Background Corticosteroids are frequently prescribed in patients with advanced cancer for a wide range of indications. Many undesirable adverse effects are frequently reported including steroid-induced hyperglycaemia. For patients commenced on corticosteroids, without prior diagnosis of diabetes, twice weekly monitoring of capillary blood glucose(BM) is advised. Previous studies have shown poor documentation of indication, monitoring and side-effects of corticosteroids in a palliative setting.
Primary Aim Within 3 months, 90% of patients treated with steroids in Roxburghe House (RH) will be screened for hyperglycaemia with twice weekly BM monitoring.
Secondary Aim Within 12 months, 90% of steroid prescriptions in RH will have documented weekly re-assessment.
Methods The Plan Do Study Act method of quality improvement was used. Baseline data was collected for all inpatients in December 2016 from medical notes and medication administration charts(Kardex). Documentation of indication, PPI prescription, twice weekly BM, evidence of re-assessment and response was reviewed. Baseline data was re-collected following interventions over 12 months.
Interventions: A new steroid form was created with input from all grades of medical staff. Form revised and re-printed on brightly coloured paper. Education given to nursing and medical staff about steroid-induced hyperglycaemia. Reminders displayed in doctors' room. Senior charge nurse implemented set days for BM monitoring. Progress discussed at quality meeting. Included in junior doctors' induction. Patients on corticosteroids highlighted in doctors' room board.
Results Between 45–76% of inpatients were prescribed corticosteroids. Documentation of BM monitoring improved from 0% at baseline to 43% at 3 months and 100% at 8 months. No trend identified in documentation of indication (33–86%), re-assessment (23–83%), response (0–43%) or PPI prescription (80–100%) over 12 months.
Conclusions Regular monitoring of BMs has become successfully imbedded. Documentation of response and re-assessment remains poor. The rotation of junior doctors is a likely influencing factor to achieving sustained improvement, highlighting the importance of induction and education.
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