Endocrine Abstracts

Background: Evidence shows that in an emergency, prompt and appropriate treatment of patients with adrenal insufficiency (AI) significantly improves outcomes and mortality risk. However, patient feedback and evidence suggest shortfalls in care and treatment of AI due to lack of knowledge and understanding from clinical staff. The aim of this survey was to explore frontline nursing knowledge and understanding of AI, to identify gaps for future training purposes within a local NHS Emergency Department (ED).

Methods: A questionnaire consisting of 9 multiple choice and open-ended questions was distributed to 50 nurse members over two local ED Departments. Nursing staff skill-set ranged from 0-30 years’ experience, at bands 4-8a. Questions focussed on self-reported knowledge, guidance, and their competence to identify and manage an AI patient. The questions asked participants to rank their knowledge from 1 (novice) to 5 (expert).

Results: Findings have shown that 51% ranked themselves as novice when identifying AI, as well as competence to treat (51%). Moreover, 30% participants reported lack of understanding of adrenal crisis (score of 1), with 71% scoring themselves 2 or below. 88% of participants were not aware of any AI guidance used within the department, 94% were not aware of the steroid ‘sick day rules’, and 80% were not aware how to advise patients on their steroid medication dose on discharge.

Conclusion: The survey has successfully identified gaps in knowledge and understanding of identifying and managing AI within an acute ED setting. It has highlighted areas needed for staff training and to improve knowledge and awareness to ensure that AI patients receive prompt and adequate medical care when presenting to ED. Future training will be specifically aimed at local ED staff with the aim to improve patient care. For comparison, the survey will be repeated post training to evaluate its success.