1. Illustrate the role in the Respiratory Distress Observation Scale (RDOS) as a tool to assess dyspnea in unconscious patients 2. Examine how the RDOS could be integrated into a practice model Dyspnea is a common symptom experienced in the palliative care unit (PCU), and providers have varying comfort levels in treating dyspnea. Previously, there was no standardized method for assessing dyspnea in unconscious patients in the PCU at Vanderbilt University Medical Center (VUMC). The Respiratory Distress Observation Scale (RDOS) has been previously described as a tool to use in assessing dyspnea in nonverbal patients.1 In Spring 2021, the VUMC palliative care (PC) fellows provided educational sessions to all PCU nurses to introduce the RDOS. Pre-education surveys and posteducation surveys were conducted to determine comfort in assessing dyspnea and utilization of the RDOS. This quality improvement project was approved by the VUMC Institutional Review Board. Pre-education and 9-week posteducation surveys were given to all PC nurses. Standardized education sessions were performed by PC fellows to the PCU nurses. These sessions introduced the RDOS and provided guidelines for use. The surveys were analyzed via unpaired t-tests and chi-squared statistical analyses. PC nurse residents had a higher comfort level with assessing dyspnea in unconscious patients after RDOS education (pre-SD 0.82, post-SD 0.55, P = 0.05). There was no statistical difference in comfort level among experienced PC nurses (pre-SD 0.87, post-SD 0.50, P = 0.39). Most agreed for the RDOS to be permanently implemented into the PCU (95%, P = 0.00001). Qualitative data highlighted time and lack of integration into the medical record as significant barriers to using the RDOS. PC nurse residents had higher comfort levels with assessing dyspnea after an educational session introducing the RDOS. There was no difference in comfort levels of experienced PC nurses after the education sessions. A majority of nurses felt the RDOS should be implemented into the PCU workflow for assessing dyspnea in unconscious patients. 1. Campbell ML, Templin T, Walch J. A Respiratory Distress Observation Scale for patients unable to self-report dyspnea. J Palliat Med. 2010;13(3):285-90. [ABSTRACT FROM AUTHOR]