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Context The Children and Young People’s Cancer Association (CCLG) Chemotherapy Induced Nausea and Vomiting Guideline 2023 1 was adopted locally in August 2024. Palonosetron a first line antiemetic recommended in the guideline was added to the formulary following the agreement to implement specific medicine safety steps. Palonosetron is administered intravenously as a stat dose on day one of chemotherapy. Palonosetron has a 40 hour half-life,2 thus it is advised that no other serotonin type 3 (5HT3) antagonist can be administered for the subsequent 5 days.The ePrescribing system used at our trust only allows ‘STAT’ prescriptions to be visible until midnight on the day administered. After this the prescription is moved off the active ‘inpatient prescription chart’ to the ‘discontinued prescriptions’ tab. This caused concern that prescribers could easily miss the previous administration of palonosetron and inadvertently prescribe a second 5HT3 antagonist within the following 5 days. Medicine safety steps introduced to avoid inadvertent overdose included a sophisticated drug build on the ePrescribing system which included a warning for 5 days following a stat dose. Palonosetron can not be prescribed as stat standalone item. It can only be prescribed as part of a protocol. This automatically forces the prescriber to prescribe a regular order which appears three times daily for 5 days on the ‘active’ prescription chart alongside a stat dose of palonosetron. This order is a dummy drug entitled ‘ WARNING – not for 5HT3 antagonists’. This acts an alert to any future prescribers not to prescribe any other 5HT3 antagonist during this time.Other medicine safety steps included regional teaching and posters for prescribing areas highlighting key information. It was considered that patients may be discharged within 5 days of administration to home or their local hospital. Hence regional teaching was conducted to raise awareness of the use of palonosetron, its duration of action and need to avoid other 5HT3 antagonists during this time frame, across the paediatric oncology network which includes 12 Paediatric Oncology Shared Care Units.It was highlighted to the medical teams, nursing teams and the wider pharmacy teams that palonosetron was added to the formulary. Our electronic prescribing systems for inpatient and discharge planning do not communicate seamlessly therefore the importance of manually adding information to discharge letters was reiterated to all teams.A post introduction audit was conducted reviewing prescribing habits and effectiveness of the medicine safety steps.Conclusion No patient received an overdose of 5HT3 antagonists, however of the discharges summaries 22% lacked all and 15% lacked partial detail of palonosetron administration. Only 63% of discharge summaries included all details. Communication on discharge relies on manual input of information. Failure to include information could be due to variation in practitioner awareness or lack of pharmacy checks on daycase discharge summaries. Enhanced awareness and prescribing support have been identified as an outcome to ensure compliance with the guideline and improved communication on discharge.References CCLG Guideline for the management of Chemotherapy-Induced Nausea and Vomiting CINV. CCLG Supportive Care Group; 2025 [updated 2025 Mar, cited 2025 Jun 05]. Available from https://app.sheepcrm.com/cclg/treatment-guidelines/supportive-care/cinv/ Summary of Product Characteristics [Internet]. Seacross pharmaceuticals Ltd; 2025 [updated 2024; cited 2025 Jun 05]. Available from: https://www.medicines.org.uk/emc/product/12627/smpc#gref