Endocrine Abstracts

Over 700 patients with known adrenal insufficiency are treated across the trust. Whilst unwell or fasting for a procedure, these patients potentially risk suffering an adrenal crisis. A flagging system has already been implemented on the electronic patient records (EPR) which identifies patients who are ‘on replacement Hydrocortisone’. Following an inpatient adrenal crisis which could have been more optimally managed, we sought to highlight care of this vulnerable cohort across the trust. Additionally, we wanted teams to consider those on long-term steroids who could potentially be at risk of unrecognised adrenal insufficiency whilst unwell. The Endocrine team initiated a trust-wide safety and education project called ‘Think Adrenal’. Firstly, we developed interactive patient banners on the EPR for patients with an ‘FYI’ flag in place. When clicked, a sidebar report opens for all clinical users.

This contains: • Emergency IM dosing regimens

• A ‘traffic light’ system for nurses, delineating the care of the well (green), deteriorating (amber) and patients in crisis (red)

• Illness Flow Charts for the medical care team to follow when the child is deteriorating, including dosing regimens.

• A ‘Think Adrenal’ branded bedside ‘WETFLAG’ which is available for the treatment team to print off, designed alongside the trust resuscitation team.

• Adrenal shift safety checks have been added to EPR to remind nurses to ensure that emergency dosing is prescribed and that the appropriate WETFLAG is in place.

Emergency Hydrocortisone Kits (‘grab bags’) are now situated on the main wards, ready to be taken with patients when moving around the hospital. In conjunction with these measures, the Endocrine nursing team are leading a trust-wide nurse education drive to empower nurses in the care of these children. This started with training practice educators and has been rolled out to other CNS teams and now onto the wards. Reassuringly, we have already seen incidents in which nurses have correctly suggested potential adrenal crises in a deteriorating child, allowing for subsequent appropriate treatment. The next stage will involve developing education packages for the medical teams in other specialities to be rolled out with the PGME (Post Graduate Medical Education) team.