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Background The ReSPECT process facilitates personalized emergency care recommendations. It has been in use in Guildford and Waverley since 2019 and is expanding across the Frimley Integrated Care System. Phyllis Tuckwell (PT) staff, doctors and clinical nurse specialists have been trained in ReSPECT form completion. This re-audit evaluates compliance with documentation standards since 2022.Aims To assess the number of ReSPECT forms completed by PT staff.Evaluate documentation quality against standards.Identify areas for improvement.Methods Patients with coded ReSPECT forms in their electronic patient records were identified. Forms were reviewed for demographic completeness, clarity, clinical documentation, patient preferences, legal aspects (e.g., Lasting Power of Attorney), and senior clinician sign-off.Results 175 patient records reviewed; 119 forms completed by PT clinicians.Documentation rates:Demographic details: 98.3%Legibility and completeness: 100%Clinical problems: 99.2%Preferences and priorities for future care: 100%Senior clinician sign-off: 89.1% (increase from 69% in 2022)Review at care setting transition: 2.5%, though 42% had multiple forms suggesting updates.Discussion ReSPECT form usage increased significantly (from 58 in 2022 to 119 in 2024). Documentation quality remains high, with improved Lasting Power of Attorney recording (62% in 2022 vs 91% in 2024) and senior clinician sign-off. Low documentation ReSPECT form reviews at care transitions may reflect updates being documented on new forms rather than explicit review of the current form.Conclusion PT staff demonstrate high ReSPECT form compliance. The increased number of hospice completed forms is due to more trained clinical nurse specialists completing the forms. Further focus is needed on explicitly recording care setting transitions. Ongoing training will reinforce best practices.Recommendations Reinforce training on care transition documentation.Continue training of clinical nurse specialists for high-quality form completion.Share findings to drive quality improvements.