Antibiotic Use in the Last Week of Life in Three Different Palliative Care Settings

2002 ◽  
Vol 18 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Doreen Oneschuk ◽  
Robin Fainsinger ◽  
Donna Demoissac
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Palliative Care Unit ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Marked Variability ◽  
Number Of Patients

The purpose of this study was to examine the frequency and types of antibiotics prescribed in the last week of life in three different palliative care settings, including an acute care hospital, tertiary palliative care unit, and three hospice units. A total of 150 consecutive patients were evaluated, 50 in each of the three settings. Twenty-nine patients (58%) in the acute hospital setting, 26 (52%) in the tertiary palliative care unit, and 11(22%) in the hospice settings were prescribed antibiotics. In the acute care and tertiary palliative care settings, the most frequent route of antibiotic administration was intravenous and, in the hospice setting, oral. We conclude that there is marked variability in the numbers and types of antibiotics prescribed in these different palliative care settings in the last week of life. The high use of intravenous antibiotics and the large number of patients who were still receiving antibiotics at the time of death indicate the need for further prospective studies.

scholarly journals Favorable effects of dietary intervention by registered dietitians in the palliative care unit: A report from an acute care hospital

2020 ◽  
Vol 23 (2) ◽  
pp. 74-78
Author(s):  
Yasuro Kato ◽  
Mami Fukuhara ◽  
Minako Takakura ◽  
Yuina Kuroda ◽  
Yui Ishida ◽  
...  
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Dietary Intervention ◽  
Acute Care Hospital ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Registered Dietitians

scholarly journals A patient cohort on long-term sequelae of sepsis survivors: study protocol of the Mid-German Sepsis Cohort

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016827 ◽  
Author(s):  
André Scherag ◽  
Christiane S Hartog ◽  
Carolin Fleischmann ◽  
Dominique Ouart ◽  
Franziska Hoffmann ◽  
...  
Keyword(s):  
Acute Care ◽  
Primary Outcome ◽  
Functional Disability ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Number Of Patients ◽  
Sepsis Survivors

IntroductionAn increasing number of patients survive sepsis; however, we lack valid data on the long-term impact on morbidity from prospective observational studies. Therefore, we designed an observational cohort to quantify mid-term and long-term functional disabilities after intensive care unit (ICU)-treated sepsis. Ultimately, findings for the Mid-German Sepsis Cohort (MSC) will serve as basis for the implementation of follow-up structures for patients with sepsis and help to increase quality of care for sepsis survivors.Methods and analysisAll patients surviving ICU-treated sepsis are eligible and are recruited from five study centres in Germany (acute care hospital setting in Jena, Halle/Saale, Leipzig, Bad Berka, Erfurt; large long-term acute care hospital and rehabilitation setting in Klinik Bavaria Kreischa). Screening is performed by trained study nurses. Data are collected on ICU management of sepsis. On written informed consent provided by patients or proxies, follow-up is carried out by trained research staff at 3, 6 and 12 months and yearly thereafter. The primary outcome is functional disability as assessed by (instrumental) activities of daily living. Other outcomes cover domains like mortality, cognitive, emotional and physical impairment, and resource use. The estimated sample size of 3000 ICU survivors is calculated to allow detection of relevant changes in the primary outcome in sepsis survivors longitudinally.Ethics and disseminationThe study is conducted according to the current version of theDeclaration of Helsinkiand has been approved by four local/federal responsible institutional ethics committees and by the respective federal data protection commissioners. Results of MSC will be fed back to the patients and published in peer-reviewed journals.Trial registration numberGerman Clinical Trials Registry DRKS00010050.

scholarly journals Recommendations for incorporating palliative care education into the acute care hospital setting

1999 ◽  
Vol 74 (8) ◽  
pp. 871-7 ◽  
Author(s):  
D E Weissman ◽  
S D Block ◽  
L Blank ◽  
J Cain ◽  
N Cassem ◽  
...  
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Care Education ◽  
Palliative Care Education

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

scholarly journals Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a non-equivalent control group design

2021 ◽  
Author(s):  
Nina Weldingh ◽  
Marte Mellingsæter ◽  
Bendik Hegna ◽  
Jūratė Šaltytė Benth ◽  
Gunnar Einvik ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Control Group ◽  
Care Hospital ◽  
Control Group Design ◽  
Group Design ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
Equivalent Control

Abstract Background Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the prevalence of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. Methods This study had a non-equivalent control group design and a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the Four Assessment Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from patient journals. Results Implementation of the dementia-friendly hospital program did not show any significant effect on the identification of patients with CI. However, the proportion of the patients with CI who received preventive measures increased by 32.2% (P < .001), compared to the control group. The share of patients screened with 4AT within 24 hours increased from 0–35.5% (P < .001). Furthermore, the number of patients with CI who were prescribed antipsychotic/hypnotic medications was reduced by 24.5% (P < .001). There were no differences in delirium, 30-day readmission or 30-day mortality. Conclusions Implementation of a model for early screening and multifactorial nonpharmacological interventions for patients with CI and delirium using quality improvement methodology may improve management of this patient group, increase staff awareness of family involvement, and reduce prescriptions of antipsychotics, hypnotics and sedatives. Trial registration: The protocol of this study was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System with the registration number: NCT04737733 and date of registration: 03/02/2021.

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