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.
