Background ‘One chance to get it right’ (Leadership Alliance for the Care of Dying People, 2014) and NICE guidance (National Institute for Health and Care Excellence, 2015) highlight the need to ensure appropriate means of providing hydration at end of life is available across care settings, including the availability of Clinically Assisted Hydration. Across our locality, the processes were not in place to achieve this and there was concern about understanding of the factors informing decision making.

Aims Develop procedure for the Administration of Subcutaneous Fluids in Adults at End of Life in the Community. Ensure robust mechanisms in place for monitoring management of hydration at end of life. Develop patient/carer information. Provide multi-professional education and training.

Methods Collaborative task and finish group established. Available literature reviewed to develop a patient/carer information leaflet. Multi-professional education and training package developed to enhance understanding of assessment and decision making.

Results Procedure for the Administration of Subcutaneous Fluids in Adults at End of Life in the Community was developed and agreed by our local community NHS Trust, hospice and clinical commissioning groups. Associated information contains a flowchart and other guidance. An audit proforma was developed to collect prospective data about the use and impact of subcutaneous fluids at end of life. A patient information leaflet was developed with agreement of partners. Multi-professional education and training was delivered to over 150 clinicians through attendance at GP training afternoons and hospice sessions (Macmillan grant funded).

Discussion A procedure has been agreed to ensure methods available to provide hydration support for patients at end of life, not limited by the place in which the person is being cared for. Feedback received from 89 attendees at the hospice education programme – score 1–6, 6 being excellent, 99% of responders scored 5 or 6; 94% recommended the session. Qualitative feedback reflected the need for individualised assessments and staff feeling empowered to support patients.