105 Antimicrobial stewardship in a specialist palliative care unit

Background Competency in Antimicrobial Stewardship relies on ‘documentation in the prescription chart and/or in patients’ clinical records regarding clinical indication, route, dose, duration and review date of antimicrobials’. This project evaluates compliance within a Specialist Palliative Care (SPC) Unit. With the value of early Palliative Medicine recognised during Oncology treatments and increasing numbers of patients with non-malignant diseases, SPC Units regularly see patients where proactive management of infections is indicated. Methods Information about antibiotic use in the SPC inpatient-unit was collected on a standardised proforma over one month. Antibiotic use was identified through searches of the electronic prescribing system and electronic notes. We defined an antibiotic episode as ‘antibiotic use separated from other antibiotic use by time regardless of the source being treated’. Antibiotics changed due to escalation/de-escalation/culture results would count as one antibiotic episode. Results There were 28 antibiotic episodes out of 61 admissions. 22 patients had antibiotics (36%). 17/22 patients had one antibiotic episode (77.3%); 4/22 had 2 antibiotic episodes (18.2%); 1/22 had 3 antibiotic episodes (4.5%). Fourteen antibiotic episodes were commenced prior to admission and fourteen were commenced by hospice doctors. 27/28 episodes documented clinical indications, mostly within electronic notes rather than the prescribing system. 5/5 intravenous and 3/9 oral antibiotic prescriptions commenced during admission were reviewed within 48–72 hours. None of the oral antibiotics commenced prior to admission had documented reviews. Two antibiotic courses were commenced for symptom control (pain from cellulitis; delirium) rather than potential life-prolongation. Conclusions Antimicrobial Stewardship is important. Strategies to improve concordance are under development, including auto-populating electronic notes/the prescribing system to review all antibiotics at 48–72 hours. The next evaluation of practice should also capture compliance with local prescribing guidance, culture results and the intention of treatment.