Endocrine Abstracts

Background: Hypothyroidism is a common endocrine condition, and levothyroxine remains the mainstay of treatment. Despite clear recommendations from the National Institute for Health and Care Excellence (NICE), hospital practice often deviates from best standards. Breakfast timings, polypharmacy, and varying awareness among doctors and nurses can compromise drug absorption and therapeutic efficacy.

Aim: To evaluate adherence to national guidelines on levothyroxine administration in hospitalised patients, identify barriers to compliance, and improve practice through targeted education and visual reinforcement.

Methods: This quality improvement project (QIP) was undertaken at Croydon University Hospital between May and September 2025. A prospective observational audit was conducted across the medical wards. Findings were discussed with clinical teams, followed by face-to-face educational sessions for nursing and prescribing staff. Key messages were displayed on the ward quality boards using eye-catching posters to reinforce correct practice. A re-audit assessed the impact of these interventions.

Results: In the initial audit of 40 patients, only 13% received levothyroxine in accordance with guidelines. Common barriers included simultaneous administration with medications that impair absorption, including proton pump inhibitors (50%), calcium supplements (20%), iron (7.5%), and post-breakfast dosing (60%). Following education and poster dissemination, the re-audit of 45 patients demonstrated a rise in overall compliance to 60%, with 42% achieving complete compliance. Concomitant use of interfering drugs reduced markedly (PPIs 27%, calcium 4%, iron 4%).

Conclusion: This QIP identified a significant gap in awareness regarding levothyroxine administration. The marked improvement following active education and visible reminders illustrates the importance of education driving changes. Efforts to embed these improvements through electronic prescribing adjustments and continued pharmacy collaboration are ongoing. Given its clear clinical implications, this initiative merits wider implementation and national consideration to enhance adherence to levothyroxine administration standards across inpatient settings.