The new Adult NHS Emergency Steroid Card has been released in PDF format to be carried by patients with adrenal insufficiency.
CAREFUL DEVELOPMENT
The card’s development has been a joint project involving the Royal College of Physicians (RCP) Patient Safety Committee, the NHS England and Improvement (NHSE/I) Patient Safety Group and the Society for Endocrinology.
The wording and information within it have been checked carefully over an extended period of time. Wording is being double checked currently to ensure wording on the reverse incorporates phrases that trigger the response by ambulance services. Clearly the medical advice on the reverse is an initial emergency management guide only.
The QR code on the reverse of the card directs the enquirer to the adrenal crisis page on the Society for Endocrinology website (www.endocrinology.org/adrenal-crisis). All relevant details are on that page, which can be updated easily.
FURTHER WORK
Guidance for emergency management of adults with adrenal insufficiency (due to be published soon in Clinical Medicine) and an NHS National Patient Safety Alert by NHSE/I (for all sectors of the NHS in England and devolved nations) are also in development, but are on hold during the coronavirus crisis due to workload pressures. Once the alert goes live, healthcare organisations will be time-bound to respond to recommendations.
We hope this will all help place the focus on patient safety issues for our patients with adrenal insufficiency, whether this results from an endocrine condition or exogenous steroid administration causing hypothalamus-pituitary-adrenal axis suppression.
Links to all the relevant guidance on adrenal insufficiency can be found in the Society’s COVID-19 web information (www.endocrinology.org/covid19). Other work is underway by a group of rheumatologists and the British Society for Rheumatology to develop patient education in groups on exogenous steroids.
POSITIVE PATIENT RESPONSE
We have been able to release the card in PDF format early, in response to patient safety concerns during the coronavirus crisis. This has had an overwhelmingly positive response from patients, and we are grateful to the Addison’s Disease Self-Help Group, CAH Support Group and The Pituitary Foundation for their support in sharing the card with their members during the pandemic.
Indeed, some patients have used the image of the card, with emergency contact details, as a lock-screen on their phone, whilst others have produced credit card-sized versions themselves and laminated them to carry them around. This has been lovely to see, and I think the card will make a real difference to patient safety.
NEXT STEPS
The RCP and NHSE/I are now discussing how we distribute the card in tandem with the National Patient Safety Alert, as well as other practical matters such as ensuring GP and community pharmacy teams have any educational resources they may need. The card will be available to order through the usual NHS procurement processes, in addition to the downloadable PDF version.
We also need to form links with our paediatric colleagues, to ensure messages are not mixed: particularly for our adolescent patients, and BSPED is taking this forward. And, of course, also all of us in the Society will be key in educating our wider teams in our own organisations.
A SUCCESSFUL COLLABORATION
So, after a long time, the work started by Wiebke Arlt and John Wass is coming to fruition. We would not have managed this without John Dean (Clinical Director for Quality Improvement and Patient Safety at the RCP) and Julie Windsor (Patient Safety Group NHSE/I). It has been a huge team effort across multiple organisations: the Society for Endocrinology, the RCP, NHSE/I, the British National Formulary and the Royal Pharmaceutical Society, to name a few. I have learnt a huge amount about working with others across multiple national bodies.
Light has definitely been spotted at the end of the tunnel.
Helen Simpson, on behalf of the RCP Patient Safety Committee and Society for Endocrinology Clinical Committee
