141 Understanding and developing a community service to support the management of behavioural and psychological symptoms of dementia

<h3>Background</h3> Providing high-quality palliative care for people living and dying with dementia is essential. Some palliative care teams lack experience managing symptoms such as behavioural and psychological symptoms of dementia (BPSD). This project aims to check our community team are managing BPSD appropriately, identify care gaps and theme any complexities, in order to improve our service. <h3>Methods</h3> Retrospective review of community caseload identified patients referred with dementia from April 2023 to March 2024. A random sample of 20% was reviewed. In addition, 8 complex cases were highlighted by the clinical team, reviewed in detail and the issues identified were grouped into themes. <h3>Results</h3> There were 323 patients referred to our team over 1 year. Of the sample (72 patients) the most frequent referral reason was ‘symptom control’ (37%). The mean length of time on the caseload was 96 days. The majority of patients (56%) died under our care, of whom 75% died within 3 months. 21 of 72 patients had BPSD. 2 patients were prescribed an antipsychotic which was reviewed by a mental health professional. Carer burden was recognised in 46%. Sedatives were used appropriately when the person was in their dying phase. Review of complex cases (n=8) identified 4 key themes. 1) Challenges with palliative care teams managing BPSD, including inappropriate drug use 2) Recognition of dying with dementia is uncertain 3) Lack of communication with relevant external services 4) High carer burden. <h3>Conclusions</h3> Despite the challenges revealed by the 8 complex cases, the case review reassuringly shows appropriate medical management of BPSD. We have identified the need to improve non-pharmacological management and carer support through an ongoing quality improvement project. Training and guidelines for the palliative care team, clarity around the specialist palliative care role and improved links with community mental health and dementia services are essential.