Development of a Surveillance Program for the Incidence of Severe Cutaneous Adverse Reactions (SCARs) among the Hospital Pharmacist Network in Narathiwat Province

Abstract

Background and Objectives Severe Cutaneous Adverse Reactions (SCARs), especially Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), are critical medical emergencies requiring the highest level of surveillance. This study aimed to examine the situation, problems, needs, development, and effectiveness of a surveillance program for the incidence of severe drug-induced skin reactions among the hospital pharmacist network in Narathiwat Province.

Methods This research and development study consisted of three phases. Phase 1 examined problems and needs through document analysis and data collection from 13 pharmacists. Phase 2 developed the model, which was validated by three experts and showed a content validity index of .67–1.00. Phase 3 evaluated the program’s effectiveness using a one-group pretest-posttest quasi-experimental design involving 266 patients and 13 pharmacists. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and the one-sample t-test.

Results Operational challenges in SJS / TEN surveillance in Narathiwat Province include a lack of education for newly diagnosed patients on monitoring for severe cutaneous adverse reactions associated with high-risk medications; incomplete follow-up over the three-month period; and the absence of defined target medications, genetic testing for drug hypersensitivity, and a coordinated pharmacogenetic card program. The developed program was the NARA SJS model, consisting of: N: Network (collaborative network), A: Arrangement for Pharmacogenetics Card, R: Risk Drug Monitoring, A: Action (clinical pharmacy interventions), S: Screening & Genetic Testing, J: Joint Pharmacovigilance, and S: SJS/TEN Prevention. After implementation, patients’ knowledge about drug allergy increased significantly at the .001 level. The incidence and severity of drug allergy were found in 7 patients receiving phenytoin. Overall satisfaction with the program was at a high level among both patients and pharmacists (M = 4.21, S.D.= 0.58; M = 3.91, S.D. = 0.76, respectively).

Conclusions and Recommendations QR code educational materials on prodromal symptoms of SJS/TEN should be developed for patients and healthcare professionals. In addition, five monitored risk drugs should be linked to a Pop-up alert system, and Line Officials Account (Line OA) should be used for timely consultation with drug allergy experts.