Background NICE guidelines for the Care of the Dying Adult recommend the prescription of anticipatory medication as early as possible to minimise symptomatic distress during last days of life. Literature on prescribing of anticipatory medications in secondary care is limited. Incorrect prescribing and inadequate understanding among hospital staff regarding symptom management for a dying patient prompted the need to establish compliance of prescribing and administration of anticipatory medications (AMs) against Trust guidelines on symptom control in the last days of life.

Method A retrospective audit cycle comprising of 3 audits was conducted examining hospital records of patients recognized as in the dying phase, between December 2015 and October 2017. Documentation within drug charts, doctors’ and nursing notes were scrutinised to establish whether AMs were prescribed and used for specific indications as per guidelines.

Results There was improvement in compliance with prescribing of AMs for patients at point of recognition of being in the dying phase (88% to 96%) and the administration of AMs according to correct indications (23% to 91%). Nursing documentation of indication for AM use improved (23% to 40%). Despite an improvement in selection of appropriate AM per symptom, compliance around doctors’ prescription of accurate doses dropped (21% to 12%).

Conclusions Whilst compliance in the initiation of anticipatory medications for the main symptoms associated with last days of life improved, accuracy of doses needs to improve. The role of hospital pharmacists in enabling compliance was identified as an additional resource alongside periodic trust-wide communication of guidelines, to support better symptom control at end of life. The prevalence of hospital staff turnover (doctors changing rotations and bank nurses) necessitates the need for regular educational events to facilitate safe, evidence based symptom control at end of life. Embedding clinical guidelines for end of life care requires an ongoing proactive approach.