Background The estimated use of steroids in palliative care patients is variable, although it is thought to be around 50% (Pallaborative North West. Guidelines for the use of corticosteroids in palliative care. 2009; Denton, Shaw. BMC Palliat Care. 2014;13(1):50). Steroids are useful, yet potent medications which have frequent adverse effects. An audit was undertaken of the prescribing of dexamethasone in a North West hospice inpatient unit against regional guidelines (Pallaborative North West. 2009), to evaluate against the previous year’s audit.

Aims To monitor the compliance of steroid prescriptions in accordance with regional guidelines (Pallaborative North West. 2009).

Methods We compared data to the year prior which had been collected in the same manner. After the previous audit a presentation was given to clinical staff. A retrospective audit over a 6-month period was undertaken. Electronic records of all admissions over the time period were screened. The inclusion criteria was: being admitted on or being prescribed dexamethasone during their admission. 125 records were screened, and 46 were included.

Results The most commonly prescribed steroid doses in both cycles were 8mg, 6mg and 4mg.

Improvements were seen between cycles in some areas; documentation of indication (59% v 72%), proton-pump inhibitors prescriptions (96% v 100%), prescription of steroids at the correct time (86% v 100%). Worse results were recorded for once weekly monitoring of blood glucose levels (45% v 20%), however, this may be due to issues with acquiring the data. A decrease in documented discussion of side effects was also seen (14% v 7%). Of the 6 patients discharged on a prolonged course of steroids, 5 were not recorded as being given a steroid card.

Conclusion Improvements were seen in most audited areas. Further developments can be gained in some areas. Results were presented at local education sessions, and also discussed at the hospice’s medicines management meeting. An action plan has been developed to improve areas audited, which includes changes such as blood glucose monitoring and recording.