We catch up with Endocrine Nurse Specialist Becci Watling from the Royal Bournemouth Hospital, on the implementation of their digital steroid coding system launched in February 2018.

The system identifies all patients admitted with adrenal insufficiency (AI) and an automated email is sent to a dedicated endocrine specialise nurse. This enables the nurse to visit the patient to address any concerns they may have, but also to enhance nursing and medical staff awareness of AI and support them to administer appropriate treatment and their understanding the importance of steroid replacement dosing and timings.

Becci updates us on their project:

Being admitted to hospital when you are acutely unwell means; placing your trust in the care of highly trained healthcare professionals who have the knowledge and skills to treat you and know what they are doing. This assumption is universal in our culture. So to find yourself as a patient, in a situation where you know more about your condition than the healthcare professionals treating you; leaves you and your loved ones feeling alone and vulnerable and possibly frightened for your life; at a time when you need  specialist support and knowledge the most….

This was the start of an article published to highlight a Patient Safety initiative at our hospital; in 2018 we described the email notification system our hospital developed; that generated an email alert to the endocrine team, when one of our patients with Adrenal Insufficiency was admitted to the hospital. The endocrine nurses visit the patient to ensure they receive specialist support and advice and this also creates an opportunity to give staff, education, support and advice. This idea came about as a result of our internal incident reporting system flagging 2 admissions where patients had not received appropriate or timely treatment of their steroid replacement during their stay.

Two and a half years and two hundred and fifty plus email alerts later; the service continues and has been well received by patients, hospital staff and management alike.

Without doubt this initiative has at the very least raised awareness within the hospital of Adrenal Insufficiency and the existence of the Endocrine Specialist Nurse Service and at its most critical has prevented serious life threatening events for some of our patients, which is exactly what we had hoped for. As well as providing much needed support for our patients and a friendly face in a time of uncertainty.

The endocrine nurse service has grown from small beginnings to a diverse and comprehensive service; this system is a key part of our ward outreach and has presented some fantastic opportunities for staff training both planned and impromptu. Both the endocrine nurses have a key interest in Adrenal Insufficiency and a passion for Endocrinology, so any chance we get to educate others is a bonus.

Locally our 2 district general hospitals have recently merged creating a University Hospital Trust, our bed based is predicted to almost double over the coming years and this will provide greater demand for the service, currently the system does not run in the sister hospital linked to us and it would be fantastic to expand it across both sites in the same way, providing more robust support for our patients during an admission; as well as further opportunities for staff education. We are hoping that having closer with links with the local University will also offer more routes to educate health care professionals about Adrenal Insufficiency and Endocrinology at the start of their professional journeys and hopefully spark a lifelong interest in endocrinology.


Photo: Becci Watling and Michelle Nation.

Myself and Specialist Endocrine Nurse Michelle Nation (pictured) have received emails from people nationally thanking us for taking this initiative to protect and support our patients, saying how they would feel really reassured if their hospital had implemented this. Other hospitals have implemented similar systems and it would be great to see something similar rolled out in all hospitals nationally. The initiative has been published on the NHS Atlas for Shared Learning website. With the release of the new national steroid emergency card and the associated guidance to healthcare providers on the use of the card, hopefully awareness will continue to increase.

Author: Becci Watling

Endocrine Nurse Specialist, Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital.

Many people can remain worried about an inpatient stay. Read our tips and advice for preparing for a hospital admission when you have Addison's disease or adrenal insufficiency

This article was first published in the Summer 2021 edition of the ADSHG magazine.

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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