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Background/Aims Fibromyalgia syndrome (FMS) is a common and complex condition with multiple symptoms. Delivering biopsychosocial assessment and tailored management, following EULAR recommendations, is difficult due to constraints on clinic appointments. A previous audit found that only 8% of our patients with FMS were referred to a specialist rehabilitation programme and medication was the primary management recommendation in 65%. We used quality improvement (QI) methods to improve this. Methods A QI project was carried out with three plan, do, study, act (PDSA) cycles over 5 years (2018-2022) with the aim of improving the recording of a quantitative and qualitative assessment of pain, function, and psychosocial impact of symptoms (minimum of 80% of encounters). The proportion of consultations that documented advice on physical activity/sleep/psychological interventions, recommended medication changes, provision of written information and referral to a pain management programme was calculated. Following each cycle, a sample of consultations conducted over a 3-month period were evaluated: Cycle 1 - ‘Moving 4ward’ booklet. An assessment booklet completed by patients and clinicians at the appointment including validated screening tools, information regarding previous treatments, summary of the medical assessment, information about FMS and treatment options leading to a shared action plan. Cycle 2 - Pilot of a digital pre-clinic assessment tool (digitalising the ‘Moving 4ward’ booklet). Link sent to patients using Microsoft Forms. Results accessed by the clinician via an Excel spreadsheet during the appointment. Cycle 3 - Complete digitalisation of the pre-clinic assessment tool. Automated interpretation of results and production of a report uploaded to patient notes using an inhouse rheumatology database, RhADIO. The report includes results of screening tools, patient history as well as targeted signposting and management advice to the clinician and patient. Results There was an improvement in the recording of quantitative and qualitative assessment of patients with FMS across all domains (pain, function, psychological) following each cycle. In the final cycle, 100% of patients diagnosed with FMS had quantitative measures recorded on their notes and greater than 80% had qualitative assessments recorded for pain and function. The interventions resulted in an improvement across each of the recorded management approaches in adherence to EULAR recommendations: 95% of patients were referred to a multidisciplinary pain rehabilitation service in 2022 compared to 8% at baseline. More patients were given advice on physical activity and sleep and provided written information regarding their diagnosis. Conclusion The project team has been able to improve the assessment and management of patients with FMS based on EULAR recommendations. Appointments are more targeted and tailored to the needs of patients based on information provided via the digital pre-clinic tool. Future work will consider how this digital tool may support all clinicians across the integrated care system in primary care, intermediate services and secondary care. Disclosure A. Saif: None. A. Wall: None. Y. Kang: None. J. Nicholas: None. R. Luqmani: None. A. Soni: None.

Background/Aims To examine the management of fibromyalgia patients referred to secondary care with respect to 2017 European Alliance of Associations for Rheumatology (EULAR) guidelines. Methods Eighty-two patients referred to the Complex Musculoskeletal Clinic in the Rheumatology Department with a resulting diagnosis of fibromyalgia were included in the audit. Data was collected retrospectively via Electronic Patient Records over the study period of December 2017 to March 2020. Variables assessed included patient demographics, clinical presentation at assessment and management. Statistical analyses were conducted using Excel 2019 and the Excel Analysis ToolPak. Results The majority of the patients were female 77/82(94%), and the mean age was 43.2yrs (SD = 12.6). Co-morbidities were common: 31/82 (38%) had a further painful musculoskeletal condition, 40/82 (49%) were obese and 46/82 (56%) had an active mental health problem. Alongside chronic widespread pain, patients reported fatigue 64/82 (78%), waking unrefreshed 69/82 (84%), and cognitive disturbance 31/82 (38%). Compared to a 2014 audit conducted in the same population and department, more patients had received pharmacological treatment (71/82 [87%] vs 34/50 [68%]; z = 2.64, p = 0.008), had received physiotherapy (28/82 [34%] vs 5/50 [10%]; z = 3.0, p = 0.002) and psychological input (16/82 [20%] vs 3/50 [6%]; z = 2.20, p = 0.03) prior to referral to secondary care. At secondary care consultation, all patients received an assessment of their pain and function, and 64/82 (78%) were assessed for psychosocial context. Fifty-three (65%) patients received information in the form of a website recommendation, leaflet or verbal education. After clinician assessment, the majority were referred to a multidisciplinary pain management programme, in a significant increase from 2014 (64/82 [78%] vs 4/50 [8%]; z = 8.04, p < 0.0001). All medication recommendations were made according to 2017 EULAR guidelines. Alongside multidisciplinary pain rehabilitation, patients were referred to physiotherapy 21/82 (26%), physical activity 26/82 (26%), sleep hygiene 9/82 (11%) and psychological 7/82 (9%) treatment options. Conclusion Multidisciplinary treatment and first-line, non-pharmacological approaches have become the standard management approach in secondary care, alongside EULAR compliant pharmacological recommendations. EULAR’s non-pharmacological recommendations of assessing not only pain, but function and psychosocial context occurs for the majority of patients. The limitation of consultation duration likely plays a role in whether psychosocial context is adequately assessed. Providing patients with information about their condition, though occurring for approximately 2/3 of patients, was recognized as an area for improvement. The high rate of co-morbidities combined with the demographics of Fibromyalgia patients emphasizes the importance of early, multimodal management. Follow-up audits are warranted to examine the effects of the COVID-19 pandemic, and the impact of the upcoming 2021 NICE guidance for chronic pain. Disclosure Y. Kang: None. R. Smith: None. A. Soni: Grants/research support; Oxford-UCB Prize Fellowship.