HP195 Steroid Treatment Card

HP195 Steroid Treatment Card

Purpose:

This protocol will:
  1. Highlight where patients are on steroid medication and
    1. If they don't have a steroid treatment card
    2. If it has been more than 12 months since they last had their steroid treatment card reviewed
    3. 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.
Don't forget, we have searches which can help you to identify patients proactively in our MHRA, NPSA and CAS alert folder of searches

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?
  1. Patients on oral corticosteroids for periods of more than three weeks should receive a Steroid Treatment Card at the outset of treatment.
  2. If receiving more than four short oral courses per year, a card may be issued at the discretion of the prescriber or pharmacist.
  3. 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.
  4. Inhaled steroids
  5. 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:
  1. 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).
  2. Patients receiving intra-articular or intramuscular glucocorticoid injections who also use glucocorticoids by another route (eg inhaled steroids, oral steroids etc)
  3. 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).
  4. Patients taking inhaled beclomethasone >1000mcg/day or equivalent or fluticasone >500mcg/day or equivalent.
  5. Patients taking more than 40mg prednisolone per day or equivalent for longer than 1 week or repeated short courses of oral doses. 
  6. Patients taking drugs that affect CYP3A4 (CP450) metabolism with a steroid treatment
Both cards can be ordered from:
  1. NHS Forms at NHS Business Services Authority (NHS BSA)
  2. Primary Care Support England (PCSE online)
  3. Both cards are available on SystmOne and EMIS1
  4. 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.

How to get it

This protocol is automatically installed in your system.  If you are waiting for installation and want us to prioritise your site please submit a ticket to request this.

Support Information

Development Log

v1.0

Published 13/9/2020
Initial release

v6.4

Published 23/11/2022
Updated medications which the alert is based upon
More extensive support article to help with implementation

Communications Log (v6.4)

Primary Care IT are pleased to announce the release of our steroid treatment card alert.  This alert will highlight where patients are on steroids and either don't have a steroid treatment card, or do have one and provide details of the last review.  This was the topic of a National Patient Safety Alert in August 2020, which we have also produced searches to support the implementation of.   The alert has recently been updated to include relevant medications.  We will be rolling this out to all subscribers over the coming weeks.  If you are waiting for installation and want us to prioritise your site please submit a ticket to request this. 




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