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Background Acute Coronary Syndrome (ACS) management relies on timely and accurate prescribing of evidence-based pharmacological therapies as per NICE NG185 guidelines. However, inconsistencies in prescribing practices, especially between cardiology-trained and non-cardiology clinicians, can lead to delays in optimal treatment, inconsistencies in care, and suboptimal discharge planning.Aim To evaluate whether implementing a standardised electronic prescribing order set improves compliance with NICE NG185 recommendations in ACS patients admitted to a tertiary cardiology centre.Method A retrospective review was conducted using EPMA (Electronic Prescribing and Medicines Administration) pre-intervention (June–October 2022, n=221) and post intervention (February–March 2023, n=76). Patients admitted with STEMI or NSTEMI were assessed within 1–3 days of admission for prescribing compliance with five core ACS medications: aspirin, beta-blockers, statins, proton pump inhibitors (PPIs) and ACE inhibitors (ACEi). Following governance approval, a standardised electronic NICE-aligned order set was implemented on the EPMA system. Prescribing compliance pre and post intervention were compared and analysed for significance.Results Pre-intervention (NSTEMI=104, STEMI=117) revealed universal aspirin prescribing (100%), but notable omissions in other therapies: beta-blockers (70.6%), PPIs (72.9%), ACEi (71.5%) and statins (91.4%) [ table 1].Post-intervention (NSTEMI=28, STEMI=48) showed significant prescribing improvements: beta-blockers: +20.2% (p=0.0007), PPIs: +15.3% (p=0.0102), and ACEi: +10.1% (p=0.1143). Statin prescribing showed smaller changes (+3.3%) [table 1].Abstract P06 Table 1Pre- (n=221) vs post-intervention (n=76) compliance,% improvement, and significance Pre order-set prescribed (%) N = 221 Post order-set prescribed (%) N = 76 Improvement (%) p-value Significant? (p<0.05) Aspirin 221 (100) 76 (100) 0 - - Beta-blocker 156 (70.6) 69 (90.8) +20.2 0.0007 Yes Statin 202 (91.4) 72 (94.7) +3.3 0.4906 NS PPI 161 (72.9) 67 (88.2) +15.3 0.0102 Yes ACE inhibitor 158 (71.5) 62 (81.6) +10.1 0.1143 NS Conclusion Introducing standardised electronic order sets significantly improved prescribing compliance for ACS medications, particularly beta-blockers and PPIs. This intervention promoted adherence to NICE NG185 guidelines, reduced prescribing variability, streamlined medication reconciliation and improved discharge readiness. Embedding digital decision-support tools into EPMA can enhance early initiation of secondary prevention and facilitate a smoother transition to cardiovascular rehabilitation to optimise ACS care. Future directions will focus on sustainability and scalability across additional clinical settings and specialties to standardise ACS care.