• Terminal care
• Hospital care

It was with interest that we read the paper recently published by Carey at al detailing the development and implementation of the AMBER care bundle.1 Like the authors of this work, we too have hypothesised that care bundles might offer an approach to incorporating care processes previously identified as likely to improve patient-outcomes into routine practise at the end of life. On behalf of the Calvary Mater End of Life group, this letter is presented to summarise our experiences thus far.

As the initial phase of a quality improvement project, an audit of care was performed with the aim of reviewing care as documented as received by people dying in the general wards of two teaching hospitals in regional NSW (Australia). The specific intent of this audit was to examine if the care documented as delivered could be considered quality care,2 with quality in this context referring to healthcare which is based on previously conducted trials, patient-centred, and safe. A care bundle was hypothesised as one solution to address the identified care gap.

A care bundle entitled the Care of the Dying Bundle was developed according to existing recommendations.3 Along with the audit of care, the bundle's contents were informed by: interviews with bereaved family members whose relatives had died on the acute wards where the project was undertaken;4 a systematic literature review (accepted for publication); an advisory committee. Collaboratively-agreed bundle items included: (1) a track and trigger chart to monitor people dying in hospital with predetermined calling criteria; (2) population of this chart with numeric (0–10) rating scales to record the presence and severity …