Pharmaceutical Care : The Assessment of Suspected Adverse Drug Reactions in Paediatric PatientsChalermsri Pummangura, Chulaporn Limwatananond, Nawaporn Vimolsarawong, David K Luscombe
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For many years, Thai hospital pharmacists have been assigned the job of detecting adverse drug reactions by the Ministry of Public Health. Causality assessment should also be the responsibility of pharmacists. Since there was no ideal algorithm in general use for Thai patients, the purpose of the present study was to design an appropriate algorithm for assessing ADRs in Thai paediatric patients and to correct some of the problems encountered when using foreign algorithms. Once developed, the new algorithm was tested repeatedly by two expert assessors until it was acceptable for use in practice. The final revised algorithm was tested for applicability by six hospital pharmacists who had responsibiligy for ADR monitoring, twelve newly qualified pharmacy graduates, two trained pharmacists with two spedialist physicians in dermatology action as reference assessors. Using the newly developed algorithm some 58 paediatric patients with 124 suspected adverse events were assessed. The degree of agreement and a corrected-chance measure (weighted kappa) were used as performance indicators. It was found that the degree of agreement between the two hospital pharmacists was extremely high (88.7%) with a kappa value of 0.618 which was statistically significant (p < 0.01). The degree of agreement between pairs of new pharmacy graduates was likewise high (89.52%) with a kappa value of 0.771 which was also statistically significant (p < 0.01). In contrast, the degree of agreement between trained pharmacists was only moderate (66.3%) with a kappa of 0.407 whilst the degree of agreement between the two medical assessors was very high (94.08%). Validity tests were carried out to determine sensitivity and specificity. The sensitivity of six raters (one trained pharmacist and five hospital pharmacists) out of eight raters were more than 50% whilst the percentage specificity of six raters were likewise more than 50%.
Keyword:
Adverse Drug Reactions , Paediatric Patients ,algorithm
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