The involvement of nurses in reporting suspected adverse drug reactions: experience with the meningococcal vaccination scheme

Abstract

Aims: In order to aid the monitoring of the new Meningococcal serogroup C Conjugate (Men C) vaccine, the Yellow Card Scheme was extended to allow nurses for the first time to report any suspected adverse reactions associated with these vaccines. We have analysed the Yellow Cards received by the Committee on Safety of Medicines (CSM) Wales from nurses reporting a suspected reaction in association with these vaccines during the first 16 months of the programme.

Methods: CSM Wales receives Yellow Cards from healthcare professionals in Wales. Details of Yellow Cards reporting a suspected adverse reaction associated with Men C vaccines during the study period were extracted from the CSM Wales database and analysed according to health professional category [nurses, General Practitioners (GP), hospital doctors or pharmacists].

Results: During the study period 534 117 doses of Men C vaccines were administered in Wales; in the same period CSM Wales received 1095 Yellow Cards containing 1952 suspected reactions. Nurses completed 529 [48.3%, 95% confidence interval (CI) 43.6, 53.1] Yellow Cards compared with 294 (26.8%, 95% CI 22.7, 30.8) from GPs, 262 (23.9%, 95% CI 20.1, 27.6) from hospital doctors and 10 (0.91%, 95% CI 0.43, 1.73) from others, which include hospital pharmacists, community pharmacists and health visitors. The proportion of Yellow Cards sent by nurses was significantly higher than those sent by GPs and hospital doctors. Ninety-five percent CIs for differences in proportions (CI diff prop) were (0.175, 0.254) and (0.204, 0.282), respectively. The majority (90.9%, 95% CI 88.7, 93.5) of the Yellow Cards from nurses reported suspected reactions children in over the age of 5 (95% CI diff prop 0.861, 0.917). The spectrum of suspected adverse drug reactions (ADRs) involved the skin and subcutaneous tissue, central nervous system, general reactions, and the gastrointestinal tract. Of the suspected reactions reported by nurses, GPs and hospital doctors, 13.4% (95% CI 10.5, 15.8), 12.9% (95% CI 9.6, 16.8) and 9.1% (95% CI 6.5, 11.8), respectively, were of serious reactions. Nurses reported 52.5% (95% CI 45.4, 60.6) of all the suspected serious reactions, which was statistically more significant than hospital doctors [chi2 = 5.864, degree of freedom (DF) = 1, P < 0.05] but not GPs (chi2 = 0.066, DF = 1, P > 0.05).

Conclusions: Nurses were the health professionals who provided the largest proportion of reports of suspected ADRs and almost half of all reports during the Men C vaccination campaign. Their reports contained an equal proportion of serious suspected ADRs and the reports were documented as completely as those from GPs and hospital doctors.

Figure 1

Distribution of suspected adverse reactions reported by the three health professional groups.General practitioners (GPs (▪)) reported a significantly greater proportion of suspected reactions affecting the skin and subcutaneous tissue than nurses () and hospital doctors (HDs (□)) [95% CI diff prop (0.135, 0.252) and (0.12, 0.226), respectively]. HDs reported a significantly greater proportion of general reactions than GPs and nurses [95% CI diff prop (0.032, 0.131) and (0.045, 0.139), respectively]. Skin, Skin and subcutaneous tissue disorders; NS, neurological disorders; GIT, gastrointestinal tract disorders; CVS, cardiovascular disorders; MS, musculoskeletal, connective tissue and bone disorders; RS, respiratory disorders.