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Lessons from an incomplete implementation project introducing the AMBER care bundle
  1. Kirsty Randall,
  2. Annamarie Challinor,
  3. Bie Nio Ong
  1. End of Life Partnership, Sandbach, UK
  1. Correspondence to Professor Bie Nio Ong;{at}


The AMBER care bundle was formally adopted in 2015 by the National Health Service (NHS) Improving Quality and provides a systematic approach to managing the care of hospital patients who are facing an uncertain recovery and who are at risk of dying in the next 1–2 months. This paper describes the introduction of this approach in an acute hospital and analyses why the implementation remained incomplete. The normalisation process theory (NPT) is used as the conceptual framework to understand the complex processes involved, the importance of context and sense-making. Key learning points from the incomplete adoption of the AMBER care bundle are outlined. We conclude that the NPT is helpful in monitoring progress and allow for timely adaptation to ensure successful implementation. We suggest that its use as a diagnostic tool might be explored.

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  • Contributors AC and KR designed and carried out the project and provided extensive comments for the final draft. BNO drafted the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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