RT Journal Article SR Electronic T1 P14 The impact of audit on CNS team development JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP A14 OP A15 DO 10.1136/bmjspcare-2013-000591.36 VO 3 IS Suppl 1 A1 Gibson, Vanessa A1 Patel, June YR 2013 UL http://spcare.bmj.com/content/3/Suppl_1/A14.2.abstract AB In 2011 the Hospice Clinical Nurse Specialist (CNS) team were facing a significant increase in patient referrals numbers (approximately 70 per month). The demand for community based care, rather than acute hospital admission, was also resulting in increasingly complex and urgent referrals from all areas of the local healthcare economy. In addition, palliative and end-of-life care services traditionally available only to cancer patients were increasingly being accessed by patients with non- malignant diagnoses. In response the CNS team undertook a month long audit of referrals to the community nurse specialist service. The audit revealed: Low levels of referral information, resulting in delayed contactDifficulties assessing levels of urgencyLack of clarity regarding other services involved with the patientUnnecessary home visits As a result the CNS team has now introduced the following: A new streamlined referral processA full time specialist triage nurse who makes first contact with all referrals: She: Responds to all referral agenciesAssesses level of urgencyHolds her own low-level caseload that she contacts by phoneHelpline established and available to patients and health care professionals: this service provides immediate access to a highly skilled CNSAccessing and completing the electronic notes systems to ensure comprehensive and up to date clinical information is readily available to the wider healthcare team.Enhanced patient documentation Continuous development is key and plans are being developed for: A visiting ‘rapid response’ CNSA nurse led triage clinicIncreased triage nurse hours The CNS team have used audit to truly ‘hear’ what is happening in practice and as a result have used this knowledge to lead service redesign- a key aspect of the CNS role identified by National Cancer Action Team (2010)