Background Patients taking exogenous steroids are at risk of adrenal crisis due to secondary adrenal insufficiency. A recent National Patient Safety Alert has mandated that all organisations initiating steroids should issue a Steroid Emergency Card to eligible patients.^{1 2} This card is designed to alert healthcare staff reviewing a patient to the risk of adrenal crisis. The card outlines emergency treatment of adrenal crisis, including IV or IM hydrocortisone, which would require hospital admission. Admission is not always appropriate for hospice patients, but a decision to give cards to all eligible patients was agreed. As part of a wider piece of work, we assessed our current compliance with this new initiative and explore a more targeted approach.

Methods A retrospective case-note review of all discharge summaries during a 3-month period, to identify patients discharged on steroids. Data collection looked at those patients who were eligible, those that were given an emergency card and any documented plan regarding their future steroid use.

Results 41% (7/17) of patients were identified to have been discharged on steroids. Of these, no patients had documented evidence of a steroid alert card, none had a documented reason why this was not done, whilst 71% (5/7) of eligible patients had documented advice regarding their steroids.

Conclusions Our current practice highlights clear shortcomings with compliance against new national guidance. Given that hospices are now caring for individuals with significant multi-morbidity and polypharmacy and more non-malignant disease, the concept of ‘steroid emergency cards’ needs to be supported with ‘sick rule’ days advice to enable individuals, their families and the community professionals supporting them to guide action rather than provoke anxiety. This has identified within our Integrated Care System (ICS) opportunity for collaboration and co-creation rather than different providers grappling individually with what is a collective issue.

References

1. National Health Service (2020). National Patient Safety Alert- Steroid Emergency Card to support early recognitions and treatment of adrenal crisis in adults [Online]. Available from: https://www.england.nhs.uk/publication/national-patient-safety-alert-steroid-emergency-card-to-support-early-recognition-and-treatment-of-adrenal-crisis-in-adults/

2. Simpson H, Tomlinson J, Wass J, Dean J, Arlt W. Guidance for the prevention and emergency management of adult patients with adrenal insufficiency. Clinical Medicine 2020;20(4):371–378.