115 Experience of using intravenous antibiotics in an inpatient hospice unit

Background The rationale for initiating intravenous antibiotics is variable (symptom control vs life prolongation). There is limited data to show efficacy. Not all hospice inpatient units (IPUs) offer intravenous therapy, and this may influence decisions to admit, particularly in the non-malignant patient group. Following staff training, intravenous antibiotics have been available in our IPU since February 2018. This audit aimed to review their use. Method A retrospective review of notes and drug charts was conducted for patients admitted between February and May 2018. Data was collected on compliance with local guidelines, overall outcome and counselling prior to initiating therapy. Results Over four months, 11 courses of intravenous antibiotics were administered to 9 patients. 7 of 9 patients subsequently died in the IPU, with an average interval of 7 days between completion of the intravenous antibiotic course and death. One patent died of sepsis shortly after discharge and the other died at home several months later. The justification for intravenous antibiotics was clearly documented in 8 of 9 patients (89%). The switch to oral antibiotics appeared to be appropriate and justified in all cases (100%). The average course length was 3 days. Prior to starting intravenous antibiotics, discussion with the patient and/or families occurred in every case except one. Conclusions The review demonstrated intravenous antibiotics frequently being administered to patients in their last week of life, leading the team to review the appropriateness of their use. However, treatment frequently supported patients’ preferences regarding place of death; avoidance of hospital transfer; wish to receive active treatment; and likely prolongation of survival in one case. Decisions to prescribe were justified and balanced, in conjunction with patients and their families wishes. We should continue to consider effectiveness alongside potential for harm, together with managing the challenges associated with intravenous therapy.