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Publication Type: Safety Alert
Single or Multiple Incident: Multiple
Date: 8/13/2020 12:00:00 AM
Country: United Kingdom
Organization: NHS Commissioning Board
This alert discusses the patient safety incident which can occur in patients with adrenal insufficiency and who are steroid dependent are deprived of their steroid medications. All patients with primary adrenal insufficiency, such as those with Addison’s disease, congenital adrenal hyperplasia, and hypothalamo-pituitary damage from tumours or surgery, are steroid dependent. Some patients who take oral, inhaled or topical steroids for other medical conditions may develop secondary adrenal insufficiency and be steroid dependent. Omission of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. Patients with adrenal insufficiency require higher doses of steroids if they become acutely ill or are subject to major body stressors, such as from trauma or surgery, to prevent an adrenal crisis. A recent two-year period identified four deaths, four patients admitted to critical care, and around 320 other incidents describing issues with steroid replacement therapy for patients with adrenal insufficiency or emergency treatment for adrenal crisis. The alert provides several recommended actions to reduce the likelihood of related patient safety incidents in steroid dependent individuals and stresses the value of carrying a Steroid Emergency Card.

Additional Details

Medication/Gas/Fluid:
steroids - oral, topical, inhaled

Rules / Policies / Procedures
  1. All organisations that initiate steroid prescriptions should review their processes/ policies and their digital systems/software and prompts to ensure that prescribers issue a Steroid Emergency Card to all eligible patients, as outlined in new guidance.
  2. Prescribers undertaking standard/scheduled reviews (eg in clinics or when authorising repeat prescriptions) should review their processes/policies and their digital systems/software and prompts to ensure all eligible patients prescribed steroids have been assessed, and where necessary issue a Steroid Emergency Card.
  3. 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/assessment/examination/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.
  4. Community and hospital pharmacies should ensure they can source and supply Steroid Emergency Cards, to replace those lost by patients or which become damaged.

Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults