Endocrine Abstracts

Aim: A QIP to improve early recognition and treatment of adrenal crisis (AC) in adults. Issuance of new NHS emergency steroid cards (SEC) in accordance with National Patient Safety Alert (NPSA) August 2020.

Background: National Reporting and Learning System found that two deaths and six incidents (severe harm) were associated with shortfalls in managing adrenal insufficiency (AI) over 4 Years. A resulting NPSA advised the care organisations to identify those at risks and issue them with a Steroid Emergency Card (SEC). Members of endocrine team led the Trust’s response to the NPSA.

Methodology: Retrospectively, all patients admitted in 2019-2020 with diagnosis of adrenal insufficiency were identified and their clinical records were analysed. 76 out of 110 cases either had a diagnosis of adrenal insufficiency or were on long term steroids. These 76 cases were reviewed for appropriate management of AC, use of sick day rules (SDR) and involvement of endocrine team.

Results: 24 patients were in addisonian crisis; 22(92%) were managed appropriately according to national guidelines while 2 were not (8%). The 52 patients who were not in AC were audited for compliance with SDR. SDR were followed in 33(63%) patients but not in 19 cases (37%). The main intercurrent illness responsible for AC was gastrointestinal (29%); followed by other infections (24%). Only 13 out of 24 AC patients were referred for inpatient endocrine review; 11 were not.

Improvements: 1-A Trust-wide guideline developed based on existing SFE publications. 2-Issuance of NPSA letters and SECs to clinicians/clinical areas that most likely deal with AI. 3- The AI patients admitted in 2019-2020 were issued with SEC. 4- Poster/Screen saver developed for awareness about AI patients and SEC. 5- AI alerts to be incorporated in e-noting and ePMA (electronic prescribing). 6-Trust wide educational activities to improve compliance with AI management.