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Background Fentanyl is the subcutaneous opioid of choice for patients with advanced renal failure or combined renal and hepatic failure (Palliative care formulary. Pharmaceutical Press [internet]; British Association for the Study of the Liver. Symptom control and end of life care in adults with advanced liver disease. 2022). Our hospice introduced fentanyl for such inpatients in 2023 with encouraging results. A guideline for fentanyl use and an equianalgesic chart were created to support this. Subcutaneous fentanyl was introduced for community patients in 2024.Aim To conduct an audit to review the impact of introducing fentanyl for subcutaneous use in the community.Methods Retrospective review of electronic notes of patients known to the community palliative care team who were given fentanyl in the community between January 2024 and February 2025.Results Ten patient records reviewed. Ages ranged from 30–93 (average 73). Diagnosis: Six malignancy, four non-malignancy. All patients were prescribed fentanyl for pain relief, with no other indications listed and met criteria for using fentanyl (8 end stage renal failure, 2 worsening renal impairment with eGFR <25). The reason for stopping fentanyl was death (9) or inpatient admission (1), with no reports of toxicity or intolerance. Of the 9 patients with fentanyl in a syringe driver, 4 required a dose increase within 48 hours, 4 didn’t and 1 died within 24 hours.Discussion/Conclusion Fentanyl was prescribed appropriately according to local guidelines and was well-tolerated with no toxicity reported. Four patients required an increase in CSCI dose within 48 hours. This may reflect the pharmacokinetics of fentanyl (Wilcock, Howard, Stark Toller, et al. (eds.) Palliative care formulary. 9th ed. Pharmaceutical Press; 2025; Cherny, Fallon. Opioid therapy. In: Cherny, Fallon, Kaasa et al. (eds.) Oxford textbook of palliative medicine. 6th ed. Oxford University Press; 2021), cautious starting doses used in opioid-naive patients and the common need for opiates to be increased as disease progresses. There were limitations in the sample collection technique and sample size of this study, and variability between geographical areas in how comfortable district nurses were with administering fentanyl. As subcutaneous fentanyl is adopted more widely, a follow-up audit at regional level is planned and equianalgesic charts and starting doses will be further scrutinised.