Patients’ perception of a Gentamicin Information-Leaflet to improve reporting of side-effects

Background Gentamicin’s narrow therapeutic index requires hospital staff and patients to be aware of the symptoms of toxicity specifically, nephrotoxicity and ototoxicity.1,2 Signs of potential ototoxicity reported by patients are not always linked to their gentamicin therapy, and they can be incorrectly reassured that symptoms are not related or will resolve upon treatment cessation.1 NHS Greater Glasgow and Clyde’s (GG&C) programme on improving the prescribing and monitoring of parenteral gentamicin, included the development of a patient information-leaflet (PIL) which covers the use, administration and potential side-effects of gentamicin. However, some practicalities (e.g. who should issue the leaflet and when) and concerns over patient acceptability have limited the uptake of the PIL. ObjectivesTo determine the patient’s acceptability and potential impact of the gentamicin PIL amongst hospital inpatients. MethodsParticipants were recruited using a convenience sampling approach. Following consent for participation, patients were given the PIL to either: read by themselves followed by a researcher administered questionnaire OR the leaflet was read to them i.e counselled on its contents by the researcher followed by questionnaire administration. The questionnaire consisted of 11 attitudinal statements measured by a 5-point Likert scale with 2 open-ended questions to test recall of information. This study did not require ethics approval, however, Caldicott Guardian approval was obtained.ResultsSeventy patients, 29 males (41.4%) and 41 females (58.6%) were recruited. Sixty three patients (90%) agreed that the leaflet would help them to recognise side-effects and 67 patients (95.7%) agreed that the leaflet would help them to report side-effects. Most patients (n=47, 67.1%) were happy to receive treatment with gentamicin after reading the leaflet. While the majority of patients (n=53, 75.7%) would not refuse gentamicin treatment after reading the leaflet, nine patients (12.8%) said they would refuse and twenty-one (30%) would be ‘worried’. Thirty-five (50%) patients agreed the leaflet should be given before treatment starts, even if the patient is too unwell to understand its contents. The responses to receiving the leaflet before treatment starts were significantly different (p<0.05) between the age groups and upon patient counselling status, with the majority (n=26, 37.1%) of >60 year olds agreeing with this action. Recall of 3 or more side-effects was more likely in those who had been counselled (P<0.05).ConclusionThe PIL was positively received by the majority of patients and counselling appeared to improve recall of side-effects. However, the views of those who were worried about treatment or would refuse treatment after reading the PIL cannot be disregarded. In this study, the >60-year-olds wanted to receive the PIL prior to treatment suggesting that if resources are limited, this group could be prioritised by staff. Implementation of the PIL would require guidance and education of staff to equip them to respond to reports of toxicity, worries and treatment refusal.