159 A CBG a day keeps the Doctor away: improving capillary blood glucose monitoring and management for patients taking a corticosteroid

<h3>Background</h3> Corticosteroids are commonly used in Palliative Care but can worsen blood sugar control or cause steroid induced hyperglycaemia.^{1 2} National guidance recommends checking Capillary Blood Glucose (CBG) levels prior to starting a steroid and to monitor throughout the prescribed course if raised.^{2 3} We aimed to establish how CBG was monitored and managed in our hospice inpatient unit (IPU) and improve the detection and management of steroid induced hyperglycaemia. <h3>Method</h3> A retrospective audit of drug charts and case-notes was undertaken for 40 patients admitted to the hospice IPU from 1st December 2023 to establish current practice surrounding CBG monitoring for patients on steroids. Guidance on CBG checking and management, including a CBG monitoring form was introduced in May 2024 following a review of published literature and national guidelines.^{2 3} <h3>Results</h3> In the first data set, 10 of the 40 patients met the criteria for CBG monitoring due to steroid prescription. Only three of these patients had a CBG recorded during the course of their steroids. Following the introduction of the CBG monitoring form, five of the 25 patients reviewed met the criteria and four of these patients had a monitoring form. All patients with a CBG over 15 were prescribed Gliclazide in line with Diabetes UK End of Life Care Guidance in both audit cycles, however the ongoing frequency of CBG monitoring was improved for those with a form.³ <h3>Conclusion</h3> Introducing a CBG monitoring form for patients prescribed corticosteroids improved the percentage of patients having a CBG checked from 30% to 80%. Twice as many high CBG readings were also identified and all managed in line with our guideline.3 Pre-tea CBG readings were taken in 53% of patients. Improvements to the form have been made to make timings and frequency of CBG readings clearer. <h3>References</h3> A Retrospective Observation of Corticosteroid Use at the End of Life in a Hospice Craig Gannon; Penny McNamara Journal of Pain and Symptom Management Volume 24, Issue 3, September 2002, Pages 328–334 Joint British Diabetes Society for inpatient care – Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy 2023. Accessed at JBDS 08 Steroids and DM Guideline with qr code.pdf (diabetes-resources-production.s3.eu-west-1.amazonaws.com) on 12/04/2024 Diabetes UK - End of Life Guidance for Diabetes Care 2021. Accessed at EoL_TREND_FINAL2_0.pdf (diabetes-resources-production.s3.eu-west-1.amazonaws.com) on 12/04/2024