A joint National Patient Safety Alert has been issued by NHS Improvement and NHS England national patient safety team, Royal College of General Practitioners, Royal College of Physicians and Society for Endocrinology, regarding the introduction of a new Steroid Emergency Card to support the early recognition and treatment of adrenal crisis in adults.
The actions to be completed as soon as possible and no later than 13th May 2021 include the following:
- All organisations that initiate steroid prescriptions should review their processes or policies and their digital systems or software and prompts to ensure that prescribers issue a Steroid Emergency Card to all eligible patients, as outlined in the new guidance.
- Prescribers undertaking standard or scheduled reviews (eg in clinics or when authorising repeat prescriptions)
should review their processes or policies and their digital systems or software and prompts to ensure all eligible patients prescribed steroids have been assessed, and where necessary issue a Steroid Emergency Card.
- Providers that treat patients with acute physical illness or trauma, or who may require emergency or elective surgical or
other invasive procedures, including day patients, should review their admission or assessment or examination or clerking documentation to ensure it includes prompts to check for risk of adrenal crisis and to establish if the patient has a Steroid Emergency Card.
- Community and hospital pharmacies should ensure they can source and supply Steroid Emergency Cards, to replace those lost by patients or which become damaged.
All patients with primary adrenal insufficiency are steroid-dependent and some patients, who take oral, inhaled or topical steroids for other medical conditions, may develop secondary adrenal insufficiency and become steroid dependent.
The omission of steroids for patients with primary or secondary adrenal insufficiency can lead to an adrenal crisis; a medical emergency which if left untreated can be fatal. If these patients become acutely ill or are subject to major body stressors, such as from trauma or surgery, they require higher doses of steroids to prevent an adrenal crisis.
Recently issued national guidance promotes a new patient-held Steroid Emergency Card to help healthcare staff identify patients with adrenal insufficiency and provide information on emergency treatment if the patient is acutely ill, experiences trauma, surgery or other major stressors.
The alert asks providers to ensure all eligible patients are issued with a Steroid Emergency Card; and to put processes in place to check if a patient has a Steroid Emergency Card ahead of any emergency treatment, elective surgery, or other invasive procedures.
You can view the new Emergency Steroid Card on the Society for Endocrinology’s Adrenal Crisis Information webpage.
This circular is being shared under the Open Government Copyright licence.