NHS Wales Message In A Bottle Scheme

– NEWS –
How can an individual’s fridge help in alerting paramedics to important care plans? Here, we describe a project that has been running in Wales for several years.
The bottle is available in all pharmacies in Wales, and can contain forms such as patient held ADRTs, or even allergy information. The sticker goes onto the inside of a patient’s door.


Paramedics from Welsh Ambulance Services NHS Trust (WAST) are increasingly called to palliative care patients at a point of sudden deterioration, or crisis. The responding paramedic will not know the patient and not always have access to medical records prior to their arrival, therefore any assistance with information gathering on site is extremely useful. In Wales, paramedics receive bespoke end of life training and many have also attended the Welsh serious illness conversation programme. They have a lot to offer and can help patients with severe symptoms, even helping to avoid unwanted (by patients) blue-light hospital admissions in end of life care situations.

The Message in a Bottle Scheme for important forms:

It may not be deemed practical for a person to carry a DNACPR (Do Not Attempt Cardiopulmonary resuscitation) or ADRT (Advance Decision to Refuse Treatment) form on their person at all times. So what happens if a person lives alone, but still wants paramedics to find important documents? It is useful when family members, friends and neighbours are aware of specific wishes and perhaps even have a copy of any forms available, or photograph them with their phone. A few patients have in the past ordered medical alert bracelets, as an additional form of communication: these can be engraved with a message, such as: “I have an Advance Care Plan” or “Please read my Advance Decision to Refuse Treatment form in my handbag”. Some have also created QR codes that directly link to such a written plan or advance statement. But the above measures may not always be sufficient.

All Welsh paramedics, when visiting a person’s home, look out for the message in a bottle sticker (see image above) on the inside of a person’s front-door: In a home situation, this scheme, also known as the Green Bottle in Fridge scheme, with a sticker inside the front door, is well established in Wales: paramedics look for a green sticker inside the front door routinely when they go on house calls, which alerts to the presence of a green bottle in the fridge. Then they know there is something important they have to check for. Anyone can put their DNACPR form, or ADRT, or other care plan summaries into the container in the fridge. Or they can place a written instruction on where to find all the important forms in the house (“My DNACPR form and my Advance Care Plan are all in living room on bottom left shelf in the red folder”). The Lions/Rotary Club websites also have information on this scheme. (1) The UK Lions Clubs and Rotary Clubs supply the bottles to health centres, doctors’ surgeries and chemists, but other green/white bottles can also be used.  The green Lions/Rotary bottles are also available directly from local clubs.

Message in a bottle poster by Welsh Ambulance Service


Paramedic training scheme in Wales


For further resources with regard to advance care planning, please visit the all Wales Advance & Future Care Planning site, hosted by the NHS Wales Executive.

A PDF with resource links can also be found here. DNACPR & AFCP NHS Wales Resources 2023

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