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5 things pharmacies need to know about steroid emergency cards

Pharmacies must stock emergency steroid cards before the approaching deadline to reduce the fatal risk to patients, Janice Perkins says

In August last year, NHS England and NHS Improvement (NHSE&) issued a national patient safety alert to introduce a steroid emergency card for patients at risk of adrenal crisis.

Pharmacies should implement the alert requirements as soon as possible, and no later than May 2021.

Why was the alert issued?

Although patients with adrenal insufficiency are steroid dependent, patients may not receive them during times of illness, trauma or surgery. If patients do not receive the steroids they need it can be fatal.

Adrenal crisis is a medical emergency. In the alert, NHSE&I said: “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.”

The card aims to increase awareness of the need to start steroids quickly and help staff identify at-risk patients, particularly when presenting in the emergency department, to acute medicine teams or undergoing surgery.

What actions does community pharmacy need to take?

Most cards will be issued to patients by prescribers. 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.

Where can community pharmacy teams access cards?

A PDF version of the cards is available to download from the Society for Endocrinology. Community pharmacies in England should go to the Primary Care Support England website to order stock. Pharmacies across the devolved nations can order cards by requesting a registration form via NHS Forms or by emailing [email protected].

Does this mean the blue steroid treatment card should no longer be issued?

No. The two steroid cards have different purposes, and we should continue to issue the blue steroid cards in the usual way.

Where can I find out more?

The Society for Endocrinology has produced more detailed guidance for implementing the national patient safety alert consistently.

Janice Perkins is chair of the cross-sector Community Pharmacy Safety Group, which includes representatives of all of the larger pharmacy chains and the National Pharmacy Association


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