Endocrine Abstracts

Background: Acute adrenal insufficiency is a medical emergency and patients at risk of adrenal crisis should be treated immediately with glucocorticoid replacement. Our aim was to ensure there were safety alerts in place for health care professionals managing steroid dependent patients, to highlight their risk of adrenal insufficiency, and therefore prevent delays in life saving treatment.

Methods: Review of the electronic documentation of all the steroid dependent Paediatric patients at the Royal United Hospital, Bath, for a safety alert highlighting their risk of adrenal insufficiency. Review of the alerts in place with the local ambulance service on the same population of steroid dependent Paediatric patients. Created an alert on high-risk Paediatric patients’ notes, flagging their risk of adrenal insufficiency. Developed a safety alert pop-up box, which must be physically acknowledged, to appear every time the patients’ notes are accessed. Formed a check list for all newly diagnosed steroid dependent patients, who are at risk of adrenal insufficiency, to ensure the appropriate alerts are created on diagnosis.

Results: 95% of Paediatric patients on steroid replacement therapy did not have an alert on their electronic documentation stating they were at high risk of adrenal insufficiency. 10% of these patients also did not have an alert with the local ambulance service highlighting their steroid dependence and risk of adrenal insufficiency. 100% of the steroid dependent Paediatric patients now have an alert on their electronic documentation and with the local ambulance service. This will be re-audited in 24 months to ensure the ongoing implementation of safety alerts for newly diagnosed steroid dependent Paediatric patients.

Conclusion: Steroid dependent Paediatric patients at the Royal United Hospital, Bath, now have multiple safety alerts in place to ensure health care professionals are aware of their risk of acute adrenal insufficiency.