Oral candidiasis in a specialist palliative care unit: assessment, diagnosis, management

Objectives: To evaluate current clinical practices of assessment, diagnosis and management of oral candidiasis in a specialist palliative care unit to improve patient outcomes through compliance with the Australian Commission on Safety and Quality in Health Care Antimicrobial Stewardship Clinical Care Standard. Methods: A clinical audit cycle: review of 100 patient records preceded an educational intervention delivered over 4 weeks to clinical stakeholders, followed by a review of an additional 100 records. Results: Eleven patients in each cohort had oral candidiasis. A statistically significant improvement in documented rates of oral examination (33% to 51%, p=0.015) and appropriate microbiological testing (0% to 63.6%, p=0.004) was achieved. Documentation of oral symptoms and prescribing practices were unchanged. Conclusions: Meaningful changes in practice relating to oral assessment and diagnosis of oral candidiasis are possible. Future iterations of the audit cycle may benefit from multimodal interventions to encourage further practice change.