Background NICE guidelines stress the importance of individualised anticipatory prescribing for people who are likely to need symptom control in the last days of life. A Community Palliative Care Drug Chart for the authorisation of individualised subcutaneous palliative care medication via injection or syringe pump was developed and introduced by a regional anticipatory prescribing working party. The chart does not use a proforma approach, which has been linked to over medication, but does incorporate guidance and is designed to cross settings. Aim . To evaluate whether the chart and guidance facilitates safe, appropriate and consistent anticipatory prescribing for patients 1 year after introduction. . To identify any required chart adaptations and areas for education.Methods The notes of 49 expected deaths from District Nurse caseloads were examined for the presence of a chart. 32 charts were reviewed to establish whether anticipatory prescribing complied with local guidelines and to record any themes from non-compliance. A survey of 20 local GPs was conducted.Results 47 of the 49 expected deaths had a chart in place. For as required medication the percentage meeting the standards for choice of drug, dose and route were as follows: opioid (84%), antiemetic (97%), antisecretory (94%) and anxiolytic (94%). In 7 cases the range for opioid or midazolam in a syringe pump was greater than advised in guidelines. All GPs surveyed agreed that the chart facilitates safe and appropriate anticipatory prescribing. Conclusion The chart and guidance facilitate safe, appropriate and consistent anticipatory prescribing for patients, resulting in improved compliance with standards when compared to a local audit from 2010. Changes to the chart and further education is needed in relation to syringe pump ranges and timing of authorisation. We have subsequently developed a new 'intelligent' protocol within the EMIS GP record to further enhance individualised anticipatory prescribing.

103 anticipatory medications administered 18.4% (19 out of 103 medications) had documentation of the effect on symptoms. There were 24 patients admitted to the specialist palliative care beds for end of life care over a 6 week perios, of which 21 had anticipatory medications administered. Of these patients 31.6% (18 out of 57 medications) had documentation of the effect on the patient's symptoms. Conclusions This study demonstrates that the effect of anticipatory medications is poorly recorded in the nursing notes on wards in a district general hospital. However, there is improvement when the patient is managed in a specialist palliative care bed on a general hospital ward. Further training is required to improve this documentation and allow accurate monitoring of symptoms. The designated specialist palliative care bed model may provide an opportunity for training of nurses across the hospital. Introduction Prescribing medications for patients 'to take out' (TTO) on discharge is a routine task for junior doctors. Prescribing end of life care medications as a TTO, such that a rapid discharge can be arranged for a patient wishing to die at home, is not so common. Inspiration and aim Born out of a highly emotive incident in which a patient did not receive his medications, a project to test, and subsequently improve, the accuracy of TTO prescriptions of these medications was initiated. Method A cohort of foundation year one doctors undertook an end of life care prescribing quiz (Quiz 1), asking them to give an example prescription for both controlled and non-controlled drugs, and to state any additional documentation required to validate the prescription in the community. A guideline was then created in collaboration with the palliative care team, junior doctors and pharmacists to improve the accuracy of TTO end of life care medications. The new guideline was delivered alongside a palliative care teaching session, with cross-reference to the Trust's palliative care guidelines. The same cohort of doctors then re-took the prescribing quiz (Quiz 2). Results The results of Quiz 1 highlighted worrying prescription inaccuracies: only 5% (1/20) of doctors correctly prescribed the medications and only 10% (2/20) identified the need for a community prescription chart. After guidance and training there was a considerable improvement in prescription accuracy (Quiz 2), with 75% (15/20) of doctors correctly prescribing the medications, and 88% (17/20) identifying the additional chart needed for administration. Future Going forward, the guideline is to be distributed to all junior doctors within the trust, through inclusion on the intranet and the introductory handbook, such that future situations of delayed dispensing of end of life care medications can be avoided. As part of a NCPC and ECIP project a day one census was carried out on the 21 st October 2015 and the patients survival followed up for a year. The census included all patients who were inpatients on the day of the census, excluding those in paediatric and maternity s...