Feature ArticlesGuidance for Safe and Appropriate Use of Antibiotics in Hospice Using a Collaborative Decision Support ToolSinert, Molly PharmD; Stammet Schmidt, Michelle M. PharmD, BCGP; Lovell, Amanda G. PharmD, BCGP; Protus, Bridget McCrate PharmD, MLIS, BCGP, CDPAuthor Information Molly Sinert, PharmD, is clinical pharmacist specialist, Infectious Diseases, Optum Hospice Pharmacy Services, Westerville, Ohio. Michelle M. Stammet Schmidt, PharmD, BCPS, is clinical pharmacist, Optum Hospice Pharmacy Services, Westerville, Ohio. Amanda G. Lovell, PharmD, BCGP, is clinical pharmacist, Optum Hospice Pharmacy Services, Westerville, Ohio. Bridget McCrate Protus, PharmD, MLIS, BCGP, CDP, is director of Drug Information, Optum Hospice Pharmacy Services, Westerville, Ohio. Address correspondence to Bridget McCrate Protus, PharmD, MLIS, BCGP, CDP, Optum Hospice Pharmacy Services, 250 Progressive Way, Westerville, OH 43082 (email@example.com). The authors have no conflicts of interest to disclose. Journal of Hospice & Palliative Nursing: August 2020 - Volume 22 - Issue 4 - p 276-282 doi: 10.1097/NJH.0000000000000655 Buy Take the CE Test Metrics Abstract 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. Copyright © 2020 by The Hospice and Palliative Nurses Association. All rights reserved.