Introduction End of life care prioritises early recognition of death and dying, and proportionate advance care planning (ACP). The National Audit of Care at the End of Life (NACEL) recommends timely communication regarding treatment options, including antibiotic use. Specialist palliative care teams often rationalise medications, but some patients who are approaching the end of life remain on antibiotics.
Aim & Methods To describe the practice of antibiotic prescribing for patients who have been admitted to a specialist inpatient palliative care unit within an acute hospital. The clinical records of all patients admitted in July 2022 were reviewed.
Thirty-seven patients were admitted The median age was 84 years (range 52–101 years). Fifty-one percent were male.
Eleven (30%) patients were prescribed an antibiotic. Co-amoxiclav and Ciprofloxacin were most frequently used (45% and 27% respectively).
Indications (n) chest sepsis (3), perforated viscus (2), colitis (1), bacteraemia (1), alcoholic hepatitis (1), urinary tract infection (1), unclear source (2).
The median antibiotic course length was 5 days (1–14). Median WCC: 13.8X109 cells per litre (3.6 to 45); Median C-reactive protein: 119.1mg/L (7 to 204).
Continuation of an antibiotic course was more likely if an IV cannula was in situ, and less likely when there was an alternative diagnosis.
A decision to prescribe antibiotics was documented as pre-emptively discussed with the patient in only 1%.
Conclusions 1. A significant proportion of patients that are identified as being in their last weeks of life are prescribed antibiotics
2. Decisions about antibiotic prescribing and ceilings of care were made as part of routine clinical care. This was without patient involvement and was not as a part of an ACP.
3. ACP, specifically including antibiotic use should be standard practice for all patients admitted to a specialist inpatient palliative care unit.
4. More research is needed, including evaluating patient acceptability.
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