Infections often impact care of hospice patients; however, limited guidance exists for end-of-life infection management. Regardless of patient prognosis, appropriate antibiotic use is necessary for maintaining quality of life. Antibiotics may be associated with serious adverse events, posing safety risks to patients that should be factored into the appropriateness determination. Fluoroquinolone antibiotics are prescribed frequently in hospice. There are 8 fluoroquinolone drug safety warnings regarding risk for serious adverse events communicated by the US Food and Drug Administration. A retrospective chart review at a hospice pharmacy services provider identified decedents who used a fluoroquinolone during a 1-month period. Charts were evaluated for the presence of risk factors for serious adverse events, including advanced age (86.0%), orders for multiple QTc prolongation risk medications (51.5%), hypertension (64.1%), and concomitant corticosteroids (22.9%). Findings demonstrate notable risk with the use of at least 1 class of antibiotics in a hospice population. STAMPS is a hospice decision support tool, developed to guide symptom-driven antibiotic use that incorporates safety assessment and individual goals of care into infection management planning. The tool can also serve as a framework for patient-centered communications about appropriate antibiotic use in hospice between providers, patients, and families.

Objectives Evaluate benefits versus risks of antibiotic therapy in end-of-life care. Identify opportunities for end-of-life care providers to contribute to global antibiotic stewardship efforts and improve patient care. Describe an approach for optimizing antibiotic use for symptom relief of infections and documenting in the plan of care. Responsible antibiotic prescribing is paramount to the success of global antimicrobial stewardship efforts. Hospice-based studies report antimicrobial use ranging 8-37%, but inappropriate and unnecessary antibiotic prescribing in end-of-life is poorly defined. Healthcare providers have limited guidance regarding the utilization of antibiotics in end-of-life care. According to the Centers for Disease Control, up to 50% of antibiotic use is classified as inappropriate in both inpatient and outpatient care settings, while nearly 75% of nursing home is reported to be inappropriate. Further, at least 30% of outpatient antibiotic treatment courses are deemed unnecessary. Hospice and palliative care providers have a responsibility to further define appropriate use of antibiotics based on symptom management and quality of life goals. Antibiotic stewardship has rapidly grown across all healthcare settings, including those serving the hospice and palliative care patient population. Improvements in antibiotic prescribing, to ensure patients receive the right antibiotic for the right indication, dose, and duration, promotes the underlying principles of effective antibiotic stewardship. In end-of-life care, conventional measures for determining antibiotic appropriateness must be considered; however, appropriateness should be weighed against anticipated symptom benefit versus side effect burden. Antibiotic prescribing in end-of-lifecare should also factor in the patients' overall prognosis and each individual's goals of care. Responsible antibiotic prescribing coupled with palliative care principles will positively contribute to global stewardship efforts and improve individual patient care and quality of life. This concurrent session will review the current landscape of antibiotic use and associated outcomes in end-of-life care, illustrate the relationship between palliative care and antibiotic stewardship (including review of new long-term care requirements), and describe how to integrate principles of palliative care with antibiotic use to improve symptom management. Clinical case scenarios will be used to demonstrate an approach for implementing symptom-driven antibiotic use, across all healthcare settings, for end-of-life patients.

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