Endocrine Abstracts

It is recommended that patients with adrenal insufficiency should be in possession of an emergency hydrocortisone kit and have sufficient knowledge and skills to administer it. Historically, in our unit patient education was dependent on referral from Doctors to endocrine specialist nurses (ESN’s). This study sought to assess if patients owned a kit and if patients and family were competent to administer the injection if required.

A ‘snapshot’ consecutive sample of primary and secondary adrenal insufficient patients, were audited using a quantitative questionnaire. All patients (n=34), who attended group education sessions in the endocrine outpatient department run by endocrine specialist nurses, for a period of 6 months in 2011–2012 were surveyed.

Of those audited 38% of patients possessed an emergency hydrocortisone kit. Although 41% had received previous training on the preparation of the hydrocortisone injection, no one had ever administered the injection themselves. Only 18% of family members had received training. 82% of patients said they wished to receive training on the preparation and administration of the injection compared to 68% of family. Almost half (44%) of patients, thought that their family knew when it was appropriate to administer an emergency injection. Worryingly, only 76% of patients carried a ‘blue’ steroid card and 35% wore medical alert jewellery.

Findings identified the number of patients who owned a kit needed to be dramatically improved. Education, training and support also required enhanced structure. Following changes recommended a universal approach to patient education has been adopted. Referrals of all adrenal insufficient patients are now made to the ESN’s, to ensure all patients are educated and have access to emergency hydrocortisone kits. The outcome of the re-audit of this patient group has been submitted as a separate abstract and has demonstrated the positive advantage of nurse led education sessions.