To support the early recognition and treatment of adrenal crisis in adults, NHS England and NHS Improvement’s national patient safety team have issued a National Patient Safety Alert. Supported by the Royal College of General Practitioners, the Royal College of Physicians and the Society for Endocrinology, here is everything you need to know about the Steroid Emergency Card and how to issue it to relevant patients.
Click here to download the NHS Steroid Emergency Card
Steroid Emergency Card And Adrenal Insufficiency
Recently published guidance on the prevention and emergency management of adult patients suffering from adrenal insufficiency (AI) outlined the general issues relating to adrenal crisis (Simpson, 2020). It highlighted four deaths, four critical care admissions and 320 other incidents related to adrenal crisis over two years.
Organisations must implement several actions to make the new Steroid Emergency Card operational. However, many groups need support on how to identify patients at risk of adrenal insufficiency from exogenous steroids. The guidance addresses the following clinical questions:
- Which patients are at risk of HPA axis suppression from exogenous steroids?
- Who should be issued with a Steroid Emergency Card and have sick day rules?
- Advice for intercurrent illness, procedures and surgery?
- Who should have steroid cover for procedures, surgery and acute intercurrent illness?
- Who requires adrenal function assessment?
Patients And Steroid Dependency
Patients with primary adrenal insufficiency, such as those suffering from Addison’s disease, congenital adrenal hyperplasia, and hypothalamo-pituitary damage from tumours or surgery are steroid dependent. Some patients who take steroids orally, through an inhaler or topically for other medical conditions may also develop secondary adrenal insufficiency and become steroid dependent.
Patients with adrenal insufficiency from any cause, or those who are at risk of adrenal insufficiency, could develop adrenal crisis and should be given stress doses of exogenous glucocorticoids. This refers especially to times that would normally provoke a cortisol stress response, including surgery, labour, invasive procedures, after experiencing trauma or when they are acutely ill.
The latest national guidance promotes the issuing of a new patient-held Steroid Emergency Card. It will help healthcare staff identify patients with adrenal insufficiency and provide information on emergency treatment.
Guidance On Issuing A Steroid Emergency Card
Organisations and prescribers that initiate steroid prescriptions and undertake standard or scheduled reviews should check their processes or policies and their digital systems and prompts to ensure that prescribers issue a Steroid Emergency Card to all eligible patients. This includes in clinics or when authorising repeat prescriptions.
Providers that treat patients with acute physical illness or trauma, or those who require emergency, elective or invasive surgery, including day patients, should review their admissions, assessments, examination and clerking documentation. It should include prompts to check for risk of adrenal crisis and to identify whether 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 become damaged. For more information, download the National Patient Safety Alert PDF document.
How To Order The New Steroid Emergency Card
You can order the new Steroid Emergency Card through the usual NHS ordering process. For those who don’t know, we’ve outlined it below.
Secondary Care to go through the Xerox online portal but you may need to raise a Non-Catalogue Requisition in Oracle and selecting XEROX as the supplier. From there, they will process the requisition by raising the order with NHS Forms.
Primary Care providers use the PCSE online portal while the private sector should email email@example.com for a registration form. Patients can also download a PDF version as many will use it as the lock screen on their mobile phones to show health care professionals in a medical emergency.
Here is some helpful information on the prevention and emergency management of adult patients with adrenal insufficiency that accompanies the NHS Steroid Emergency Card.
The safety alert is aimed at Acute trusts, private providers or independent treatment centres providing NHS care, ambulance trusts, mental health and community trusts, general practices and community pharmacists. Any actions that organisations or establishments need to take should be completed no later than 13 May 2021.
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