This protocol will:
- Highlight where patients are on steroid medication and
- If they don't have a steroid treatment card
- If it has been more than 12 months since they last had their steroid treatment card reviewed
- If they have a steroid treatment card which has been reviewed within the required time frame
What does it actually do?
The protocol helps practices respond to the joint
National Patient Safey alert by NHS Improvment and NHS England national patient safety team, the RCGP, RCP and Society for endocrinology. This was about the introduction of a new Steroid Emergency Card to support the early recognition and treatment of adrenal crisis in adults.
To summarise the guidance:
There are now 2 types of steroid alert cards a patient may be required to carry:
A steroid treatment card (blue card)
An NHS Steroid EMERGENCY Card (new red card)
Patients on exogenous steroids are at increased risk of adrenal insufficiency and need a
Steroid Emergency Card and advice regarding “sick day rules” if unwell outside of hospital.
When to give a Steroid Treatment (blue) Card?
- Patients on oral corticosteroids for periods of more than three weeks should receive a Steroid Treatment Card at the outset of treatment.
- If receiving more than four short oral courses per year, a card may be issued at the discretion of the prescriber or pharmacist.
- Topical and nasal steroids if considered necessary by the prescriber, including dispersible tablets used as mouth rinses and sublingual tablets for treatment of mouth ulcers.
- Inhaled steroids
- Steroid Treatment Cards (blue) should be given at lower doses if there is concomitant use of: (a) intranasal and/or topical corticosteroids; OR (b) medicines that inhibit the metabolism of corticosteroids (cytochrome p450 inhibiting drugs especially ritonavir, itraconazole and ketoconazole).
NHS Steroid Emergency Cards should be given to:
- All adults aged 16+ with adrenal insufficiency, such as those with Addison’s disease, congenital
adrenal hyperplasia, and hypothalamo-pituitary damage from tumours or surgery that are
steroid dependent (includes injectable steroids).
- Patients receiving intra-articular or intramuscular glucocorticoid injections who also use
glucocorticoids by another route (eg inhaled steroids, oral steroids etc)
- All patients receiving exogenous steroids at a dose of prednisolone 5mg/day or equivalent for 4
weeks or longer and for 12 months after stopping oral steroids. This is across all routes of
administration (oral, topical, inhaled or intranasal) as they are also at risk of adrenal insufficiency
(see links above).
- Patients taking inhaled beclomethasone >1000mcg/day or equivalent or fluticasone
>500mcg/day or equivalent.
- Patients taking more than 40mg prednisolone per day or equivalent for longer than 1 week or
repeated short courses of oral doses.
- Patients taking drugs that affect CYP3A4 (CP450) metabolism with a steroid treatment
Both cards can be ordered from:
- NHS Forms at NHS Business Services Authority (NHS BSA)
- Primary Care Support England (PCSE online)
- Both cards are available on SystmOne and EMIS1
- The NHS Steroid Emergency Card is available online, which is useful for remote
consultations.
What does it look like?
Clicking on the alert will take you to a template with the relevant information:
Supporting CQC key areas
Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership and capability
Vision and strategy
Culture of the organisation
Management of risk and performance
Management of information
Learning, improvement and innovation
System Dependencies:
This is dependent on you using EMIS to record all issues of steroid medication and issues of steroid cards, but otherwise automatically launches
System Trigger
Automatic triggers
System Trigger: Load a patient
Run mode: Always run
Enable trigger for: All clinical prescribers
Fitting your practice
Alert your team that if they will see the alert if patients have steroid treatment and don't have an alert card, or will provide information about the last alert card issued it they do have one.