Background Assessment of hydration needs including, if appropriate, a trial of clinically assisted hydration (CAH) is a key recommendation of national guidelines for dying patients.^1,2 There is insufficient evidence regarding the benefits and burdens of CAH at the end of life^3,4,5 including inconclusive findings from a systematic review.⁶ Research is ongoing⁷ including a cluster RCT.⁸ The audit aim was to assess compliance with national guidelines in three settings: the hospice inpatient unit (IPU), a district general hospital and patients known to the community palliative care team.

Methods Ten audit standards were derived from NICE and GMC guidelines.^1,2 A target of 100% compliance with each standard was set. The audit comprised retrospective case note review of 60 patients (20 in each setting), identified as consecutive deaths of patients on an individualised end of life care plan from 1 st October 2016.

Results The frequency of documented mouth care and hydration assessment did not meet the audit standards in any setting. Most hospital inpatients had CAH in the last week of life (90%), compared with 10% of IPU patients and none of the community cohort. Discussion regarding risks and benefits of CAH was not widely documented, with the lowest figures for community (5%) and IPU patients (15%). In all cases in which CAH was started, the documented frequency of reassessment was less than the twice daily recommendation in national guidelines.¹

Discussion In part, some of the findings may reflect incomplete documentation. Since the audit, the following steps have been taken:

• Review of hydration needs assessment including changes to care plan documentation

• Meetings with district nursing teams

• Review of access to required equipment for administering CAH

• Education sessions for staff

• Review of hospital mouth care guidelines

We plan to re-audit to assess compliance with the guidelines following implementation of these changes.