Background Novel oncology therapies mean many palliative patients are living longer and therefore long term side effects of medical interventions require more consideration. Steroids are widely used in the palliative setting for both specific and nonspecific symptoms and ‘The adverse effects of oral corticosteroids are dose-related. They can often be predicted…’ (NICE, Clinical Knowledge Summaries: Corticosteroids – oral, last rev. Aug. 2015).
Aims To evaluate whether monitoring for side effects, whilst on steroids (Dexamethasone/Prednisolone), was in accordance with NICE guidance and if this was appropriate for the hospice patients.
Methods A retrospective audit of inpatient case notes – August to September 2017. Inclusion criteria:
Patients already on steroids on admission
Patients initiated on steroids during admission.
Evaluation of whether the following were checked on and during admission as per NICE guidance:
Capillary blood sugar (CBG) [surrogate for HbA1c]
Results Over two months there were 55 admissions to the inpatient unit. 62% (n=34) fulfilled the inclusion criteria. 76.5 .% of these had a pre-existing steroid prescription and were more likely to have these increased than stopped. Only 29.4% had CBG documented on admission and other parameters were not regularly reviewed. Overall, the hospice did not fully comply with NICE guidance.
Conclusions Of those included, 58% died during admission. This suggests regular parameter testing may be inappropriate in this cohort as long term side effects (SE) may be prognostically irrelevant.The SE profile may be more acceptable than unmanaged ongoing symptoms. Therefore repeated testing for certain parameters (e.g. weight/potassium) may not be appropriate. However, diabetes mellitus is more likely to be an early side effects of steroid use and therefore CBG testing would be of symptomatic importance. A re-audit is planned following implementations of these recommendations:
Steroid alert box on drug charts
Health care professional teaching on steroid SEs and monitoring.
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