Background Antimicrobial stewardship is a global health issue. Antibiotic resistance is the subject of a 2024–2029 UK government national action plan (Department of Health and Social Care, UK Health Security Agency, Department for Environment, Food & Rural Affairs. New 5-year plan to combat antimicrobial resistance. [internet] 2024) and UN General Assembly in 2024 (World Health Organization. Antimicrobial resistance. [internet] 2023). The ‘Start Smart Then Focus’ (UK Health Security Agency. Antimicrobial prescribing and stewardship competency framework. [internet] 2023) campaign provides a toolkit for antimicrobial stewardship in inpatient settings. Hospice inpatient units provide unique challenges. Despite infection being common, antibiotic use may conflict with palliative care goals (Lannon, Reilly, Kennedy, et al. Antimicrobial stewardship in end-of-life care. BMJ Support Palliat Care. Blog. 14 June 2023). A multiprofessional group of experts in end-of-life care and antimicrobial stewardship have developed ‘good practice’ recommendations for this cohort of patients (Seaton, Cooper, Fairweather, et al. BMJ Support Palliat Care. Published Online First: 19 January 2021).

Aim To review incidence of antibiotic prescribing, and audit against ‘Start Smart Then Focus’ guidance and the ‘good practice’ recommendations for a cohort of inpatients.

Method A retrospective review on drug charts was conducted on 112 patients who were admitted to the inpatient unit from 01/02/23 to 31/07/23. Twenty-one of these patients received antibiotics (19%), yet two were excluded as antibiotics were used as long-term prophylaxis. The patient care records of the remaining 19 patients were reviewed for evidence of practice in accordance with the aims.

Results Antibiotic choice was predominately driven by either guidelines or microbiology results (58%). Duration and antibiotic review at 48 hours were documented in 79% and 42% respectively. The aim of treatment (curative or palliative) was documented in 63%, with evidence of shared decision making in 47%. Limitations of treatment were not documented as being discussed in any of the cases reviewed.

Conclusion Antibiotic stewardship is a topical issue and is more complicated in hospice inpatients. Whilst choice, intention and duration of antibiotics were documented in most cases, review at 48 hours and limitations of treatment were less commonly documented. Hence, this has been highlighted as an area for education within the medical team. Antibiotic guidelines for the inpatient unit will be developed, including stipulation of required documentation, followed by re-audit in six months’ time.