Nursing studies

How my simple sticker system improved steroid management

When serious illness left a student reliant on life-saving steroids, she devised a way to help busy nurses administer them on time

When serious illness left a student reliant on life-saving steroids, she devised a way to help busy nurses administer them on time


Nurses used stickers to identify which patients needed steroids and at what time. Picture: iStock

In 2014, just as I was about to start my nurse training, I became ill and had to spend months in the high dependency unit of my local hospital.  

I deferred my start date to March 2015, but my health took a downward turn a couple of months before and I was admitted to intensive care in a coma. 

I was diagnosed with Addison’s disease – an endocrine disorder in which the adrenal glands do not produce enough steroid hormones – and a mild hypoxic brain injury resulted in dyslexia and dyspraxia and some memory loss. I was then diagnosed with the rare and life-threatening condition, polyglandular autoimmune syndrome.

Gained valuable insight as a patient

I persevered with my nurse training, but my health continued to deteriorate. In 2017, my weight dropped to 38kg and I had a body mass index (BMI) of just 13. I also had a grade 2 pressure ulcer, was admitted to hospital for persistent hypoglycaemia, and had a cardiac arrest. 

After having a nasojejunal tube fitted to bypass my stomach following a bleed, I spent six weeks in hospital due to severe re-feeding syndrome. 

Despite these challenges, my passion for nursing was undeterred and I was determined to carry on with my course. My experiences also gave me a valuable insight into what it is like to be a patient, fuelling my desire to improve the lives of others. 

Vital medicine can't wait

Throughout my time in hospital, one thing that stood out was a lack of awareness and understanding of the importance of receiving steroids at the prescribed time. 

Steroid replacement therapy is a core treatment for Addison’s disease – if the medication is not given on time, patients can experience a life-threatening adrenal crisis. 

The bright stickers stuck on the corner of the drug charts of steroid-dependent patients so nurses could identify them easily

Yet the nursing staff did not understand how vital it was that I received my steroids at specific times, and that they could not just be added to the other list of intravenous drugs to be administered after the drug round. 

I would often receive my steroids two to three hours late, which is frightening considering how quickly my condition can deteriorate. 

Method was rolled out 

This highlighted the importance of individualised patient care, and while in recovery I developed a method to help the busy medical and nursing staff on the ward ensure steroid-dependent patients received their medication on time. 

I now act as a patient volunteer for junior doctors’ training

I designed small, bright stickers that could be stuck on the corner of the drug charts of patients who required steroids, so nurses could easily identify patients needing these drugs at specific times. 

This led to a meeting with a consultant neurologist who was interested in implementing the steroid stickers throughout the trust. He asked if I would be willing to be involved in teaching sessions for junior doctors, and I now act as a patient volunteer for junior doctors’ training. 

I also assist tutors in the clinical skills lab, teaching other nursing students about the acute medical management of critically ill patients, including fluid resuscitation and the ABCDE approach to identifying deteriorating patients. 

Illness influenced my practice

Now that I have completed my dissertation and am almost at the end of my training, I am working on developing an algorithm for patients at risk of re-feeding syndrome. 

Research on this is limited but the evidence available suggests the majority of clinicians do not know the signs of re-feeding syndrome, despite its prevalence among hospital patients. 

My journey to becoming a qualified nurse has not been an easy one, but I believe my condition has changed my nursing path for the better. 

Not only do I have a better understanding of what it feels like to be a patient, I have been able to use my experiences to raise awareness of my condition and help educate other health professionals. 

By working together, we really can improve the lives of others.

 

Charlotte Lomas qualifies as a registered nurse at the end of August. She will take up her first role on the burns unit at the St Andrews Centre, part of Mid Essex Hospital Services NHS Trust, on 3 September. 

 

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