Day -Day practice on Management of steroid replacement
Education surrounding steroid replacement is vital in the optimal management of patients with adrenal deficiency. Non-adequate replacement may be life-threatening, especially in case of severe physical stress, and unfortunately, acute adrenal failure is still a major cause of death. Our Endocrine Specialist Nurse Service is actively involved in the day-to-day management of patients with adrenal insufficiency offering advice and support during patient visits following referral from the outpatient clinic or through telephone enquires. Since 2010, the Department of Endocrinology in Oxford has been organising biannual events open to patients with adrenal insufficiency and their family members/carers aiming to enhance knowledge on steroid replacement and to teach hydrocortisone injection technique. Each event includes two lectures from Endocrine Registrars on manifestations, causes, management of steroid deficiency and the practical issues surrounding steroid replacement. These are followed by a practical demonstration, where in groups of 68 patients and guests are able to watch the reconstitution and administration of a steroid injection by an experienced Endocrine Specialist Nurse following the procedure described in the Pituitary Foundation leaflet, Hydrocortisone Advice for the Pituitary Patient. Attendees are encouraged to replicate what they had seen with supervision from the Nurse. Most found the manipulation of a syringe and needle difficult, but with guidance succeeded. Questionnaires were offered to attendees to look at the impact of the course. 33 patients responded: 45.5% felt fully confident injecting steroids after the course. 94% found the practical demonstration extremely useful and a similar percentage rated the course excellent. 24 guests responded: 12.5% felt confident injecting steroids before; this rose to 50% after the practical demonstration, which 87.5% rated as excellent. 91.6% rated the event as excellent. Education of patients with adrenal insufficiency during day-to-day practice or by training sessions is essential to optimise the quality of care for these subjects.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.