Steroid tapering for patients with spinal cord compression or symptomatic brain metastases at Jackson Memorial Hospital.

Abstract

238 Background: Metastases to the spinal column and brain for patients with cancer are common occurrences seen in oncology practices. Steroids play a critical role in symptom management upon patient presentation and proper tapering of steroids is necessary to minimize risk of recurrent symptoms. Within our institution, which is a tertiary care facility primarily for the poor and near-poor of a large urban environment, 78% of patients with spinal cord compression or symptomatic brain metastases do not receive appropriate tapering of steroids following completion of radiation treatment. This leads to unnecessary side effects from continued steroid use, ultimately leading to an inefficient use of resources, including time and money. Methods: Through the guidance of American Society of Clinical Oncology (ASCO) Quality Training Program, we created a process map, cause and effect diagram, and acquired preliminary diagnostic data. This data was acquired via electronic medical record (EMR) review including evaluation of inpatient notes, discharge summaries, medication orders and prescriptions, and outpatient clinic visit notes. We then completed several PDSA cycles including grand round presentation, tapering template incorporation into clinic, and template creation within our EMR. Results: We identified that a single physician primarily was responsible for the patients that appropriately received steroids. We utilized this physician's expertise to help create meaningful interventions. By the complete of our last PDSA cycle, we have reduced the percentage of patients who do not receive an adequate steroid taper form 78% to 20%. Conclusions: Practitioner education and incorporation of steroid tapering templates into an outpatient radiation oncology clinic can reduce the percentage of patients with spinal cord compression or symptomatic brain metastases, who do not receive and adequate steroid tapering regimen.