Background Acorns Children's Hospice provides paediatric palliative care to children and families in the West Midlands. Currently, there are over 600 children and families who access care in the Hospice. Care and support is offered from diagnosis of a life limiting condition through death and bereavement. A key aim of the hospice is to provide excellent end of life care. In order to provide an objective assessment of the quality of care provided we audited services against standards described in the guidance ‘Quality Markers for end of life care’ published in 2009 by the Department of Health.

Results/Recommendations/Actions The data was collected by retrospective case-note review of 15 consecutive deaths within the hospice. Analysis showed: Quality markers were met at 100% for: • recording and communicating wishes and preferences for those approaching end of life (although this varied in the specific detail) • written evidence of continuous assessment • A nominated key worker • families involved in end of life care decisions Areas for improvement and actions undertaken included: • Care pathway after death – we have now developed a pathway in line with National Guidelines • Communication with other professionals around family's hopes and wishes – we have been involved in the development of a regional tool (WMPPCN Advanced Care Plan) which we are now using. • Training programme – we have expanded and centralised this. • Refining documentation and recording of children and young people's choices at the end of life-a new procedure has been implemented so information is more easily accessible. We have found the Quality Markers for End of Life Care1 while developed for adult patients provide a useful framework to help assess care provided to younger patients.