Karuppannan, Mahmathi
(2012)
Adverse drug events in Malaysia: medication-related admissions and pharmacists' experiences.
PhD thesis, University of Nottingham.
Abstract
Adverse drug events (ADEs) are a significant cause of patient morbidity and hospital admissions. There are many studies in this area in Western countries. However, little is known about the prevalence and patterns of such events in Malaysia. Health care professionals are in the best position to reduce and prevent adverse drug events. In order to devise preventive strategies based on the prevalence studies, it is important to understand the current practices of health care professionals in this area. This study aimed to determine the different occurrences of ADEs in a Malaysian public hospital as well as the experiences of some Malaysian pharmacists’ of ADEs.
A study of an observational chart review determined the prevalence of adverse drug event-related admissions in a tertiary public hospital and drugs implicated in such. This was achieved through a prospective review of the patients’ medical notes and charts in two medical wards. All cases were assessed using a classification tool which was developed after a pilot study. Following this, a postal survey of some Malaysian pharmacists explored their experiences about ADEs: the types of ADEs they have observed, actions taken in response to these incidents and their awareness of and involvement in adverse drug reaction reporting, and their attitudes towards this task.
Both studies revealed that the occurrence of adverse drug events was high in Malaysia – the chart review study found that 39% of admissions to two medical wards were related to ADEs whilst more than half of the sample pharmacists revealed having observed them in their daily work activities. Moreover, cardiovascular drugs, anti-diabetics, anti-asthmatics, and analgesics were responsible for more than 80% of the admissions related to an ADE. Similar drug classes were also associated with ADEs as recounted by the pharmacists. Moreover they claimed to have communicated with patients about ADEs: on the ADE experienced by a patient, proper use of medicine, importance of adherence, alternate medicines and other appropriate measurements. Although more than 80% hospital and clinic pharmacists claimed to have reported adverse drug reactions, less than 20% of community pharmacists have claimed sending a report. This may have resulted from their lack of awareness of the procedures and processes of reporting an adverse drug reaction.
Compared to other countries, the prevalence of ADEs is higher in Malaysia. It remains to be an important cause of patient injury and hospital admissions. Some useful strategies such as educational intervention on main causes of adverse drug events, monitoring of patients, and appropriate prescribing should be targeted at all health care professionals to prevent its likely future occurrences. Pharmacists play an important role in preventing ADEs by providing education and counselling to patients. Furthermore, as they were able to identify ADEs in their daily work activities, they should be included in any prevention programs. Documenting ADEs and interventions taken in relation to those ADEs should be encouraged, as this will be useful in monitoring the occurrence of ADEs and sharing the documented information with others could improve awareness and therefore improve prevention.
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