Assessing the Knowledge of Sick-Day Rules Among Patients on Long-Term Glucocorticoids and Healthcare Professionals in a UK District General Hospital

Abstract

Abstract Introduction  Adrenal insufficiency can happen because of decreased cortisol production as a result of negative feedback on the hypothalamic–pituitary–adrenal axis, caused by excess exogenous glucocorticoids (GC). The most common cause of adrenal insufficiency is, in fact, abrupt stoppage of exogenous GC. Patients with adrenal insufficiency are at risk of developing life-threatening adrenal crisis if GC is reduced or stopped abruptly, or if GC dose is not increased during periods of increased stress. The adrenal crises should be preventable with education of patients and healthcare professionals (HCPs) about “sick-day” rules, the importance of “steroid cards,” and the utility of parenteral steroids. Methods  This study was aimed at assessing the knowledge of sick-day rules in patients on long-term GC as well as HCPs. Patients aged above 18 years on long-term GC presenting to the endocrinology clinic over 6 weeks were included after audit-committee approval. Results  We assessed 18 consecutive patients in total, 61% (11/18) of whom said that they have received information about sick-day rules from an HCP. Only 38% (7/18) had access to emergency hydrocortisone-kit. We assessed 36 HCPs. Thirty-six (13/36) percent were aware of steroid emergency card and 50% (18/36) HCPs exhibited awareness regarding steroid dose during acute event and 27% of (10/36) HCPs were aware of accessible hospital intranet resources. Conclusion  This study revealed significant lack of awareness of sick-day rules among patients and HCPs alike. Majority of patients failed to carry steroid emergency card or medic alert bracelet and majority of HCPs and patients lacked knowledge of sick-day rules.