1. Asya Rasul1, Dr Lee Stewart1, Fiona Robb1, Dr Gazala Akram2
Understanding the patient’s perception of a Gentamicin information-leaflet provided during treatment to improve reporting of side-effects
Asya Rasul1, Dr Lee Stewart1, Fiona Robb1, Dr Gazala Akram2
1Pharmacy Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Scotland.
2Strathclyde Institute of Pharmacy & Biomedical Sciences. University of Strathclyde. Glasgow, Scotland.
INTRODUCTION
Inappropriate use of gentamicin can cause toxicity, specifically nephrotoxicity and ototoxicity.1 Yet, there is a perceived lack of knowledge and understanding of the pathophysiology and onset of ototoxicity caused by gentamicin.2 Treatment guidelines3,4 focus on preventing nephrotoxicity and the use of audiometry to detect cochlear toxicity (hearing loss, tinnitus) and HCP review/patient input to identify vestibular toxicity (imbalance, vertigo).
To improve prescribing and monitoring of gentamicin, NHS Greater Glasgow and Clyde (GG&C) developed a gentamicin information-leaflet. The purpose of which was to educate patients to identify and report signs of ototoxicity earlier and hence lead to improved outcomes. However, practical and logistical issues, such as the timing of providing the leaflet and by whom, as well as its general acceptability and utility have still to be determined.
AIMS & OBJECTIVES
AIM: To investigate the patient’s perception of the readability, content and overall acceptability of the gentamicin information-leaflet.
OBJECTIVES:
To determine the acceptability of the information in the gentamicin information-leaflet.
To determine utility of the information in the gentamicin information-leaflet.
To determine acceptability of gentamicin treatment based on information in the gentamicin information-leaflet.
RESULTS
70 patients were recruited. 41 (58.57%) were female and 29 (41.43%) male; with a similar distribution of patients from all directorates.
Most patients (n=47, 67.1%) were happy to receive treatment with gentamicin after reading the leaflet whilst others (n=16, 22.9%) were undecided. The majority of patients (n=53, 75.7%) would not refuse treatment after reading the leaflet whereas some patients (n=9, 12.89%) would refuse treatment and others (n=21, 30%) would be worried about treatment. Nonetheless, the majority of patients agreed the leaflet would help them to recognise (n=63, 90%) and report (n=67, 95.7%) side-effects regardless of counselling status.
Most patients (n=58, 82.9%) agreed on receiving the leaflet only when they were able to read it and understand it even if this was after treatment had started. The response to receiving the leaflet before treatment starts even if too unwell to understand it was significantly different (p<0.05) between the age groups and whether patients had been counselled or not [X2 (1 d.f)=4.93, p=0.02].
Recall of side-effects was significantly different (p<0.05) in counselled and not-counselled patients [X2 (1 d.f) = 8.27, p=0.004]. Table 1 shows the number of patients who remembered (recalled) the side-effects. ‘Hearing impairment’ and ‘disturbance in balance’ were the most frequently recalled side-effects.
Table 1. Recall of side-effects based on age group and counselling status (N=70).
METHOD
The study was performed at the Queen Elizabeth University Hospital (QEUH) in downstream wards*, of the Medical, Surgical, Care of the Elderly and Orthopaedic directorates. *A downstream ward is where patients are not in the very acute and early stages of admission and do not receive one-to-one nursing.
Following consent for participation, the patients were given the information-leaflet to either:
Read it themselves followed by questionnaire administration.
Read it themselves then be counselled on the contents of the information-leaflet (by the researcher) followed by administration of the questionnaire.
Acknowledgements
I would like to thank my supervisors Lee, Fiona and Gazala for encouraging and supporting me through this research as well as the patients for completing the questionnaires.
CONCLUSIONS
Overall the leaflet was fairly well received. Although most patients wanted to receive the leaflet, there were conflicting results on the best time to do this amongst the different age groups. Counselling appeared to improve the recall of information, which suggests that simply handing out a leaflet does not mean that it has been understood. A good way to prioritise services would be to counsel those >60 years old as a priority.
REFERENCES
1. British National Formulary. Gentamicin. London: BMJ Group and Pharmaceutical Press < [Accessed on [13/11/2017]]
2. Black, F., Pesznecker, S. and Stallings, V. (2004). Permanent Gentamicin Vestibulotoxicity. Otology & Neurotology, 25(4), pp
3. NHS Greater Glasgow and Clyde. Adult Therapeutics Handbook: GGC Medicines (2017). Available at: [Accessed 13/11/2017]
4. Scottishmedicines.org.uk. (2017). Scottish Medicines Consortium Gentamicin. Available at: [Accessed 13 Nov. 2017].