Startseite Implementation of IT supported standardization of individualized hydrocortisone management for treatment of patients with adrenal insufficiency
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Implementation of IT supported standardization of individualized hydrocortisone management for treatment of patients with adrenal insufficiency

  • Varshini Chakravarthy EMAIL logo , Katie Barger , Rob Gonsalves , Gabriel Q. Shaibi , Vinay Vaidya , Chirag Kapadia und Dorothee Newbern
Veröffentlicht/Copyright: 3. November 2023
Journal of Pediatric Endocrinology and Metabolism
Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 36 Heft 12

Abstract

Objectives

Hydrocortisone stress dosing guidelines for children with adrenal insufficiency (AI) recommend a wide range of acceptable stress doses. This has led to variability in dosing recommendations resulting in confusion among endocrine, non-endocrine providers and patient families. This quality improvement project sought to standardize documentation and hydrocortisone stress dosing within our pediatric endocrine division to optimize communication regarding AI management.

Methods

Plan-Do-Study-Act (PDSA) cycle one aimed to address documentation of components important in AI management including body surface area (BSA), home daily dose, home stress dose, in-patient stress dose, procedure dose and crisis dose using a smart phrase within the electronic health record (EHR). To automate the process, PDSA cycle two introduced two smart buttons within the endocrine notes. PDSA cycle three focused on standardizing hydrocortisone stress doses.

Results

Initial documentation targets were met for all AI management components except for the crisis dose. The second target was only met for the home stress dose. Implementing the smart buttons aided in reaching the second target for home daily and home stress doses. Dose standardization targets were achieved in all categories except for the on-going crisis dose. A follow up survey after an in-service for non-endocrine providers showed increased knowledge of locating hydrocortisone stress dosing recommendations within the EHR.

Conclusions

With the assistance of technology, this quality improvement project ultimately enhanced communication through the standardization of documentation and individualized hydrocortisone stress dosing for children with AI. Although not all secondary targets were met, there was meaningful improvement in documentation and stress dose standardization compliance.

Keywords: adrenal insufficiency; hydrocortisone; standardization; quality improvement; stress dosing
Corresponding author: Varshini Chakravarthy, MD, Pediatric Endocrinology and Diabetes, Phoenix Children’s, 1920 E. Cambridge Ave Suite 301, Phoenix, AZ 85006, USA, Phone: +1 602 933 0935, E-mail:

Acknowledgments

We would like to thank Dr. Wendy Arafiles for adding the Complex Care Button and for her work on helping us improve patient care for our patients with AI. We would also like to thank Shelley Flecky and Cliff Fortner for their work on implementing the smart button into the electronic medical record outpatient note as well as the endocrine clinicians for their participation and insightful feedback. Lastly, we would like to thank Dr. Victoria Bernaud and Dr. Ted Swing for their feedback on the manuscript.

  1. Research ethics: This study has been granted an exemption from requiring ethics approval by Phoenix Children’s Institutional Review Board.

  2. Informed consent: This study has been granted an exemption from requiring written informed consent by Phoenix Children’s Institutional Review Board.

  3. Author contributions: VC was involved with data collection, analysis and preparation of the table and figure. VC, KB, RB, GQ, CK, and VV drafted and wrote the manuscript. All authors approved the submitted version of the manuscript.

  4. Competing interests: Authors state no conflict of interest.

  5. Research funding: None declared.

References

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3. Miller, BS, Spencer, SP, Geffner, ME, Gourgari, E, Lahoti, A, Kamboj, MK, et al.. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings. J Invest Med 2020;68:16–25. https://doi.org/10.1136/jim-2019-000999.Suche in Google Scholar PubMed PubMed Central

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2023-0313).

Received: 2023-05-01
Accepted: 2023-10-11
Published Online: 2023-11-03
Published in Print: 2023-12-15

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2023-0313
Schlagwörter für diesen Artikel
adrenal insufficiency; hydrocortisone; standardization; quality improvement; stress dosing

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. Intracranial germ cell tumors: a view of the endocrinologist
  4. Original Articles
  5. Technology use and clinical outcomes in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes
  6. The use of CGM to identify hypoglycemia and glycemic patterns in congenital hyperinsulinism
  7. The N221D variant in PCSK1 is highly prevalent in childhood obesity and can influence the metabolic profile
  8. Evaluation of the risk factors for noncommunicable diseases in patients with inborn errors of amino acid metabolism receiving nutrition therapy
  9. Features of liver injury in 138 Chinese patients with NICCD
  10. A case-control study of early-stage radiological markers of endothelial dysfunction and cardiovascular findings in patients with osteogenesis imperfecta: genotype–phenotype correlations
  11. Caregivers’ knowledge and medication adherence in children with thyroid disorders: an exploratory study
  12. Implementation of IT supported standardization of individualized hydrocortisone management for treatment of patients with adrenal insufficiency
  13. Interdisiplinary and intraobserver reliability of the Greulich-Pyle method among Turkish children
  14. Case Report
  15. Alpha-mannosidosis: a case with novel ultrastructural and light microscopy findings
  16. Letters to the Editor
  17. Reply to: The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
  18. In reply re: The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
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