Background Octreotide is a somatostatin analogue used to reduce gastric and intestinal secretions therefore helping to improve symptoms of nausea and vomiting. There is mixed evidence for the use of octreotide however in both local guidelines and the Palliative Care Formulary 6 it is considered second line for the treatment of vomiting and managing secretions in malignant bowel obstruction with hyoscine butylbromide as first line.

Objectives 1. To gain insight into the scale of prescribing of octreotide for inoperable malignant bowel obstruction in a tertiary cancer centre.

2. To compare the prescribing practices for octreotide in inoperable malignant bowel obstruction to those outlined in the local and national guidance.

Methods A retrospective audit of the electronic notes and online prescriptions for inpatients prescribed octreotide for inoperable malignant bowel obstruction over a one-year period. A total of 17 patients.

Audit standards:

1. The patient has been prescribed hyoscine butyl bromide prior to being prescribed octreotide

2. The patient has been started on a dose of octreotide between 300–600 mcg/24hrs

3. The patient has not been prescribed a dose of octreotide greater than 1500 mcg/24hrs

4. The patient has a clearly documented indication for the use of octreotide.

Results

• Only 41% patients had hyoscine butyl bromide prescribed prior to being prescribed octreotide.

• 100% patients received the recommended starting dose of octreotide.

• No patients received octreotide received a dose greater than 1500 mcg/24hrs.

• 71% patients had a specific indication documented in the notes

Conclusions There are relatively few prescriptions for octreotide despite the audit data coming from a large cancer centre. Prescriptions generally follow the guidelines however documentation of indication and reason for divergence from the guideline needs improving.

Recommendations Consider using standardised documentation for when starting octreotide including indication, other medications concurrently prescribed, dietician involvement and NG tube placement.