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<h3>Background</h3> Steroids are widely used in palliative care to relieve symptoms but carry risks including adrenal insufficiency, hyperglycaemia, and complications from unsafe withdrawal. National guidance recommends monitoring blood glucose and considering gastric and bone protection. In 2020, NHS England introduced the Steroid Emergency Card following safety concerns and fatalities. With no specific national or local guidelines for the use of steroids in palliative care, an audit was conducted at St Christopher’s Hospice to assess prescribing practices. <h3>Methods</h3> A three-month retrospective audit was undertaken, reviewing the electronic records of hospice in-patients. Using a standardised proforma, we assessed current prescribing practices, evaluated documented weaning plans and reviewed management plans on discharge, including whether eligible patients were given a Steroid Emergency Card. <h3>Results</h3> Of 170 patients, 57 were prescribed oral/subcutaneous steroids, with over 90% prescribed before admission. The majority were prescribed a moderate dose of Dexamethasone (4-8mg). 70% had a review plan documented but only two patients had review dates consistently documented. A proton pump inhibitor was prescribed for 79% of patients; however, 86% received no bone protection. No patients had blood glucose levels monitored in accordance with local guidelines; 88% had ≥1 BM recorded. Steroid management plans were consistently communicated to the GP on discharge, but no eligible patients were provided with a Steroid Emergency Card. <h3>Conclusions</h3> A significant number of patients receiving palliative care are prescribed steroids. Improvements are essential to ensure steroids are prescribed safely. Interventions will include; electronic alerts when prescribing steroids, prompting both monitoring of blood glucose levels and documentation in an allocated place for indication and steroid plan. In addition, we will create a section on the discharge summary to record when a Steroid Emergency Card is indicated and issued. We will re-audit in a plan, do, study, act cycle and updated results will be presented.