National patient safety alert: Early recognition and treatment of adrenal crisis (25 March 2021)

Summary

Dr Helen Simpson, Lisa Shepherd and Dr Steve Kell summarise the guidance and implementation of the steroid emergency card in primary care.

Content

Adrenal insufficiency (AI) is an uncommon but potentially life-threatening condition, where patients are unable to produce enough of the glucocorticoid, cortisol. Every practice will have patients with a known diagnosis of AI, such as those with Addison’s disease, congenital adrenal hyperplasia or hypothalamo-pituitary diseases. Patients who take oral, inhaled, injected or topical steroids for other medical conditions may develop adrenal insufficiency and become steroid dependent.

Over a two-year period in England between July 2018 and July 2020, four deaths and four intensive care admissions were attributed to steroid omission, according to the NHS Improvement national reporting and learning system.

To prevent such incidents, the Society for Endocrinology, Royal College of Physicians, and NHS England’s patient safety team has developed an NHS steroid emergency card (SEC). This is a patient-held prompt that can be given to healthcare professionals when in crisis, or when undergoing a procedure to ensure steroid treatment is given appropriately and promptly. These cards should also be flagged up by hospital electronic systems and by patients in remote consultations.

A patient safety alert was issued alongside this, which requires general practice to take action by 13 May 2021. This includes assessing patients who are prescribed steroids and ensuring that all eligible patients are issued with an SEC.