Background Dexamethasone is a corticosteroid with potent glucocorticoid but limited mineralocorticoid activity suitable for high dose anti-inflammatory therapy.It is used in Palliative Medicine for a variety of licenced and unlicenced indications. Glucocorticoid toxicity depends on the dose that is administered over a certain period of time. Therefore even low doses can have toxic effects if administered long-term. Because dexamethasone is used for various indications in palliative care it is pertinent that the indication is clearly documented in order to facilitate medication review. The aim of this audit is to identify those patients treated with dexamethasone on a single day in an in-patient hospice unit and to identify if indication for treatment with dexamethasone has been documented
Methods A manual review of patient medication records was carried out on a single day in a 36- bed in-patient hospice unit to identify patients prescribed dexamethasone. Documentation of indication in either the patient medication record or patient clinical record was audited. Education was provided to medical staff. Subsequent re-audit took place to complete the audit cycle.
Results Initial data collection identified 8 patients on current dexamethasone treatment. 2 had clinical indication documented. The range prescribed was 2 mg-6 mg. Mean prescribed was 3.625 mg and median was 4 mg.
Following re-audit, 10 patients were identified on current dexamethasone treatment. 5 had clinical indication documented and five did not. The range of dexamethasone prescribed was 1-24 mg. The mean prescribed was 5.1 mg and median was 2 mg.
Conclusions Dexamethasone is used for both licenced and unlicenced indications in the palliative care setting. Because its toxicity is dependent on the dose that is administered over a certain period of time, the smallest dose for the shortest period of time is crucial in limiting toxicity. This audit has shown that a brief educational session improves documentation of clinical indication for dexamethasone.
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