Aim To describe the prescribing patterns of dexamethasone in a cohort of palliative care inpatients. Method Data were collected from a consecutive sample of patients admitted to 2 palliative care units over an 8 week period. Data on dexamethasone use was also collected, i.e. indication for use, dosages, concurrent medications, adverse effects, blood glucose levels and reasons for changes in dose. Results 359 patients were admitted during the recruitment period and 185 (52%) were prescribed dexamethasone. 37 (20%) patients were prescribed dexamethasone for specific indications, such as cerebral disease, spinal cord compression and bowel obstruction. The majority of dexamethasone was prescribed for non‐specific indications: poor appetite, nausea, and poor wellbeing. A range of doses was prescribed for each indication and during their inpatient stay most patients (65%) had their dose reduced. Adverse effects were commonly reported; 117 (63%) patients experienced adverse effects attributable to dexamethasone. Conclusion Dexamethasone use is widespread in palliative care for a myriad of indications.

Background Despite the risks of contributing to antibiotic resistance, guidelines recommend antibiotic prophylaxis for plastic surgery,. Aim To evaluate institutional antibiotic prescribing patterns for breast cancer surgery. Method As there are no national antibiotic prophylaxis guidelines for breast cancer surgery, the Therapeutic Guidelines: Antibiotic for head, neck and thoracic surgery were the most appropriate reference point. Data were reviewed for 95 patients from 1 hospital who underwent 134 breast cancer operations performed by 12 surgeons over a 6‐month period in 2012. A bivariate scoring system (in agreement/not in agreement) assessed each surgical record against 4 criteria: antibiotic, route, timing of administration, dosage. A conservative assumption, that all surgical cases would require single‐dose antibiotic prophylaxis, was applied. Results Of the 134 operations (comprising 241 surgical procedures), 71 (53%) involved prophylactic administration of antibiotics, mainly IV cefazolin. 38 of the 71 operations also used postoperative antibiotics. There were no trends between surgeons. None of the cases was in complete agreement with the Therapeutic Guidelines: Antibiotic. Conclusion The lack of specificity of the Therapeutic Guidelines: Antibiotic may account for the observed divergence in antibiotic prescribing patterns. Guidelines for breast cancer surgery are needed that are based on consultation with surgeons and balance specificity with flexibility for the surgeon's judgement of infection risk.