This is the first study to engage directly with palliative care patients and to establish their views on the timing of corneal donation discussions. Patients are willing to discuss donation, and further exploration of patient views in this area should be undertaken.

Haemorrhage can be a distressing symptom encountered as a presenting feature of illness, or in extreme cases as a terminal event. Bleeding can occur locally at the site of disease, as a complication of its treatment, or as part of a systemic bleeding disorder. Initial management includes control of blood loss, fluid resuscitation, and identification and reversal of potential causes. Careful consideration and discussion with the patient is needed to clarify preferences for life-prolonging treatment versus symptom control alone, and preferred place of care. Acute care settings can provide additional therapeutic options such as surgery, interventional radiology, and radiotherapy for cancers. Site-specific measures are included in this chapter along with general interventions for control of bleeding.

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. 1 CCG now has 68% of all deaths (90% 'predictable' deaths) identified, registered on EPaCCS and receiving care. This CCG also has the lowest% hospital deaths in England. One CCG is less well engaged. Discussion Multiple interventions to identify, communicate and provid...

Background CPR decisions are a significant part of advanced care planning. Clear communication with patients and those important to them, and documentation of decision making, is essential for good care and, following court cases, is now also a legal requirement. Purpose The audit aim was to assess documentation of CPR decisions and communication on admission to Marie Curie Hospice Bradford and review CPR documentation on the patient's electronic palliative care co-ordination system (EPaCCS). Methods Standards were set using Resuscitation Council (UK) and GMC guidance and the hospice's CPR policy. All admissions between 1 st-31st January 2017 were audited and results compared to an initial audit in 2016. The 2017 audit was extended to assess CPR decision making documentation on EPaCCS.Results 38 admissions were audited. All had a CPR decision documented of which 32 were DNACPR. 22 were discussed with patients, 9 with relatives and 8 were not discussed. In 2016 of 37 admissions audited, all had a CPR decision. Only 13 DNACPR decisions were discussed with patients.On EPaCCS, of the 10 DNACPR decisions not discussed at admission, 6 were discussed previously with patients and 2 were not discussed. Conclusions and recommendations In both audits 2 audit standards were met:. All patients should have a decision about CPR at the time of admission. . CPR decisions and rationale should be clearly documented.2 standards were not met:. CPR should be discussed with all patients. . CPR should be discussed with relatives/those important to the patient.As the hospice moves to electronic patient records documentation will be modified. In addition to general advanced care plans, 3 specific sections are to be completed for CPR decision, discussion with patient and discussion with relatives.The aim is to improve documentation of discussions and continuity with EPaCCS. A re-audit will be completed. 80 WHAT PREVENTS ADVANCE CARE PLANNING IN HAEMATOLOGY?Alice Travers, Graeme Donald. Salford Royal NHS Foundation Trust, University of Manchester 10.1136/bmjspcare-2018-ASPabstracts.107Background Despite a clear emphasis in policy on the importance of advance care planning (ACP) for achieving quality end of life care, rates of ACP completion remain low. This is particularly apparent for patients with haematological malignancies and is associated with high rates of hospital death and patients receiving aggressive treatments at the end of life. This impacts on quality of life and family bereavement. Although patients tend to be receptive to ACP discussions they expect healthcare professionals to instigate them. Current evidence exploring barriers and facilitators to ACP from the healthcare professionals' perspective is limited.Aim To explore what doctors and nurses identify as the barriers and facilitators to ACP for patients with haematological malignancies. Method One-to-one semi-structured interviews were conducted with a purposively recruited sample of 5 doctors and 5 nurses working in a haematological malignancy setting. Thematic data an...