The present questionnaire-based survey was conducted at a regional PV center at an oncology hospital in Nepal with the aim to assess the impact on HCPs (nurses and pharmacists) before and after an educational intervention. Previously no any study was conducted in a regional PV center attached to the cancer hospital [5], regarding PV and ADR reporting, therefore this study was carried out to assess the knowledge and attitude of ADR reporting among HCPs (nurses and pharmacists) in this hospital, also the factors which influence ADR reporting are discussed. When it comes to reporting ADRs, the KAP study is considered as the leading study.
Several studies in Nepal which have reported that HCPs have a lack of knowledge regarding the PV before any kind of educational intervention [15, 17–20]. However, there are only very few limited studies [21, 22] that have assessed the PV knowledge after educational intervention among HCPs of tertiary care hospital, and community pharmacists [23]. To the best of our knowledge, the present study is the first to assesses the impact of education on PV at a regional PV center of an oncology based hospital in Nepal.
The current study showed a higher percentage of females (85.4%) than males as HCPs in the oncology hospital. These findings are similar to the studies conducted at different hospitals in Nepal [15,17,19,21] These findings were also similar to studies conducted at different countries such as neighboring countries India [25], and other countries like Japan [27], Iran [28, 29], UAE [30] and Turkey [10]. While sub-classifying participants, most of them were nurses. The reason for being more female and nurses in this study could be explained by the preference of females to choose the nursing career compared to males [15, 20]. However, there is a recent trend of males joining nursing as a career [31]. Most of the participants were found to be in the age group of 21–30 years and were qualified in their professional work with the mean ± SD of age was found to be 25.88 ± 4.131. The average age of HCPs in our study ranged between 20–46 years which is similar to studies [15,23, 28–30], unlike study conducted at Turkey [10] where the maximum age group was 50–55 years. With regard to work experience, the HCPs working in this hospital were well experienced in their profession. Eighty (89.9%) of the participants had work experiences of 0.2- 5.1 years and 1 (1.1%) participants had work experience of more than 15 years. In similar other studies [32, 33], participant’s age and work experience have shown an impact of PV activities and ADR reporting as shown in other studies. However, in the other studies [34, 35], there was no statistical difference found between ADRs reporting practicing and other independent variables including age, gender, and experience in years.
Majority of participants educational qualifications were 48 (53.9%) diploma degree (staff nursing and a diploma in pharmacy) and 36 (40.4%) bachelor degree (Bachelor in nursing and Bachelor in pharmacy) which is similar to study conducted by Santosh KC et al [15] that was conducted at four regional PV of Nepal. These findings are also similar to the study by John LJ et al [30] at UAE, unlike Hanafi et al. wherein, the majority were undergraduates and graduates [29]. The probable reason may be due to the maximum number of diploma staff in hospitals as these professionals can be paid less than an undergraduate degree and graduate degree.
Majority of the participants responded that it was difficult for them to decide whether ADR has occurred and lack of time as major factors that discourage HCPs from reporting ADRs. Difficulty in deciding ADR and lack of time are reported by other studies conducted in Nepal [15, 17, 19] and in other countries [30, 36–38] In studies from other countries, reasons for under-reporting of an ADR were found as uncertainty concerning the causal relationship between the ADR, too trivial to report, yellow card unavailability, lack of knowledge about the reporting procedure unavailability of the reporting center mailing address, unavailability of the ADR report form, lack of knowledge of the existence of a national ADR reporting system, and belief that the ADR in question was already well known, ADR is not serious, and the drug, forgetting to report the ADR and ignorance of reporting procedure [27,33,35,39–42].
The majority of the participants suggested “Keep ADR register in all the wards and OPD”,” Frequent Pharmacovigilance awareness via Continuing medical education(CME) /workshop “and “Include ADR forms along with case sheet”. They also suggested for a frequent pharmacovigilance awareness through the means of CME or workshop, including ADRs forms along with the medical case sheet of the patients, making an institutionalized protocol for reporting ADRs. These suggestions made by participants were almost similar to other studies in different hospitals in the world [25,30,38]. These suggestions were almost similar to other studies conducted in other countries which show that educational interventions and other activities help to encourage ADR reporting increase awareness to ADRs and then increase the reporting rates of ADRs [20,21,25, 30,38,43–45]. Drug and Therapeutics Committee (DTC) also plays an active leading role in the advancement of medicine safety and strengthening PV centers at the hospital [46]. Practical training or workshop regarding PV might assist to resolve this up-and-coming problem of underreporting of ADRs at the hospital [47]. A systematic simulated environment and workshop on PV should be conducted for the HCPs (pharmacists, nursing staff, and even medical doctors) and intervallic interaction and interprofessional collaborations should be done to know the difficulties they are facing. Clinical pharmacists or pharmacists also play a vital role in PV and increasing ADR reporting [48].
The knowledge score was found to be low before an educational intervention among HCPs which is similar to several studies conducted in Nepal [15, 17, 20, 21, 23] and other countries [10,28,29, 47, 49]. However, the knowledge score was found to be increased after the educational intervention. These findings are almost similar to other studies [21,23,25] This evidence clearly showed that after the introduction of educational intervention on PV, knowledge of HCPs were improved. When it comes to ADRs reporting, knowledge regarding ADR is very important which is very important for nurses and pharmacists. They should possess great knowledge of ADR and the process of reporting ADRs to the PV center. Among nurses and pharmacists, pharmacists have good knowledge of PV. While, the score was good after -post-study of HCPs working in the hospital which clarifies that PV course, training should be provided to all HCPs in Nepal.
This study revealed that a majority of participants believed that ADR reporting is necessary and increase patient safety. An interesting finding was found in this study, where the attitude score was found to be decreased slightly after the educational intervention. This result was found to be different than other studies [18, 21, 23, 25]. However, since most of the nurses and pharmacists consider ADR reporting is necessary, they should overcome the obstacles in reporting ADR and report ADR voluntarily, whenever they encountered and should consider ADR reporting as their professional obligation.
A pre-training study among HCPs of the hospital showed a score of attitude 5.56±1.616 (4–10). and post-training showed 6.97±1.793 (4–12). These findings are almost similar to other studies [21, 23, 25]. This evidence clearly showed that after the introduction of educational intervention on PV, attitudes of HCPs were improved.
The present study showed that the change in knowledge and attitude of the participants after PV education yet this study couldn’t demonstrate the adjustment in the practices of the participants because of time confinements which are the major limitations of this study. The other limitations of this study contain; the results were of a single-center and fewer sample size. The study can be additionally reached out to other governmental and non-governmental hospitals in Nepal, to sum up, these findings of the study.