Background Dysphagia is a common life-threatening condition which can present as a complication of over 100 different palliative conditions (Chan, Tse, Sham. Dyspnoea and other respiratory symptoms in palliative care. In: Cherny, Fallon, Kaasa. (eds.) Oxford textbook of palliative medicine. 5^th ed.,2015). People with dysphagia have a high risk of acute choking episodes which is one of the most distressing symptoms of progressive disease (Murphy, Zatarain, Cmelak, et al. Palliative issues in the care of patients with cancer of the head and neck. In: Cherny, Fallon, Kaasa. (eds.) Oxford textbook of palliative medicine. 5th ed.) and is associated with significant morbidity and impact on quality of life (Coffey, Pasquale-Styles, Gill. Acad Forensic Pathol. 2014;4(1): 94–99). Choking episodes can be frightening for the person experiencing them and the carers and healthcare professionals who support them (Murphy, Zatarain, Cmelak, et al., 2015; Gotesman, Lalonde, McKim et al. Muscle Nerve. 2021;65(4): 400–404). It is essential to prepare health care professionals to confidently manage choking episodes (Chan, Tse, Sham., 2015).

Aim Quality improvement project to design, implement and evaluate an evidence based guidance flow chart and document for healthcare professionals on managing a palliative care medical emergency of adult acute choking episodes.

Methodology Quality improvement methodology (Jones, Kwong, Warburton. Quality improvement made simple: What everyone should know about health care quality improvement. The Health Foundation, 2021) included:

• Systematic literature review.

• Key stakeholders engagement.

• Plan Do Study Act (PDSA) cycles.

• Healthcare professional evaluation and feedback.

Results Choking management guidance can be used as a:

• Single page stand-alone flow chart.

• 6 page guidance document with list of 29 references.

• ‘Live’ PDF document with hyperlinks to key information.

A varied range of 150 health care professionals throughout the South West of England, completed an education session introducing the flow chart and guidance document.

• 100% evaluated the session as ‘very good’ or ‘excellent’.

• 100% reported an improvement to knowledge and 95% improvement in confidence in managing adult acute choking episodes.

Next steps Launch the guidance document widely. Incorporate into ICS (Integrated Care System). Amend for individual patient management plans. Choking management app for smartphone use.

Conclusion Dysphagia related acute choking episodes are common in palliative care conditions. The use of an evidenced based flow chart and guidance document has demonstrated to be an effective tool in improving healthcare professionals’ knowledge and confidence in managing this distressing symptom.