Introduction: Patients with adrenal insufficiency (AI), continue to face many challenges including: dealing with symptoms and associated disorders; managing medication regimens; prevention and management of complications, and effective engagement and interactions with healthcare providers. In patients with AI, adrenal crisis (AC) continues to lead to unnecessary deaths. We illustrate how University Hospitals Birmingham NHS Foundation Trust used the 4E framework (Engage, Educate, Equip and Empower) as a strategy in implementing the National Patient Safety Alert on steroid emergency card (SEC) to support the prevention, early recognition and management of AC in adults.
The 4E Framework: • Engage. A working group was established consisting of: consultant Endocrinologist; endocrine nurse; emergency and critical care clinicians; pharmacists, and members on non-clinical team (Patient Safety, Communications and IT services). To understand patients experience and expectations, a series of patient engagement sessions were also facilitated.
• Educate. A series of webinar sessions and speciality specific education sessions were facilitated on: AI; safe prescribing and monitoring of glucocorticoid treatment, and prevention and management of AC. An online on-demand module on AI was also developed.
• Equip. Clinicians were provided with tools including: a comprehensive guideline on the management of AI and AC; simple management algorithms; access to steroid emergency cards, and direct access to the Endocrinology helpline. Patients were equipped with SEC, hydrocortisone injection kit as well as means of accessing expert support and advice through our helpline.
• Empower. Well-engaged, well-informed and well-equipped patients are likely to be empowered to facilitate effective self-management of their condition. Similarly, clinicians are likely to be empowered to provide timely and appropriate live saving interventions.
Conclusion: AC is a life-threatening emergency that contributes to the excess mortality in patients with AI. The 4E framework (Engage, Educate, Equip and Empower) provides a systematic and effective system to support the prevention, early recognition and effective management of AC in adults.
08 Nov 2021 - 10 Nov 2021