Endocrine Abstracts

Objective: The project was designed to Assess And IMprove (AAIM) the practice of healthcare professionals (HCPs) around the corticosteroid sick-day rule, involved in caring for transplant and oncology patients requiring treatment with corticosteroids long-term.

Introduction: Corticosteroids are widely prescribed drugs in oncology and post-transplant patients. Long-term treatment with corticosteroids dose, which equals prednisolone 5mg/day for at least 4 weeks, suppresses the hypothalamic-pituitary-adrenal (HPA) axis, known as tertiary adrenal insufficiency. These patients are at risk of developing life-threatening adrenal crisis if corticosteroid dose is not increased during periods of stress, which is preventable with education on steroid sick-day rules.

Methodology: A survey including a set of questions was circulated among HCPs (clinicians and nurses) looking after Transplant (Liver and Kidney) and Oncology patients at Royal Free Hospital, to evaluate the educational practice of corticosteroid sick-day rules. These included internal medicine trainees (IMTs), speciality registrars, consultants and specialist nurses.

Results: Variability was observed in sick-day rule education; 40% confirmed counselling patients at the time of initiation of long-term corticosteroids, 27% counselled on subsequent contact after initiating treatment, 50% HCP counselled on illness with fever and 27% mentioned they do not offer advice on sick-day rules.

Discussion: Trust-wide corticosteroid sick day rules guidelines and patient information leaflet were formulated based on the recent evidence with specific mention of sick-day rules for patients on dexamethasone. Education is being arranged Trust-wide for HCPs on steroid safety. Education sessions are delivered to the foundation and IMTs, who deal with these patients at the front door. A steroid safety session was also arranged on local oncology day.

Conclusion: This is the first single-centre project that can be replicated Nationally to AAIM implementation of corticosteroid sick-day rule across non-endocrine specialities, hence improving the level of care of patients on long-term corticosteroids and reducing hospital admissions with adrenal crises.