NHS England published a national patient safety alert for patients at risk of adrenal suppression in August 2020, please see further information here.
We have number of resources to support you to complete the actions required by this alert.
Ardens CAS Alert searches have been designed to help practices identify patients who have recently had multiple issues of steroid medications or a diagnosis of adrenocortical insufficiency and would therefore need a steroid emergency card.
To access the searches, navigate to the Clinical Reporting > Ardens Ltd > Alerts | Other > CAS Endocrine folder:
This folder contains a suite of searches relating to MHRA and CAS alerts.
Whilst the NPSA alert did not specifically exclude topical steroids, Ardens’ clinical team felt that to include them would lead to excessive ‘false positives’ as most patients on topical steroids are unlikely to be having doses sufficient to cause adrenal suppression.
You may wish to review these patients’ medication and check that they have had a steroid card issued recently. If they have not, a printable steroid card is available from the Corticosteroid monitoring template.
Similar reports to assist with actioning the NPSA alert can be found in:
Clinical Reporting > Ardens Ltd > Prescribing | Alert > Endocrine
Clinical Reporting > Ardens Ltd > Prescribing | Alert > Respiratory
It is not possible to report on the dose of a medication in SystmOne, which means we use other measures to try and find patients who should be considered for a steroid card. To explain further, we cannot tell if a patient on a 100mcg inhaler is having 2 puffs a day or 8 puffs a day, so they could be receiving medium or high dose steroids with the same device.
We therefore look for patients prescribed an oral steroid >3 times in the last 8 months or the patient has been coded as “Using inhaled steroids - high dose (663g2)” or “Oral steroid therapy (Xa6ba)”, and a steroid card has not been recorded as given in the past year.
If you want to remove people from the search and they have been coded as either “Using inhaled steroids - high dose (663g2)” or “Oral steroid therapy (Xa6ba)”, recording ‘Oral steroids stopped (663G.)’, ‘Not using inhaled steroids (663g0)’, ‘Using inhaled steroids - normal dose (663g1)’ or ‘Using inhaled steroids - low dose (XaZHv)’ will remove the patient from the search.
The following reports assist you in ensuring the coding is correct and the appropriate group of patients is captured in the parent report:
• Clinical Reporting > Ardens > Prescribing Respiratory > ICS | ?Record 'Using inhaled steroids - high dose' as high dose on repeat and
• Clinical Reporting > Ardens > Prescribing Respiratory > ICS | ?Review 'Using inhaled steroids - high dose' as not high dose repeat
These reports help find patients on potentially high dose ICS without this being coded, or on low dose ICS and have been coded as “Using inhaled steroids - high dose (663g2)”
There is a pop up to prompt consideration of a steroid alert card in patients at risk. This will be triggered when issuing a prescription for a steroid.
The pop up can be disabled from Setup > Workflow Support > Protocols > Ardens > Prescribing by deselecting the ‘Steroid Emergency Card' protocols. This deactivation will affect all users in your organisation.
Corticosteroid Monitoring template
The pop up alert will give you the option to ‘Review’ which will launch the Corticosteroid monitoring template.
This template can also be accessed from the Drug Monitoring template, Auto-Consultation, any template containing steroids, F12 favourites or the ‘Search features’ box in the bottom left hand corner of SystmOne.
The template will assist with managing individual patients, with quick access to:
1. Ensure patient monitoring is up to date
2. Review GI protection, diabetes or osteoporosis risk
3. Record the provision of a steroid treatment card
If you require any further assistance, please contact Ardens SystmOne support: firstname.lastname@example.org