A National Patient Safety Alert has been issued regarding the introduction of a new Steroid Emergency Card to support the early recognition and treatment of adrenal crisis in adults.
All patients with primary adrenal insufficiency are steroid dependent and some patients, who take oral, inhaled or topical steroids for other medical conditions, may develop secondary adrenal insufficiency and become steroid dependent.
The omission of steroids for patients with primary or secondary adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal. If these patients become acutely ill or are subject to major body stressors, such as from trauma or surgery, they require higher doses of steroids to prevent an adrenal crisis.
A search of the National Reporting and Learning System (NRLS) for a recent two-year period identified four deaths, four patients admitted to critical care, and around 320 other incidents describing issues with steroid replacement therapy for patients with adrenal insufficiency or emergency treatment for adrenal crisis. While substantial resources exist, clinical staff are not always aware of the risk of adrenal crisis, or the correct clinical response should one occur.
The alert promotes a new patient-held Steroid Emergency Card to help healthcare staff identify patients with adrenal insufficiency and provide information on emergency treatment if the patient is acutely ill, experiences trauma, surgery or other major stressors.
Advice for Community Pharmacy teams
Patients will initially be given a Steroid Emergency Card by their clinician or prescriber.
Community pharmacies should have copies of the steroid emergency card available to provide to patients if they lose or misplace their original cards.
 Community pharmacies should also issue a card if:
- A patient requests one
- A health professional requests a card for a patient
- The patient has a letter from a healthcare professional, or
- In the professional judgement of the pharmacist, the patient should receive one.
 They are available from:
- England: Community pharmacies in England can order Emergency Steroid Treatment Cards via Primary Care Support England (PCSE online)- https://secure.pcse.england.nhs.uk/_forms/pcsssignin.aspx
- Wales: Community pharmacies in Wales can request forms by emailing nwssp-primarycareservices@wales.nhs.uk
- Scotland or any other devolved nations or private doctors/facilities: request a registration form at http://www.nhsforms.co.uk or email nhs.print@nhs.netÂ
 The new steroid emergency cards do not replace the blue steroid treatment card but will be issued in conjunction
- All oral corticosteroids for periods of more than three weeks should receive a blue steroid treatment card at the outset of treatment.
- Â For patients on oral corticosteroids for three weeks or less, those receiving more than four short oral courses per year, high dose topical, nasal or inhaled steroids a card may be issued at the discretion of the pharmacist.