Behind the Research: Implementation of perioperative guidelines & steroid emergency card

At the annual Society for Endocrinology BES Conference in November 2023, we had the privilege of awarding Louise Breen the Annette Louise Seal Memorial Award for her research titled: ‘Implementation and impact of perioperative guidelines and the steroid emergency card for the management of adrenal insufficiency and prevention of adrenal crisis.’

The Annette Louise Seal Memorial Award is an annual research award funded by the ADSHG. The award is for research by endocrine nurses on any aspect of adrenal crisis prevention and treatment, the management and monitoring of steroid replacement therapy or associated patient education.

Here we speak with Louise Breen, Advanced Nurse Practitioner and first Chair Elect of the Society for Endocrinology Nurse Committee, to find out more about her work and what this means for those living with Addison's and adrenal insufficiency.

Research Facts:

Title: ‘Implementation and impact of perioperative guidelines and the steroid emergency card for the management of adrenal insufficiency and prevention of adrenal crisis.’
Lead applicant: Louise Breen, Advanced Nurse Practitioner at Guys and St Thomas NHS Foundation and current Chair for the Society for Endocrinology Nurse Committee.
Organisation: Guy’s and St Thomas’ NHS Foundation Trust
Grant Award: Annette Louise Seal Award 2023 – Society for Endocrinology BES Conference 2023

Congratulation Louise! Please could you explain the aims of this research?

I am honoured to receive this award and thank the ADSHG for continuing to recognise and support nurses in research. The aim of the research is to assess the implementation and impact of the Peri-operative Guidelines (POG) and National Patient Safety Alert (NatPSA) via a targeted survey of endocrine clinicians in the UK.

Why is this research important?

The National Patient Safety Alert (NatPSA) aimed to support early recognition and treatment of adrenal crisis whilst the Peri-Operative Guidelines (POG) aimed at avoiding adrenal crisis by providing guidance on the management of adrenal insufficiency pre, intra and post-operatively.

Assessing the impact and implementation of the NatPSA and POG are important as it allows us to see where positive impacts have been made and highlights where further improvements are required. Our findings, whilst on a small scale, suggested the POG have been helpful in clinical practice.

There has been good uptake of the NatPSA in some organisations, but our findings highlighted a need for organisations to improve processes in order to ensure safe practice for patients with adrenal insufficiency is implemented. Communication of NatPSA needs to improve, alongside organisations communication and compliance of the NatPSA.

Read: National Patient Safety Alert

Read: Peri-operative Guidelines (POG)

Steroid Emergency Card information for patients & those who support them

Download Louise Breen's award winning research poster

How will findings benefit people with Addison’s disease and adrenal insufficiency?

By highlighting the need for improved communication and implementation of the NatPSA and POG to ensure safe practice.

How can we support your research and aims moving forward?

There are several ways Endocrinologists and Endocrinology Nurses, fellow Patient Support Groups, as well as people with adrenal insufficiency can support:

Involvement and support of the Society for Endocrinology and organisations in the management of adrenal insufficiency.
Continuing to highlight the importance of the management of adrenal insufficiency and prevention/treatment of adrenal crisis.
Taking part in future research opportunities.
Supporting nurse-led research.

Meet the Researcher: Louise Breen

Louise speaks to us about what inspires her and her passion for helping to improve medical awareness for people living with rare health conditions

I have worked in the field of Endocrinology since 1996, initially as a Research Nurse. Over that time, I have developed the nurse-led service at Guy’s and St Thomas. I am the current Nurse Chair for the Society for Endocrinology (SfE) and sit on the SfE Patient Support Group (PSG) Network. I have always been passionate about improving patient care and endocrine nurse training.

When I first started out in endocrinology I realised we had large gaps in the provision of patient education and accessibility for support and advice. Over the years I have focused on increasing the provision of nurse-led care to enhance patient care and accessibility to our service.

In regards to adrenal insufficiency, we introduced dedicated patient education sessions for patients, carers, and all who support them, on the management of adrenal insufficiency and adrenal crisis. I am grateful for all the PSG’s who provide an invaluable source of information and training for both patients and staff.

Tell us a bit about your background and research?

In 2002 I looked at patient satisfaction on steroid management at my place of work.

"This piece of work highlighted the importance of patient education, written patient information and ensuring all patients were offered training on the use of emergency intramuscular hydrocortisone."

This study highlighted the need for an Endocrine Specialist Nurse (ESN) to support patients with adrenal insufficiency and in 2003 I was appointed as the first Guy’s and St Thomas’ Hospital, NHS funded, Endocrine Specialist Nurse (ESN).

I have continued to explore different areas within endocrinology and am currently working collaboratively on improving patient information for patients with adrenal suppression. I am a current member of the SfE Steroid Emergency Card Group.

In regards to my research on the impact and implementation of the NatPSA and POG, I will continue to work with my collaborators on the next steps in this research and expect the launch of NICE Guidance on adrenal insufficiency will further inform this project.

What are your research highlights to date?

I have learnt so much from my work in adrenal insufficiency and this has led to improvements in my service.

My work in Graves’ Disease on the implantation and evaluation of a nurse-led telephone review service demonstrated a significant improvement in patient satisfaction and our telephone consultation service has continued to expand over the past 10 years and ultimately led to us being more than ready for the virtual services required during COVID.

ADSHG note: to learn more about the ADSHG's continued aim to fund an Endocrine Nurse helpline please read the ADSHG 2022 Annual Report. If you'd like to help make this service a reality, please donate to fund and support this vital project.

What are your plans for the future?

I will complete my current research projects and continue to expand my research portfolio. Through my work as the Nurse Chair for the SfE I am committed to raising the research profile of endocrine nurses and encouraging nurses into research via dedicated sessions at our academic meetings, such as Endocrine Nurse Update.

Do you have any advice that you would give to other researchers?

If you are new to research, undertaking key academic courses in research, i.e. research methods and identifying a supervisor/mentor for your proposed research project are key. I'd also recommend:

Negotiate time in your job plan for research.
Explore potential funding resources to support your research project.
Ensure you have a dedicated supervisor.

Thank you for the vital work you do Louise and congratulations again on receiving the award! Is there anything else you would like to say?

I am honoured to receive this award and thank the ADSHG for continuing to recognise and support nurses in research. I thank my fellow researchers Lisa Shepherd and Dr Helen Simpson for their collaboration on this piece of work.

	Author: Louise Breen Advanced Nurse Practitioner at Guys and St Thomas NHS Foundation and current Chair for the Society for Endocrinology Nurse Committee.
	Implementation and impact of perioperative guidelines and the steroid emergency card for the management of adrenal insufficiency and prevention of adrenal crisis. Endocrine Abstracts (2023) 94 P4 \| DOI: 10.1530/endoabs.94.P4
	Learn more about the ADSHG research grants and how we can support you.
	If you're an Endocrine Nurse and would like to set up an awareness stand in your hospital, please download our information poster to learn more and how we can support you! Read our Blog for inspiration and to hear how Endocrine Nurse Joanne Brown created her stand at Stockport NHS Hospital.

If you're a healthcare professional and would like more resources for people with Addison's and adrenal insufficiency please visit our dedicated webpage here.

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