Background Antimicrobial stewardship (AMS) is a key national policy agenda (Department of Health and Social Care. UK 5-year action plan for antimicrobial resistance 2019 to 2024. GOV.UK [internet]. 2019). Attentiveness to antibiotic review and stop dates mitigates the risks of antimicrobial resistance (AMR). Whether antibiotics are used with symptomatic or curative intent, the potential burden of adverse effects and broader threat of AMR necessitates a diligent approach to AMS within hospice settings (McCracken, Nakeshbandi, Sainvil, et al. Open Forum Infect Dis. 2020; 7(Suppl 1):S89–90). NICE guidelines on AMS recommend education and feedback as a way of changing prescribing practices (National Institute for Health and Care Excellence. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. [NG15], 2015). This project utilised QIP methodology to drive improvements in antimicrobial stewardship.

Aims To improve antimicrobial stewardship in a hospice inpatient setting to reduce the risks of AMR and ensure patients receive appropriate treatment of infections.

Methods A retrospective audit of patient notes and drug charts was conducted to establish baseline data on antimicrobial prescribing practices in our 32-bed hospice inpatient unit. A series of PDSA cycles were implemented with data collection in January-March 2023, November 2023 and March 2024. Key process measures were i) clinical reviews at 48–72hrs, ii) documented antibiotic stop date. Phase 1 consisted of awareness raising through presentation of initial audit findings to all doctors. Phase 2 involved an education session on AMS and mapping of barriers to timely clinical review which will guide subsequent cycles.

Results Baseline audit showed patients had clinical reviews at 48–72hrs in 31% (12/38) of cases and documented stop dates in 26% (10/38). Following phase 1, frequency of clinical reviews improved to 73% (11/15) and stop dates to 73% (11/15). Phase 2 identified knowledge and process gaps and led to collaboration with local microbiology colleagues to update existing guidelines.

Conclusion This project used awareness raising and education sessions to increase the frequency of timely clinical reviews to align practice with national targets. Further PDSA cycles are planned to incorporate AMS into the pharmacist-led drug chart screening process and the local induction to sustain improvements.