Endocrine Abstracts

Background: For patients on hydrocortisone (HC) steroid therapy, educating families on ‘Steroid Sick Day Rules’ (SSDR) is key in preventing adrenal crises.

Aim: To audit education provided to patients and their families in emergency management of known adrenal insufficiency against published standards.

Method: A questionnaire assessing information provision and confidence with SSDR was given to 49 caregivers of children on HC treatment within the local Paediatric Endocrine Clinic and those attending the Peripheral Joint Endocrine clinics between June 2014 and January 2015. Mean patient age 9.9 years (range 0.7–21years).

Results: The majority of families had received information on SSDR (94%) but only half reported having information on IM HC injections (53%). Most families were ‘very confident’ or ‘somewhat confident’ (51 and 27%) in how to increase their child’s HC dose during illness. Confidence increased with number of years from diagnosis. Families were less confident with when (24% ‘very confident’ and 37% ‘somewhat confident’); and how (23% ‘very confident’ and 23% ‘somewhat confident’) to give the IM HC injection. Confidence levels decreased with time from diagnosis. Caregivers who had previously (14%) given the IM HC injection were generally more confident in when and how to give the injection.

Discussion: Many cases of adrenal crises are preventable with pre-emptive corticosteroid supplementation. Education on SSDR plays a major role in managing patients with adrenal insufficiency.

Our results show good confidence levels regarding sick day rules and provision of information on oral dosing. Increasing confidence with time may be related to the amount of practice caregivers have had at applying sick day rules. There are lower levels of confidence and provision of information for IM injection. Decreasing confidence levels over time may be due to the length of time elapsing since an initial demonstration on how to administer the injection (usually given at the time of diagnosis).

Recommendation: It is important to provide separate written information on IM HC administration for SSDR. A regular refresher course should also be offered to ensure caregivers maintain confidence in managing their children during a time of stress or illness.