Background Corticosteroids are used within specialist palliative care for a variety of indications, from wellbeing to medical emergencies such as spinal cord compression. For benefits to outweigh toxicity, it has been suggested that they should be used according to defined guidelines.
Aim The NorthWest Audit Group aimed to review the practice of organisations across the Northwest of England regarding corticosteroid use.
Method This multi-centre, cross-regional, retrospective case-note audit used a standardised data collection tool to gather information on patients with advanced malignancy, known to specialist palliative care. A multi-professional steering group developed standards of good practice against which the first 2 weeks of steroid therapy was audited.
Results Data were collected on 181 patients from 22 sites including hospital, hospice and community settings. Specialist palliative care professionals were involved in the commencement of steroids in 63%. The indication was documented in 82%, with most commonly cited reasons being anorexia, pain, fatigue and raised intracranial pressure. Previous steroid use was documented in 18%. When patients were prescribed medications that interact with corticosteroids, 4/21 (19%) had evidence of this being taken into consideration. Instructions for blood sugar monitoring were present in 24%. Where there was concurrent aspirin or NSAID use, gastro-protection was prescribed in 36/41 cases (87%). For patients remaining in the same care setting, there was evidence of a dose review in 79%. For those who were discharged from the service, there was a plan for future monitoring in 58%.
Conclusion This audit was well received with a very positive return. It demonstrated scope for improvement in current practice. Issues highlighted include the need for improvement in documentation of previous steroid use, instructions for blood sugar monitoring and review of drug interactions. Communication is vital when a patient is transferred between services so that monitoring of safety and efficacy is on-going.
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