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In 2021, Nakajima and colleagues published guidelines for the diagnosis and management of Normal Pressure Hydrocephalus (NPH). Locally, we set clinical standards based on these guidelines and reviewed cases of possible NPH (pNPH) seen in the Royal Victoria Infirmary between 2017-2019. 87 patients were identified of which 80% (70/87) patients met the diagnostic criteria for ‘possible NPH’. 77% (54/70) had CSF tap/drainage of which 37% (4/54) had clear documentation of objective measure of change. Of all 87 patients, 60% (52/87) had a shunt inserted and 71% (37/52) shunted patients had an improvement.The NPH Multi-disciplinary team (NPH-MDT) was set up aiming to improve the management of pNPH patients. We reviewed patients discussed in NPH-MDT in 2022. 89 patients with pNPH were identified from the database of which 84% (75/89) fulfilled diagnostic criteria for ‘possible NPH’. 27% (20/75) had CSF tap of which 100% (20/20) had clear documentation of an objective measure of change and 70% (14/20) improved. 93% (13/14) had a shunt and of those shunted 92% (12/13) had an improvement.These results show that following discussion in NPH-MDT, there was improved adherence to clinical standards for the investigation and management of NPH and improved outcomes of patients following shunts.stephanie.ong1@nhs.net