Background Steroids are frequently prescribed in palliative care for many different indications. However, use of steroids can also lead to side effects which can negatively affect the well-being of patients. Although there are no local or national guidelines on steroid prescribing in palliative care, on reviewing the relevant literature a number of common standards are identified.¹

• Steroids should be prescribed for a recognised indication;

• a plan should be in place for review of the steroid prescription;

• steroids should be prescribed before 2 pm in order to prevent insomnia;

• GI protection should be prescribed, particularly if concurrent NSAID or history of peptic ulcer disease.

Methods Using these standards records from patients admitted to an inpatient palliative care unit over a 1 month period were examined retrospectively, focusing on documentation at the time of admission (if the patient was already prescribed steroids) or at the time of first steroid prescription.

Results Of 20 patient records examined 12 had been prescribed steroids. 9 of these 12 were already prescribed steroids at the time of admission to CMC. All patients were prescribed steroids prior to 2pm and all patients had a prescription for GI protection. 5 patients (42%) had an indication for steroids recorded and 3 patients (25%) had a plan for review of steroid prescription recorded.

Conclusion These results demonstrate there is scope to improve the recording of the indication and plan for review of the prescription of steroids. A sticker has been developed and after multi-disciplinary team discussion it was added to the admission documentation with the aim of improving practice at the time of admission. Work to evaluate this intervention is on-going.

Reference

1. . Twycross R, Wilcock A and Howard P. Palliative care formulary (6th Edition). Palliativedrugs.com Ltd, Nottingham, 2017.