97\u2005Compliance with local antimicrobial guidelines in an inpatient hospice unit

Abstract

Background Hospice patients are extremely susceptible to infection and the decision to use antimicrobials is multifactorial. Compliance with the inpatient hospice unit’s (IPU) antimicrobial guidelines, adapted from local acute trust and community guidelines, based on Public Health England’s (PHE) antimicrobial stewardship principles, was audited. Method A retrospective review of notes and drug charts was conducted for patients admitted to IPU between February and May 2018, who were given antimicrobials. Data from electronic notes and drug charts was collected and compared to the local hospice antimicrobial standards. Results Over 4 months, there were 87 admissions to IPU, with 46 systemic antimicrobial prescriptions in 23 patients. Compliance with documenting patient information and recording drug allergies was excellent (100% and 91% respectively). Documenting an indication for the chosen antimicrobial in the drug chart and documenting the course duration or review date in the notes had a poor compliance (30% and 17%). Other standards included documenting an indication for the chosen antimicrobial in the notes (83%), documenting the course duration or review date in the drug chart (67%) and choosing the appropriate antimicrobial based on local guidelines (67%). Discussions to improve compliance have included considerations around updating drug charts and further involvement of pharmacists regarding antimicrobial prescriptions. Conclusions Antimicrobial guidelines aim to encourage consistent prescribing and documentation to produce safe, effective and economical antimicrobial use. There is evidence here to show decisions to start, review, and stop antimicrobials (in line with the PHEs recommended ‘Start Smart – then Focus’ approach) in most cases was clearly documented and compliant with local guidelines. However, it is also important to recognise the hospice population have different needs, and therefore total reliance on hospital or community guidelines may not always be appropriate. Decisions to start antimicrobials must continue to be an individualised approach.