Endocrine Abstracts

Background: In steroid dependent patients the knowledge of steroid dose change during illness and stress is of paramount importance.

Objectives: i) To assess patient’s knowledge of steroid management during acute illness and stressful condition. ii) To evaluate whether there is a relation between patient knowledge and admission with documented adrenal crisis. iii) To improve medical access to information about patients on steroid at Emergency Department.

Methods: i) Self-completed patient’s questionnaire of 53 patients testing knowledge of on-going steroid treatment; self-held safety alert methods, dose adjustment during acute illness or surgery. ii) Review of patients’ Clinical notes for documentation of advice given by the medical team. Also notes were reviewed for any documented hospital admissions in proven or suspected adrenal crisis over the study period.

Results: While vast majority of participants opted for continuing steroids during illness, only less than half answered they would double the dose. In case of recurrent vomiting; only 40% suggested the need for steroid injection. Half of participants were aware of the need for extra steroid during surgical procedure. Fifth of the total 53 participants did not carry a steroid card, and half did not wear any bracelet or have an emergency steroid injection.

Conclusion: This audit showed considerable gap in patients’ knowledge and education. More effort is needed, probably using new methods. We introduced an electronic alert message for patients on steroid at the hospital emergency computer systems. We also suggested adopting a smart phone application advising patients about all aspects of steroid use.