lack of information with regards to patient care & wishes, meaning their default position was Hospital admission as they could not ‘waste time’ looking for relevant documentation eg Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms, ‘hidden’ in copious patient records.

Aims To give crews readily accessible Patient information, enabling them to make decisions about best care, recognising patient choice.

To prevent unnecessary or unwanted hospital/hospice admissions for palliative patients. A form was designed which included Information regarding patients’ Preferred Priority of Care, DNACPR, medications and contact details of relevant Health Professionals. This was agreed by the Ambulance Service.

An A5 Red envelope labelled ‘FOR AMBULANCE CREW ONLY’ held the completed form, to be The Scheme was piloted for 3 months from April – July 2012

During the trial 24 forms were completed and held by the patient and family

The checklist was described as ‘Directional Documentation’ by the Ambulance service. The contact numbers and information gave crews the opportunity to call and discuss the situation with other professionals.

Subsequent improved communication between services has resulted in Ambulance crews anecdotally describing a change in practice and increased confidence in making decisions to support patients to remain at home.

Discussion In the absence of Electronic Registers within our locality, the intermediate solution was to introduce the Red Envelope Scheme which gave Ambulance crews the right information at the right time. However despite the large catchment area of the Hospice the Scheme reaches a small percentage of patients with palliative care needs.

Conclusion Crews now look for a red envelope in the patient’s home. It gives support to crews to make the right clinical decisions and the opportunity to influence the patient journey in a more positive way.

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