Patients with Adrenal Insufficiency are potentially at risk of life threatening events if during intercurrent illness they do not take adequate glucocorticoid replacement. The National Institute for Health and Care Excellence Clinical Knowledge Summaries for this patient group recommend that they should: know how to self inject intramuscular hydrocortisone in an emergency; how to adjust their steroid replacement in response to illness; understand the importance of medical identification.
Current education in our department is given during clinic visits, supported by written information. Patients identified by clinicians are seen by the endocrine specialist nurse for education and supply of an emergency kit. There is little evidence of subsequent reinforcement of this knowledge.
Method: Four hundred and fifty-nine questionnaires were sent to those currently on steroid replacement questioning: possession of in date injection kits and knowledge of use; knowledge of dose adjustment; possession of steroid dependence identification and recent hospital admissions. Two hundred and fifty-eight valid replies were received.
Results: Seventy-two per cent had emergency kits; 57% were in date. 50% knew how to give the injection. Seventy-five per cent carried identification of steroid dependence. Seventy-one per cent felt they knew enough to alter the doses but <45% gave correct answers to action required for severe illness. Ten per cent had hospital admissions possibly related to hypoadrenalism in the last year.
Conclusion: Possession of in date emergency kits is inadequate; Knowledge of how to self-inject is inadequate; there is insufficient knowledge of dose adjustment in severe illness.
Actions planned: Bigger and brighter posters on sick day rules and emergency kits to be produced; design a new concise information sheet and send to all on steroid replacement; Produce a prompt list to remind clinicians to question knowledge of sick day rules and possession of in date emergency kits at each clinic visit. Repeat audit in 1 year.