Adrian Wilder-Smith1, Thomas Gillespie2, D Robin Taylor3,1. 1. College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK. 2. University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK. 3. Department of Respiratory Medicine, University Hospital Wishaw, Wishaw ML2 0DP, UK, rtaylorscot@gmail.com.
Abstract
BACKGROUND: Antimicrobial treatment is common at end of life. A treatment escalation/limitation plan (TELP) offers the opportunity to avoid non-beneficial treatment in critically ill patients. Our aim was to evaluate antimicrobial prescribing in terminally ill patients, and assess whether it was modified using a TELP. METHODS: Appropriateness of antimicrobial treatment was audited using a priori criteria in 94 consecutive hospital deaths. Prescribing in patients whose death was expected/unexpected, and who had a TELP with/without a 'ceiling' for antimicrobials, were compared. RESULTS: Twenty three of 94 patients (24.5%) were receiving antimicrobials at time of death. This was not influenced by evidence of infection or whether death was expected. The use of a TELP (n = 81) with an antimicrobial 'ceiling' (28 with, 53 without) was associated with a significant reduction in antimicrobials administered (28.6% vs 81.1%; p < 0.0005). CONCLUSIONS: Many complex factors contribute to antimicrobial misuse at end of life. An appropriately constructed TELP reduces inappropriate prescribing.
BACKGROUND: Antimicrobial treatment is common at end of life. A treatment escalation/limitation plan (TELP) offers the opportunity to avoid non-beneficial treatment in critically illpatients. Our aim was to evaluate antimicrobial prescribing in terminally ill patients, and assess whether it was modified using a TELP. METHODS: Appropriateness of antimicrobial treatment was audited using a priori criteria in 94 consecutive hospital deaths. Prescribing in patients whose death was expected/unexpected, and who had a TELP with/without a 'ceiling' for antimicrobials, were compared. RESULTS: Twenty three of 94 patients (24.5%) were receiving antimicrobials at time of death. This was not influenced by evidence of infection or whether death was expected. The use of a TELP (n = 81) with an antimicrobial 'ceiling' (28 with, 53 without) was associated with a significant reduction in antimicrobials administered (28.6% vs 81.1%; p < 0.0005). CONCLUSIONS: Many complex factors contribute to antimicrobial misuse at end of life. An appropriately constructed TELP reduces inappropriate prescribing.
Authors: Olivia S Kates; Elizabeth M Krantz; Juhye Lee; John Klaassen; Jessica Morris; Irina Mezheritsky; Ania Sweet; Frank Tverdek; Elizabeth T Loggers; Steven A Pergam; Catherine Liu Journal: Open Forum Infect Dis Date: 2021-08-02 Impact factor: 4.423