Assessment of sociodemographic and work-related determinants of pharmacists and nurses on their knowledge, attitude, and practice on Triple whammy drug interaction at the Base and Teaching Hospitals in Jaffna

Abstract

Background: The "Triple Whammy" (TW) drug interaction, simultaneous use of diuretics, Renin-Angiotensin-Aldosterone System inhibitors (ACEIs/ARBs), and NSAIDs, increases the risk of acute kidney injury (AKI), especially in vulnerable groups. In Sri Lanka, where hypertension is common, pharmacists and nurses are key to identifying and managing TW risks. Objectives: To evaluate their knowledge, attitude, and practice regarding TW interaction and explore how sociodemographic and work factors influence these aspects among healthcare professionals in Jaffna hospitals. Methodology: A descriptive cross-sectional survey was conducted from August 2024 to August 2025 among all pharmacists and nurses in Jaffna District teaching and four base hospitals (Tellipalai, Manthikai, Kytes, Chavakacheri) without sampling. A validated self-administered questionnaire collected data on sociodemographic, work-related factors, and knowledge, attitude, and practice about TW interaction. Descriptive and inferential statistics (Kruskal-Wallis, Mann Whitney, Spearman’s rank correlation) were used for analysis. Results: Among 130 participants (83 nurses, 47 pharmacists), most were aged 25 36 (55.4%), female (77.7%), and diploma holders (85.4%). Nurses comprised 63.8%, with 54.6% in teaching hospitals and 56.2% working in general wards. Most had ≤20 years’ experience (84.6%), and only 33.8% participated in continuing professional development (CPD). Pharmacists scored significantly higher than nurses in knowledge (p < 0.01) and attitude (p < 0.01). Degree holders outperformed diploma holders in knowledge (p < 0.01) and attitude (p < 0.01). CPD participation correlated positively with knowledge (p < 0.01) and attitude (p < 0.01). Practice scores moderately correlated with education (p = 0.035) and CPD (p < 0.01), but not with age, profession, or experience (p > 0.05). Conclusion: KAP regarding TW interaction among pharmacists and nurses in Jaffna is influenced mainly by education, professional role, and CPD participation. Enhancing CPD and targeted training is vital to close knowledge gaps, improve practice, and ensure patient safety by reducing adverse drug interactions.