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Sublingual fentanyl (Abstral) is licenced for the treatment of breakthrough cancer pain. The prescribing and administration of Abstral is more complex than for conventional opioids. Objective: To improve the prescribing, administration and titration of Abstral. Methods: We educated staff in Abstral use. We introduced a new prescription chart for Abstral administration. We performed a retrospective review of the clinical notes of all patients prescribed Abstral between November 2015 and February 2016 in our in-patient specialist palliative care unit. Results: 14 patients were prescribed Abstral in the study period. Abstral was started de novo in five patients.124 episodes of breakthrough cancer pain were treated with Abstral. The median number of episodes treated for each patient was 10 (1-17). Second doses of Abstral were given for 18 episodes when the initial dose had been ineffective. Second doses were required in seven of 14 patients. After a second dose was given, the initial dose of Abstral was uptitrated in 9/18 episodes. The median dose of Abstral at the end of the study period was 300mcg (100-800mcg). Conclusions: We have shown improvement in the prescribing, administration and titration of Abstral in our in-patient unit since the education sessions and the introduction of a new prescription chart for Abstral. We achieved higher doses of Abstral, which better approximate the effective dose of Abstral in the literature. The initial dose of Abstral was only uptitrated in half the episodes where a second dose of Abstral was required, so further improvement work is still required. [ABSTRACT FROM AUTHOR]