Patients on palliative care are often susceptible to infection due to decreased immunity from reasons such as immune-suppressive chemotherapy. Antibiotics have been suggested for symptom relief in these patients if they have concurrent infections, primarily to improve their remaining quality of life. As studies have concluded that infections had no correlation with mortality in palliative care patients, hence if the antibiotic usage did not improve the quality of life, there is no benefit in giving antimicrobial therapy. SGH’s ASP program is a prospective review of the use of broad spectrum antibiotics in the hospital for appropriateness with immediate concurrent feedback. Currently, there is no studies looking at ASP impact on palliative management. Thus we aim to evaluate the impact of ASP interventions on patient safety & outcomes in palliative care patients.
We conducted a retrospective review of palliative care patients who were prescribed broad spectrum antibiotics and were audited at SGH from Dec 2010 to Dec 2013. Primary outcomes evaluated were length of stay & 30-day mortality between those whose ASP interventions were accepted by the primary team compared to those who were rejected.
580 cases were audited. 232 interventions were done by the ASP team, on patients from department of Internal Medicine (59.9%), Hematology & Oncology (30.3%), & Surgical (9.8%). The interventions done were mainly to discontinue antibiotic use (81.0%) if the quality of life is not improved, followed by narrowing of empirical coverage (6.9%) and de-escalating antibiotic based on available cultures (6.9%). The overall acceptance rate of 60.3%, with physician preference & death within 48 hours of intervention being made as the commonest reasons for rejection. There was no difference between the length of stay of patients who accepted intervention (17.9 ± 15.5 days) & patients who rejected intervention (16.2 ± 19.9 days) (p=0.313). There was also no difference between overall 30-day mortality (p=0.181) & 30-day readmission (p=0.263) between the two groups.
ASP interventions were able to reduce inappropriate antibiotics use in palliative patients without any concessions to the safety of the patients.
L. W. Lee,
W. Lee, None
M. P. Chlebicki, None
A. L. Kwa, None