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Introduction Presentation with decompensated liver cirrhosis (DC) is associated with high mortality rates. 1 To provide standardised approach to care, the British Society of Gastroenterology and the British Association for the Study of the Liver have published an updated decompensated cirrhosis care bundle (DCCB).This project aimed to evaluate the management of patients admitted with DC and determine whether current practice within our DGH aligns with national recommendations.Methods A retrospective review of 23 patients admitted with DC in October/November 2025 was carried out using electronic patient records. Data was collected for individual investigation and management components of the DCCB. A survey was sent to resident doctors to quantitatively assess confidence using rating scales of 1-10 (10 being very confident) for complications of DC, as well as their concerns in managing such patients.Results Different components of the DCCB had varying rates of compliance. Full blood count; renal function; liver function; clotting and CRP had a 100% completion rate. Alpha-fetoprotein and viral hepatitis screening had some of the lower completion rates at 26% and 52% respectively. 48% of patients had portal venous imaging, mostly of the computed tomography modality. 34% had an ascitic tap performed and 83% of the patients were screened for their alcohol consumption. Record of bowels was documented in 61% of patients with 35% being prescribed regular lactulose.The survey had 40 total respondents. 80% were not aware of an updated DCCB. Average confidence for managing complications was as follows: spontaneous bacterial peritonitis 6.3, acute kidney injury 4.9, GI bleeding 5.3 and hepatic encephalopathy 5.2. Regarding apprehension in the management of DC patients, the common themes included - multi-organ involvement; complexity; acuity and fluid status.Conclusion The DCCB provides a comprehensive guide to management of patients with DC and has been shown to improve patient outcomes. 2 We have highlighted significant variability in management of this patient group along with low levels of confidence amongst resident doctors with easily addressable gaps in knowledge. In response to our findings, we have created a local guideline that summarises the DCCB in a user-friendly format. We organised teaching activities and educational material focussing on bundle components performed less frequently. We are confident that these measures will help to optimise care of patients with DC moving forward.References Williams R, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014 Nov;384(9958):1953–1997.Dyson JK, et al. Implementation of a ‘care bundle’ improves the management of patients admitted to hospital with decompensated cirrhosis. Aliment Pharmacol Ther 2016 Nov;44(10):1030–1038.