1767. Because I Could Not Stop for Death, They Gave Me Antibiotics? Perceptions And Reality of Antibiotic Prescribing When Patient Care Is Transitioned to CMO at an Academic Medical Center


 
 
 Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multi-disciplinary survey and retrospective chart review to gain insight into antimicrobial prescribing in this population at an academic medical center.
 
 
 
 A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in Infectious Disease, Pulmonary/Critical Care, Hematology/Oncology, Palliative Care, and Hospital Medicine, and responses were compared across divisions. A retrospective chart review was performed of patients admitted to Beth Israel Deaconess Medical Center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the frequency of patients on antimicrobials after the transition to CMO and provider rationale for continuing antimicrobials.
 
 
 
 We received 113 survey responses for a response rate of 35%; 111 were included for analysis. 41% of respondents indicated that they “sometimes” or “often” continued an antimicrobial during the transition to CMO. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials (Figure 1).
 Patient/family preference was the most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 77% of respondents (Figure 2). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued due to patient/family preference.
 Symptom palliation was the second most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 62% of respondents. For patients already on symptom directed medications, many providers perceived antibiotics to be helpful to palliate symptoms, though there were inter-division differences (Table 1). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued for palliation of symptoms.
 Perceived Helpfulness of Antimicrobials for Specific Symptoms by Division
 Number/percentage of survey responses indicating antimicrobials were at least somewhat helpful for specified symptoms in patients already on symptom directed medications. Divisions compared using Kruskal-Wallis Tests.
 
 
 
 Even after transition to CMO, a substantial number of patients remain on antimicrobials. Patient/family preference and symptom palliation are important factors when continuing antimicrobials in this population.
 
 
 
 All Authors: No reported disclosures.
