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Introduction Non-invasive ventilation (NIV) has been shown to significantly reduce in-hospital mortality in patients with acute hypercapnic respiratory failure. However, national audits found mortality rates in to be rising, resulting in the publication of clearly defined quality standards and recommendations. This study aimed to assess acute NIV practices at an NHS hospital compared to current evidence-based recommendations and implement quality improvement processes.Methods The OPCS Classification of Interventions and Procedures code was used to identify all adult patients treated with acute NIV within the defined audit period (01/05/25 – 31/07/25). Data was collected retrospectively from electronic case notes. Compliance ratings for evidence-based recommendations were calculated and used to calculate assurance. Quality improvement processes were implemented, including a flow chart describing the acute NIV pathway and a patient information leaflet. The audit is currently being repeated, and overall compliance pre- and post-intervention will be compared using the Mann-Whitney U test.Results The initial audit period (n=59) offered very limited assurance indicating improvements were required ( figure 1). Key areas requiring improvement included timely application of NIV (25.86%), maintaining target oxygen saturation of 88-92% (30.19%), hourly vital signs checks (3.45%), regular clinical reviews (45.61%), and timely review where blood gas measurements fail to improve (41.67%). A structured plan at discharge was only documented in 28.26% of cases. Mortality pre-intervention was 22.04% and median length of hospital stay (LOS) was 8d (IQR = 6 – 19d).Conclusion This local clinical audit has highlighted some key areas of improvement include timely intervention, prevention of over-oxygenation, regular reviews and structured plans for discharge. As a result, quality improvement processes have been implemented Trust-wide. It is anticipated that overall assurance will improve. Despite limited assurance, patient outcomes are better than the latest national audit published in 2019 (mortality 26%, median LOS 9d) (BTS, 2020; 11:3). The re-audit period will help to assess whether quality improvement processes can improve practice.Abstract P23 Figure 1Compliance ratings of evidence-based standards pre-intervention. Good practice >95%; acceptable practice 75-94%; requires improvement <75%