Background Steroids are a commonly used drug in palliative care with the potential for serious side effects or adrenal crisis. Dexamethasone is often used at high doses, requiring extended weaning schedules and making prescribing accuracy important. Safe and effective steroid management relies on clear communication between hospital palliative care services and community teams. This is supported by the use of red steroid emergency cards to identify patients at risk of adrenal crisis, and blue steroid treatment cards which identify patients on steroid treatment.
Methods This audit evaluated steroid prescriptions on discharge from a specialist inpatient palliative care unit over a three-month period in late 2021. 23 electronic discharge summaries were identified. Data were collected regarding documentation of steroid indication, weaning plan, and issue of red & blue cards. These data were evaluated against an internal best practice standard, formulated using NICE guidance, BNF prescribing advice and National patient safety alerts.
Results Steroid indication was adequately documented in 61% of the sample and weaning plans were sufficient in 52%. 91% of discharges met criteria for issue of red & blue cards, but only 5% received red cards and none received blue cards.
Conclusions This audit found that steroid prescriptions on discharge from this palliative care unit require improvement. A QIP was designed to improve steroid prescribing on discharge: a blue steroid ‘booklet’ was created, containing the information from a blue card along with a dose titration record and side effect journal, facilitating documentation from both patient and healthcare professional. A new electronic prescribing alert was installed prompting prescribers to issue the booklet, and guidance for issue of steroid alert cards was sent to prescribers and posted within the unit. Prescribing from this palliative care unit will be re-audited following three months of these interventions to determine their effectiveness.
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