Steroid Card.

Patient Safety Alert.

Severn Valley Medical Practice would like to draw your attention to the recent patient safety alert on the new NHS Steroid Emergency Card. In August 2020, a joint National Patient Safety Alert was issued regarding the early recognition and treatment of adrenal crisis in adults.

All patients with primary adrenal insufficiency are steroid dependent. In addition, some patients who take oral, inhaled or topical steroids for other medical conditions may develop secondary adrenal insufficiency and become steroid dependent. The latter includes:

• Patients taking oral prednisolone ≥5mg/day, or dexamethasone ≥ 0.5mg/day, or hydrocortisone ≥15mg/day for 4 weeks or longer

• Patients taking inhaled beclometasone >1000mcg/day or fluticasone >500mcg/day (or equivalent)

• Patients taking nasal steroids >1000mcg/day

• Patients taking oral prednisolone >40mg (or equivalent) for longer than 1 week or those who have repeated short courses of oral steroids

• Patients taking a course of oral glucocorticoid within 1 year of stopping long-term therapy

Patients who fit within the above criteria should retain a copy of the new NHS Steroid Emergency Card. You can view, print and download an electronic version of the new card from the Society for Endocrinology. Physical copies of the card are available to collect from local community pharmacies.

The omission of steroids for patients with primary or secondary adrenal insufficiency can lead to adrenal crisis; a rare medical emergency which can be fatal if left untreated. If these patients become acutely ill or are subject to major body stressors, such as from trauma or surgery, they require higher doses of steroids to prevent an adrenal crisis.

We would like to highlight the occurrence of adrenal crisis is relatively uncommon and medical staff are not always aware of the risk of adrenal crisis, or the correct clinical response should one occur. Presenting your new NHS Steroid Emergency Card to medical staff can flag up your risks of an adrenal crisis and sets out the initial steps for managing it.

Patients at risks of adrenal insufficiency usually require their usual steroid dose to be increased at times of stress, intercurrent illness and surgical procedures. We advise patients at risks of primary and secondary adrenal insufficiency (steroid dependent) to ask their GP, clinical pharmacists or their specialist team for advice on ‘sick day rules’ to increase their oral glucocorticoid should they become unwell. An easy read patient information leaflet on 'Sick Day' rules is available here.

Please do not hesitate to contact the surgery if you require further clarification.