Introduction There was anecdotal observation by professionals working across both sites that there was a difference to practice with opioid and sedative titration at the end of life. As an extension to early work at one of the hospices, it was decided to consider practice across the region, so a second hospice was invited to participate.

Aims To quantitively assess practice of sedative use in relation to the EAPC recommended framework for the use of sedation in palliative care.

To quantitively assess practice of opioid use in the terminal phase.

To assess whether practice differs between hospices in North Wales, and to consider any potential reasons for the difference and implications for practice.

Methods A retrospective case-note review of patients who died in the two units. Data collected included drugs, doses and increments, and proxy assessment of symptoms in the last week of life (MSAS-GDI).

Results Groups were comparable in terms of background and demographics.

Practice differed with one unit using Midazolam and Levomepromazine more frequently and at higher starting doses.

There was no difference to symptom burden between sites.

Discussion All doses used were within the limits described in the EAPC framework.

At subsequent focus group discussion potential reasons were discussed including differences in anti-secretory medication use and its impact on sedative use.

These findings have precipitated further work on both sites.