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Aims 1. To assess documented practice on post-ligature assessment following a teaching session and simulated induction session introducing a post-ligature assessment tool. 2. To implement the post-ligature assessment tool, for assessing patients who have tied a ligature, into trust guidance. 3. To support the incorporation of simulated induction teaching on post-ligature assessment into the standard induction timetable delivered to all new trainees in the trust, in order to complete the audit cycle. Methods Audit Cycle 1 - Patient data collection November 2020 - January 2021 Action - Locality teaching presenting findings of audit and post-ligature assessment tool developed as part of audit. Concurrent trial of incorporation of post-ligature assessment tool into trust-wide simulation teaching for new trainees. Audit Cycle 2 - Patient data collection August - October 2021 Results Audit Cycle 1: 15 incidents 2 involving anchor point/drop Medic informed in 4 incidents 0 documented in ABCDE format 0 NEWS monitoring 3 follow-up plans documented 3 complications reported Audit Cycle 2: 10 incidents 0 involving anchor point/drop Medic informed in 4 incidents 0 documented in ABCDE format NEWS monitored in 6 incidents 4 follow-up plans documented 3 complications reported Overall, slight improvement in documentation of NEWS monitoring and follow-up. Conclusion Documentation continues to be highly variable. This may be because the teaching done was not trust-wide, simulation session involved only on new doctors in August, some incidents involved locum doctors, and small reach of assessment tool. We aim to introduce the post-ligature assessment tool as part of trust practice through liaison with the resus teaching team, as well as incorporating it permanently into trust-wide simulation induction teaching.