3746 Improving prescribing of anticipatory medications for deteriorating patients in an acute hospital setting

Abstract Background Anticipatory medications (AMssupport symptom management in patients nearing end of life. NICE guidance recommends early, individualised prescribing with shared decision-making. At WUTH, AMsare prescribed via a Cerner PowerPlan. A 2023 quality improvement project (QIP) identified delays in prescribing and inconsistent documentation. Interventions included junior doctor and pharmacist teaching, and feedback to the palliative team. Methods A retrospective review of adult inpatient deaths during October 2024 at Arrowe Park Hospital was undertaken. Exclusions included sudden and paediatric deaths. Extracted data from electronic records included AM timing, prescribing team and Care in the Last Days of Life (CILDOL) template usage. Results were compared to October 2023 data. Results: 90 patients met inclusion criteria. AMswere prescribed in 98% of patients, up from 96% in 2023. Average time between prescribing and death improved from 6.9 hours to 4.8 days. 76% received AMswithin one week of death. Prescription of all four recommended drug classes rose from 84% to 93%. Palliative care referrals occurred in 85% of cases. CILDOL use by the palliative team improved from 60% to 76%, but parent team use remained low (13%). Documentation of side effect discussions improved from 44% to 70%, though over half were brief. Conclusions Improvements were seen in timely and comprehensive AM prescribing following targeted education. However, underuse of the CILDOL template by non-specialist teams persists, highlighting the need for ongoing sustained education and system-level prompts. Regular re-audits are planned to embed best practice and support high-quality end-of-life care.