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Introduction Phenobarbitone is a barbiturate used in palliative care for terminal agitation resistant to first and second line measures. Whilst there is evidence that it is effective for terminal agitation, it is usually used last line suggesting a difficult death. If this patient group could be identified in advance, their end of life care could be improved with better advance care planning, more timely prescribing, and improved support for them and their families.Objective To identify if there is a specific cohort of patients who are at high risk of a bad death as identified by use of phenobarbitone.Method A retrospective case note review of hospice inpatients who died within a specified 2 year time frame and required phenobarbitone for terminal agitation. Patients were identified using keyword searches on electronic patient records and the following data was extracted: age, gender, diagnoses and cause of death. Patient records were then reviewed to identify any ‘stand out characteristics’ that could indicate those at risk of requiring phenobarbitone at the end of life. This data was then compared to data for all inpatient deaths over the same timeframe as well as a control group of 40 patients selected at random and examined in more detail.Results 37 patients required phenobarbitone for terminal agitation over a two- year period. Demographic data has shown that these patients were younger in comparison to the control group. Further more detailed review looking for themes in the patient records is underway and will be presented.Conclusion Phenobarbitone is required in some patients for refractory agitation resistant to other measures at the end of life. Our data shows they are likely to be younger. If other indicators can be identified earlier in the patient’s journey this could lead to improved end of life care.