From Wednesday 19 November, new Electronic Patient Record (EPR) features will help prescribers reduce the risk of adrenal crisis during hospital stays. These changes follow a National Patient Safety Agency (NPSA) alert after multiple incidents linked to missed steroid prescriptions.

Changes will also be made to reduce the risk of over-prescribing products containing paracetamol.

What’s changing?

Steroid Emergency Card (SEC) prompt

When prescribing enteral or parenteral steroids (prednisolone, dexamethasone, hydrocortisone, methylprednisolone, or budesonide – including nebulised/inhaled) for inpatients aged 16+, you’ll see a prompt to consider providing an SEC. (Main image)

• Based on your PowerForm response, a placeholder will appear on the Drug Chart. (Screenshot below)
• If you don’t have SECs, contact Pharmacy.
• Prompts stop once you document “Patient already has an SEC” or “SEC not required.”
• To reinstate prompts, modify the PowerForm in Form Browser.

Steroid prescribing prompt for at-risk patients

You’ll also see prompts to prescribe steroids for patients identified as at risk of adrenal crisis. This includes those who:

• Already have or will receive an SEC
• Have documented adrenal insufficiency in Problems and Diagnoses

Prompts stop if you record “Patient is on a different steroid regime” or “Not at risk of adrenal crisis.” To reinstate, modify the PowerForm in Form Browser.

Adrenal crisis PowerPlans

To support prescribing, Adrenal crisis prevention and treatment PowerPlans will be available. Search for: MEDS Adrenal Crisis…

Paracetamol prescribing and administration improvements

For prescribers:

• You will receive an alert if you attempt to prescribe multiple paracetamol-containing products.
• If clinically appropriate, you can bypass the alert when prescribing a second paracetamol-containing product.
• The system will block any prescription that would result in more than two paracetamol-containing products on the Drug Chart.

For colleagues who administer medicines:

You will receive an alert if you attempt to administer:

• Too many paracetamol doses within a 24-hour period
• Paracetamol doses less than 4 hours apart
• Paracetamol 1g / 1000mg to patients weighing under 50kg

Here is a link to our Paracetamol Dosing Guidance.

*Important Reminder*

These EPR tools do not replace clinical judgement, thorough history taking, or accurate documentation of Problems and Diagnoses.