The British National Formulary advises that all patients prescribed corticosteroids for more than 3 weeks are issued with a steroid treatment card that they carry on their person at all times.1 An audit was carried out to determine if these guidelines are being met in patients receiving palliative care at Willow Wood Hospice. A similar survey carried out by Zeppetella in 1998, and published in a letter to this journal, revealed that 43% of patients referred to St Joseph's Hospice, London, did not have a steroid treatment card,2 and I was interested to determine if practice had now improved.
Seventeen patients were included in my audit; all were prescribed corticosteroids orally, either dexamethasone or prednisolone, which they had been taking for over 3 weeks. Nine patients (53%) did have a card; eight (47%) did not. Out of those with a card, only two (22%) admitted to carrying it at all times.
Steroids are prescribed for many indications in palliative care, including the relief of non-specific symptoms, such as anorexia, fatigue, and cachexia syndrome.3 However, their long-term usage is associated with serious side effects, such as Cushing's syndrome and an increased susceptibility to infection. Prolonged use may cause suppression of the hypothalamic-pituitary-adrenal axis resulting in adrenal insufficiency with risk of adrenal crisis, cardiovascular collapse, or even death in the event that steroids are stopped suddenly, including during anaesthesia.4 The steroid treatment card acts as a reminder to patients about the potential side effects and dangers of abrupt cessation, as well as a warning to healthcare professionals about patients' medication status: ultimately it aims to ensure patient safety.
This audit demonstrated that the British National Formulary guidelines are not being met in 2010: almost 50% of patients did not have a steroid treatment card and of those with a card, few always carried it. These findings reflect those of Zeppetella's survey, suggesting that this may be a long-standing, widespread problem. Steroid treatment cards should be distributed to and carried by patients on long-term steroids: this issue needs to be recognised and steps taken to improve clinical practice in this area.
- © British Journal of General Practice, 2010.
