Background Dysphagia is a common life-threatening condition which can present as a complication of over 100 different palliative conditions (Chan, Tse, Sham. In: Cherny, Fallon, Kaasa, et al (eds.) Oxford textbook of palliative medicine. 5th ed. Oxford University Press; 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. In: Oxford textbook of palliative medicine. 5th ed., 2015) and is associated with significant morbidity and impact on quality of life (Coffey, Pasquale-Styles, Gill. Academic Forensic Pathology. 2014;4(1): 94–99). Increasing evidence demonstrates personalised care through individualised contingency plans creates a positive impact on patient safety, experience and wellbeing (Healthcare Improvement Scotland. What matters to you? [internet] 2024; NHS England. The NHS Long Term Plan. 2019).

Aim A quality improvement project to design, implement and evaluate an evidence-based guidance template document which can be adapted for individualised contingency care planning for managing a palliative care medical emergency of adult acute choking episodes.

Methodology Quality improvement methodology included:

• Systematic literature review to develop an evidence based pathway.

• PDF template document created which can be personalised for individual patient needs.

• Patient and carer evaluation and feedback.

• Plan Do Study Act (PDSA) cycles.

• Incorporation to ICS (Integrated Care System).

Results During a 12-month period, 17 patients with palliative conditions including motor neurone disease, multiple sclerosis and progressive supranuclear palsy were identified in either a hospice or community setting as being at risk of dysphagia related choking episodes. All 17 patients had an individualised choking plan created using the PDF template and issued with a hard copy. 100% reported they were pleased to have a written hard copy plan. 100% of patients evaluated the choking plan as extremely helpful. 100% of patients reported improvement in confidence and preparedness in managing adult acute choking episodes.

Conclusion Dysphagia related acute choking episodes are common in palliative care conditions. The use of an evidenced based individualised contingency care document has demonstrated to be an effective tool in improving the impact on patient safety, experience and wellbeing in managing this distressing symptom.