G418(P) Positive impact of clinical governance and quality improvement initiatives on patient care in patients with adrenal insufficiency. (25th October 2020)

• Record Type: Journal Article
• Authors: Varughese, RS; Gilbert, J; Sotiriou, E; Makaya, T
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A150
• Page End: A151
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.360
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Patients with adrenal insufficiency are required to follow 'steroid sick day rules' in illness or stress. Failure to do so, in particular delays in administering intramuscular (IM) hydrocortisone (HC), may precipitate a potentially fatal adrenal crisis. An audit comparing published standards to local patient education on steroid sick day rules was undertaken in 2015, prompted by two local mortality cases related to adrenal insufficiency. Questionnaires were distributed to families for baseline data collection. Subsequent interventions included introducing 'red flags' on the electronic patient record and introducing age-banded refresher teaching sessions for families, run by staff, with patient/carer peer support opportunities. Aims: To evaluate the impact of the teaching intervention on carer knowledge and confidence around IM HC injections. Methods: Questionnaires were then redistributed to families four years later (2019). Questionnaires involved binary responses for factual questions, five-point Likert scale for opinion-based questions, and a free-text box for further comments. Results: Response rate was 94% (49/52) in the first audit cycle (C1), where questionnaires were distributed after clinic appointments. Response rate was 36% (39/109) in the second audit cycle (C2), with mail distribution, perhaps reflecting this change. With particular focus on the IM HC injection, in C1, 53% (n=26) received written information on IM HC injections, increasing to 69% (n=26) in C2. Similarly, 61% (n=30) were 'very confident' or 'somewhat confident' in C1 about when to give IM HC injection, increasing to 72% (n=28) in C2. Respondents recalled demonstration on IM HC administration in 90% (n=44) in C1 and 92% (n=35) in C2. In C1 46% (n=22) were 'very confident' or 'somewhat confident' with how to give IM HC, increasing to 63% (n=24) in C2. Families have given very positive feedback, and value the opportunity to engage in peer support. There have been no further deaths in our region over the last 4 years relating to adrenal insufficiency. Conclusion: Following introduction of the refresher teaching sessions, there is a significant increase in confidence and knowledge on administration of the potentially lifesaving IM HC injection. This reflects the positive impact of a patient centred quality improvement initiative. Further work will be done to integrate these sessions into standard care.