Endocrine Abstracts (2003) 6 S25

AN AUDIT OF SELF-CARE OF PATIENTS ON HYDROCORTISONE REPLACEMENT THERAPY

VM Kieffer, CL Robinson & TA Howlett


Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, UK.


Patients with hypoadrenalism are at risk of life-threatening events if they do not receive adequate glucocorticoid replacement during intercurrent illness. We think that these patients should know when and how to adjust their steroid dose when ill. We also think they should possess, and know how to give themselves, an injection of hydrocortisone for emergencies.

Current education is given ad hoc at clinic visits, supported by written information, but there is doubt as to how consistent this is. We do not know how many possess hydrocortisone injection kits for emergency use.

243 questionnaires designed to address knowledge of dose adjustment, possession of injection kits, precautions for holidays, recent illness or hospital admissions, and possession of some form of identification that on steroid replacement, were sent out to those currently on hydrocortisone replacement

172 valid replies were received.

Results:

32 had in-date emergency kits. 17% had been shown how to give the injection. 73% of patients and 51% of partners would like to learn how to give the injection. 41% felt they knew enough to alter doses in response to intercurrent illness. 51% had altered doses in last year.6 had hospital admissions in last year with incidents possibly related to hypoadrenalism. Less than 40% gave correct answers when asked for action required in cases of severe illness.

Conclusions:

Knowledge of dose adjustment appears to be inadequate. Few patients are in possession of emergency kits. Substantial numbers would like to learn how to administer the injection.

Action:

Education evenings have been organised. Written information has been updated. A new 'steroid information' card has been designed.

250 hydrocortisone injection kits have been ordered.

A poster showing action in case of intercurrent illness to be designed and displayed in clinic.

Patients to be asked to show current identification at clinic visit.

Reaudit next year.

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