Background Steroids are frequently prescribed in palliative care for several indications, often concurrently. Identifying the original indication and thus a safe withdrawal regimen is, however, not straightforward as patients transition across different clinical settings. We conducted this Quality Improvement Project to assess current practice of steroid prescribing and titration in dying patients on an NHS Palliative Care Unit in Northumbria Healthcare NHS FT.
Methods All patients who were prescribed steroids between January and April 2019 were included in the study, and followed through until discharge or death. Details of the indication, dose, and the documented plan for dose reduction and cessation were collected.
Results 43 patients were prescribed steroids: all of these were given dexamethasone. 17 patients died in the period under study; the remainder were discharged. While 48% had a plan for reduction of steroids documented, this was inconsistent and highly variable.
The mean number of days patients remained on dexamethasone was 19.2 (range 3–54 days). The most common reason for stopping steroids was patient deterioration or death (40%). 88% of patients who died, were given dexamethasone subcutaneously in the last days of life.
Discussion Steroid use can lead to significant morbidity, with adverse effects reported in up to 63% of prescriptions. Adrenal suppression can occur when steroids are used for over 3 weeks. It is critical to be able to establish the indication for and the duration of steroid use, in order to prevent unnecessary harm by the continuation of a subcutaneous injection even into the last days of life. This is the start of a plan, do, study, act cycle. The next iteration of this introduces mandatory documentation of the indication for use within electronic prescribing modules.
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