167 Improving safe delivery of steroids and side effect management in brain tumour patients

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Abstract Background Dexamethasone’s role in improving tumour related oedema has been known for more than four decades. Unfortunately steroids come with numerous and well recognised side effects. In a busy clinic it is difficult to ensure they are monitored thoroughly, leading to a potentially serious toxicity such as vertebral fracture or weight gain, or life threatening side effects relating hyperglycaemia. Patients can also find it difficult to manage frequent dosing changes leading to accidental over or underdose, or going longer than recommended without review. Methods Two interventions- Steroid booklet- given to all patients on dexamethasone. Patient information on key toxicities including serious/ suitable for monitoring eg. gastric ulceration, osteoporosis, steroid induced diabetes and hepatitis reactivation. Clinician sections to document baseline Hba1c, DEXA scan and viral screening and preventative medications. Dose adjustment and symptom record to allow patient and clinician to track changes. Weekly nurse led steroid telephone clinic Move regular steroid reviews out of the busy outpatient clinic. Proforma to standardise review including steroid dose and changes, glucose control and bone protection. Results Steroid booklet- Clinicians experienced easier review of dose changes over time. It also aided focus on key toxicity including bone health and blood glucose testing. In viral hepatitis it highlighted potential need for antiviral treatments. Nurse led clinic- Approximately ten patients were reviewed each week. 90% of patients required a dose change at each review. Frequently additional interventions were required including prescribing steroids or bone protection. Diabetes team referrals were also initiated. 95% of patients found it useful with no negatives experienced. Conclusion Introduction of the steroid booklet and nurse led clinic has helped standardise steroid management in outpatient clinic. This should in turn improve treatment safety.