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Use of Quick Response (QR) coded bracelets and cards for the improvement of cortisol deficiency/Addison’s disease management: an audit of quality of care of the management of steroid deficiency in acute illness
  1. Andrew W Colman1,
  2. Jack F K Sellick2,
  3. Jolanta Urszula Weaver1,3
  1. 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
  2. 2 Faculty of Medical Sciences, Newcastle University, Newcastle, UK
  3. 3 Department of Endocrinology, Gateshead NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
  1. Correspondence to Dr Andrew W Colman, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK; Andy.Colman{at}


Background An adrenal crisis is a rare but life-threatening condition in which hydrocortisone and fluid resuscitation must be given promptly to prevent hypotensive shock and death. A clinical audit assessed healthcare professionals’ experience of adrenal crisis management and if there was a need for immediate access to clinical guidelines. The proposed system in which a patient-worn Quick Response (QR) coded bracelet provides healthcare professionals with web-based clinical information in acute settings was explored for the management of adrenal crisis.

Methods Fifty-four healthcare professionals, 21 doctors, 12 nurses, 15 paramedics and 6 dentists completed a questionnaire about the care, confidence in managing an adrenal crisis and the feasibility of using a QR-coded bracelet designed and linked to a website dedicated to patient information on steroid replacement therapy we have developed.

Results 37% of healthcare professionals have never seen and 59% have never managed an adrenal crisis. The median confidence score (1—low to 7—high) in managing an adrenal crisis varied for doctors, nurses, paramedics and dentists between 5, 2, 4.5 and 1.5, respectively. 94% of healthcare professionals thought the proposed QR code-linked system was useful and 84% would use it in an acute setting. The median usability score (1—low to 7—high) for the QR code-linked system for healthcare professionals was 6.5 out of 7.

Conclusion There is a clinical need to improve the acute management of adrenal crisis and QR code-linked information was desired by healthcare professionals. QR code-linked information may allow patients with rare diseases presenting acutely to receive improved management through immediate access to treatment protocols.

  • addison’s disease
  • adrenal crisis
  • addisonian crisis
  • cortisol deficiency
  • hydrocortisone
  • QR code
  • treatment protocols
  • web
  • patient information
  • patient education

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  • Contributors AWC was responsible for the original project concept, the design, prototyping, testing and fabrication of the QR code bracelets and cards, the design, coding, testing and publishing of the ADIS web app and all the figures and photographs. He authored the Appendix and made a major contribution to writing the medical part of the paper. JFKS drafted questionnaires designed for healthcare professionals, collected the responses and analysed them. JUW was responsible for the overall supervision of the project and the clinical supervision of JFKS, a medical student. She contributed to the design and content of the patient and healthcare. professional questionnaires and made a major contribution to writing the medical part of the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.