Background The London Ambulance Service NHS Trust (LAS) performs a vital role in the assessment and management of symptoms in end-of-life care (EoLC) patients during times of crisis. A previous clinical audit identified symptom control as an area requiring improvement. Following funding of a Macmillan EoLC team and release of national guidance, a re-audit was conducted to assess symptom control by ambulance clinicians.

Aim Review ambulance clinicians’ assessment and management of symptoms for patients nearing their end-of-life.

Method A retrospective clinical audit was conducted using data from 01/11/2019- 30/11/2019. From a total of 363 cases, 58 were excluded due to the patient having no identified EoLC needs. A resulting sample of 305 patient report forms were clinically reviewed.

Results Several elements of practice were encouraging but results highlighted a number of areas for improvement:

• Pain assessment: 84% of patients had an appropriate pain assessment documented.

• Pain management: 65% of patients presenting with pain/discomfort had analgesia administered by the attending ambulance clinicians.

• Pharmacological symptom control: 61% of patients received an appropriate pharmacological intervention when necessary. This included providing LAS issued medication for nausea/vomiting or anticipatory medications.

• Non-pharmacological symptom control: non-pharmacological interventions (e.g. re-positioning for breathlessness) were documented for 18% of eligible patients.

Conclusion End-of-life care is a novel area of pre-hospital care and whilst service improvement progresses (Murphy-Jones, Laverty, Stonehouse, 2021) it will take time to embed guidance and education into practice. Inherent actions in pre-hospital practice, such as non-pharmacological interventions may be undertaken but not documented and thus not captured by the audit process. It is clear however that EoLC symptom control requires improvement. The Macmillan EoLC team have shared findings with staff to highlight areas for improvement, created new guidance and enhanced education, covering both pharmacological and non-pharmacological symptom control. A continuous EoLC clinical audit within the Trust has been introduced to monitor and improve compliance.