Background Syringe drivers are routinely used in palliative medicine for the subcutaneous infusion of drugs. Local site reactions can lead to patient discomfort and the potential for sub-optimal symptom control. A site reaction is defined as 'an adverse incident occurring at the point of drug delivery'. Anecdotally, we observed frequent site reactions in our clinical practice without formal record of prevalence within our inpatient unit. We decided to perform an audit to determine whether our practice is in keeping with local/national guidance and whether outcomes were within acceptable limits.

Methods Aims/objectives -

• Site reactions are within 'acceptable limits'

• Site reactions are recognised

• Recommendations/guidelines regarding site management are followed

• Appropriate drugs/diluents used.

Standards

• Prevalence of site reactions <20%,

• Sites inspected 4 hourly (100%),

• Sites rotated every 7 days (100%)

• Reactions recorded (100%)

• Diluents appropriate (100%).

• Line changed with prescription change (100%)

Results 46 prescriptions and sites reviewed (completed 13/12/2017). Site reactions observed in 8.6%. 100% of sites recorded as inspected every 4 hours but zero reactions identified/recorded. Rotation frequency documented -72% -average 10 days, and not documented -28%. Diluent appropriate -100%. Line changed with a change in prescription -39%.

Conclusion We have demonstrated compliance with standards 1, 2 & 5. However, problems were identified with standards 2, 3, 4 & 6. 100% of reactions identified were documented as inspected 4 hourly highlighting poor recognition of reactions. Average length of site rotation exceeded 7 days. And only 38% of lines were changed with prescription change. Our recommendations include reviewing processes of site inspection. To provide education on site reaction recognition and the importance of line change in conjunction with prescription change. And to standardise clear documentation of site rotation and local policy adherence. Following implementation of these interventions we recommend annual re-audit to ensure standards met.