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Poster Number 142 – 184 – Pain & symptom management: Poster No: 161
Audit on documentation of steroid usage in palliative care patients in a UK inpatients' hospice
  1. Sivakumar Subramaniam,
  2. Paula Newens,
  3. Krishna Vellaturi,
  4. Bettini Caio,
  5. Jane Marshall and
  6. Simon Fisher
  1. Pilgrims Hospice, Ashford, UK

Abstract

Steroids are commonly used medications in palliative care patients. It is well known that inappropriate or prolonged prescribing of steroids could be harmful for patients. An Audit of documentation of steroid usage in in-patients was completed in 2007 at three hospices with 90 patients. This recommended (1) every patient on steroids must have indication, dose, response and planned length of treatment documented. It may be feasible to record this in both case notes and drug chart. (2) All patients on steroids and NSAIDs should be on a PPI. (3) All patients discharged on steroids should have a management plan documented.

Aim To evaluate our current practice against the recommendations from the 2007 audit.

Methodology Retrospective, case notes &drug chart review of all the patients discharged from two inpatients' units from November 2010 to May 2011 with 32 beds in total.

Results Total patients: 133, patients discharged on steroids: 60 (30%). Indication documented: 52/60; Response clearly documented: 37/60.Planned duration documented: 40/60.Patient on steroids and NSAIDs not on PPI: 2/5. No documented plans about steroids in discharge letter: 28/60.

Conclusion A significant number of patients are discharged on steroids from inpatients' units. However, the documentation of indications, planned length of use, response to the treatment and reduction plans needs further improvement. One of the main findings from the audit is that the documentation regarding steroid prescription and planned reduction in discharge summaries needs to be significantly improved. It is recommended that a separate box be added to the discharge letters regarding steroids and plans of reduction and introduce steroid card for the patients to carry to alert the professionals. To re-audit in 2 years time to check progress.

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