Background: Adrenal crisis is a potentially life-threatening situation which can affect any patient with adrenal insufficiency (AI). Patients with AI and healthcare professionals looking after them should know the sick day rules and when and how to use parenteral hydrocortisone. Patient stories and feedback from patients with AI indicated low standards locally. We therefore aimed to empower patients through education and provide them with a hydrocortisone emergency kit.
Method: Patients with known AI were invited to a group education session run by an endocrinologist and pharmacist to discuss their condition, sick day rules, training on when and how to administer IM hydrocortisone and were supplied with an emergency kit containing everything to administer that injection. A maximum of 12 patients were invited to each session.
Results: Since February 2019 29 patients, mean age 55 years old (range 1973), have attended the sessions and were provided with education, leaflet on sick day rules, link to patient website, educational material and an emergency kit. Patient feedback from the session rated the sessions between 1 (unsatisfactory) and 5 (very good), the average rating was 4.8, Some patients had never had an emergency hydrocortisone kit, some did not know the sick day rules. Many patients reported concern about lack of awareness of the severity of adrenal insufficiency amongst medical professionals, especially in emergency situations.
Discussion: Feedback has been extremely positive with patients feeling more confident on sick day rules and how to use emergency hydrocortisone. Patients were actively encouraged to request additional doses of hydrocortisone if they felt they needed it in emergency situations. Education sessions for the emergency department doctors, advanced clinical practitioners and junior doctors have been started as a result of this.