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Clinical Intentions of Antibiotics Prescribed Upon Discharge to Hospice Care
Author(s) -
Servid Sarah A.,
Noble Brie N.,
Fromme Erik K.,
Furuno Jon P.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15246
Subject(s) - medicine , hospice care , antibiotics , intensive care medicine , nursing , family medicine , palliative care , microbiology and biotechnology , biology
Objectives To better understand the clinical intentions for antibiotic prescribing upon discharge from acute care to hospice care. Design Retrospective cohort study. Setting Five hundred forty‐four–bed academic, acute‐care, tertiary referral hospital in Portland, Oregon. Participants Adults (≥18) who received an outpatient prescription for antibiotics on discharge from an acute care hospital to hospice care between January 1, 2009 and December 31, 2011 (N = 149). Measurements We determined whether antibiotics were indicated for treatment of an active infection, palliative treatment, prophylaxis, or prescribed according to family or participant preference. Results Antibiotics were prescribed to 17.6% (n = 149) of individuals discharged to hospice care over the 3‐year study period. Antibiotics were most frequently prescribed for pneumonia (19.5%), urinary tract infections (18.9%), and gastrointestinal tract infections (17.0%). The explicit rationale for antibiotic prescription was documented for only 72 prescriptions (45.3%). For 84 (52.8%) participants, antibiotics were used to treat an active infection in the hospital. Of prescriptions with a documented rationale, 37.5% indicated that the intent was curative, 26.4% prophylaxis, and 22.2% to suppress an infection. For 19.4% of prescriptions, participants or their family members specifically wanted to be treated with antibiotics. Only 9.7% of prescriptions specifically indicated that antibiotics were prescribed for palliative reasons. Conclusion Antibiotics were frequently prescribed for treatment of active infection in individuals discharged to hospice care. Further research is needed to document antibiotic benefits and risks and optimize medication management at the end of life.