Recently published guidance on the prevention and emergency management of adult patients with adrenal insufficiency outlined the general management issues relating to adrenal crisis. This was subsequently supported by an NHS England and NHS Improvement national patient safety alert (NatPSA) promoting the use of a new Steroid Emergency Card.

 

The NatPSA specified a number of actions that organisations need to implement, to operationalise the introduction of the new Steroid Emergency Card. The NHS has been asked to implement this alert by May 2021. However, it has become clear that many groups need support on how to identify:

 

• Patients at risk of AI from exogenous steroids; both for clinical safety around the advice given for patients undergoing surgery, or invasive procedure, and to clarify who needs additional steroid cover for procedures 

• Who needs to be given sick day rules, 

• Who requires a Steroid Emergency Card. 

 

In order to support implementation, the Society for Endocrinology, the Specialist Pharmacy Service (SPS), and the British Association of Dermatology (BAD) are working on more detailed guidance. This will provide more clarity on those patients taking exogenous steroids who should be given the new Steroid Emergency Card, and provide advice on increasing steroids during intercurrent illness, procedures and surgery. We hope to have this ready to share in January 2021.