Exploring Pakistani Physicians' Knowledge and Practices Regarding High Alert Medications: Findings and Implications

Abstract

Introduction: While many low-middle income countries (LMICs), including Pakistan, try and ensure patient safety within available resources, there are considerable concerns with medication use. Unsafe and inappropriate medication use, especially high alert medications (HAMs), is one of the important factors compromising patient safety and quality of care. Besides economic loss, HAMs contribute to greater morbidity, hospitalization, and mortality. Physicians as key members of the provision of healthcare are expected to be well aware of the administration and regulations surrounding HAMs. However, the current status is unknown in Pakistan. Consequently, the objectives of this study were to evaluate the knowledge of Pakistani physicians about the administration, regulation, and practices related to HAMs. This builds on our recently published study with nurses.Methods: An online cross-sectional study design was used, and data were gathered from the physicians throughout Pakistan using previously used self-administered questionnaires during a period of 5 months (January 1 to May 30, 2021). All data were entered and analyzed using SPSS 22 for Windows.Results: Physicians (847) who provided consent were enrolled in the study. Most physicians (62.2%) were male, aged between 25 and 30 years (75.2%) and had 2- to 5-year work experience (50.9%). About 27% were working in the emergency departments. The median (IQR) knowledge score for HAMs administration and regulation was 5 (3) and 5 (2), respectively. About 46.4% of respondents were found to have moderate knowledge about HAMs; increasing age, work experience, and higher qualifications were significantly associated (p < 0.05) with better HAMs knowledge. Around 58% had good practices relating to HAMs during their routine work. Median practice scores increased significantly (p < 0.05) with age, work experience, and postgraduate qualification.Conclusion: Most Pakistani physicians possess moderate knowledge about HAMs administration and regulations. However, their practices relating to the HAMs administration and regulations are typically sub-optimal. Consequently, HAMs awareness needs to be improved by including course content in the current curriculum, provision of hospital-based continuous training programs about patient safety and care, and establishment of multi-disciplinary health care teams, including board-certified pharmacists and specialized nurses, for the effective execution of medication use process in Pakistani hospitals in the future.

Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large, Multicenter, Cross-Sectional Survey in China

“…All participants reported that the questionnaire was clear and easy to understand. The Cronbach’s alpha of this questionnaire was 0.830, showing adequate internal consistency, similar to a previous study ( Mustafa et al, 2022 ). The results from the pilot test were not included in the final analysis of the data.…”

“…The U.S. Food and Drug Administration also warned of the potentially deadly exposure of fentanyl patches in children (Food and Drug Administration, 2021). In addition, 65.7% of the participants agreed with the existence of multiple concentrations to choose from for each drug, which was much higher than the percentage in previous studies (Zyoud et al, 2019;Salman et al, 2020;Mustafa et al, 2022). However, multiple concentrations and multiple dosing options may be potentially serious sources of preventable medication errors, particularly for pediatric patients receiving HAMs (Zyoud et al, 2019;Irwin et al, 2008).…”

“…The finding on the three lowest-scoring items regarding HAMs was alarming. For example, surprisingly, only one-fifth of the participants chose the right answer to the item about the fentanyl patch, which was much lower than in other countries (Zyoud et al, 2019;Salman et al, 2020;Mustafa et al, 2022). The fentanyl patch is a conventional narcotic for pain relief in adults and has several advantages, including effectiveness, good tolerance, and a long duration of action.…”

“…Our findings revealed that Chinese pediatric nurses had higher knowledge of HAMs than nurses in other countries ( Kim and Kim, 2019 ; Zyoud et al, 2019 ; Salman et al, 2020 ). Compared to physicians in Pakistan, Chinese pediatric nurses’ knowledge of HAMs was better, with 76.4% of the nurses possessing excellent knowledge ( Mustafa et al, 2022 ). Nevertheless, special attention should be given to the lower score for HAM regulation and the three lowest-scoring items.…”