Endocrine Abstracts

Introduction: Children on long-term steroid treatment are at risk of developing an Addisonian crisis during an acute illness unless their steroid dose is increased appropriately. It is essential for all staff involved in the care and management of such patients (Paediatric Nurses, Paediatric Doctors, ED Doctors) to be familiar with the relevant management guidelines.

Methodology: Between November 2015 and May 2016 Paediatric and ED nursing and medical staff (F1 to Consultant) were surveyed to assess the level of knowledge of local guidelines at a large DGH offering a Tertiary Paediatric Endocrine service.

Results: Forty-One responses were analysed (11 nurses and 30 doctors of which 4 were ED doctors). 85% (35/41) of staff knew to measure blood glucose and 90% (37/41) blood pressure on arrival but only 47% (14/30) of doctors knew to request U&E and laboratory glucose. 54% (22/41) of staff knew to treat hypovolaemia with an IV fluid bolus and 88% (36/41) to treat hypoglycaemia with fast acting glucose (orally or IV). 83% (25/30) of doctors knew to contact the on-call consultant and 93% (28/30) where to find the dose of hydrocortisone. 95% (39/41) of staff knew to give IV/IM hydrocortisone to seriously unwell children and 83% (25/30) of doctors knew to increase the oral dose if oral medicines were tolerated in moderately unwell children.

Discussion: Our survey covered a representative section of the majority of the staff likely to be in contact with this patient group. The knowledge of the acute treatment of seriously unwell children was high as was where to located local guidelines. The survey highlighted that there was a knowledge gap in the initial investigations needed, the treatment of hypotension and management of those children who were moderately unwell but not in acute crisis. We aim to set up teaching sessions targeted at not only junior doctors in Paediatrics (at induction) but also senior doctors and most importantly staff in ED, where these patients may often be initially seen and assessed, whilst also publishing the management guidelines on the hospital wide intranet. We hope to complete the audit cycle at the end of 2017.