Adverse Drug Events Trigger Tool Research Articles

Adverse drug event trigger tool: construction and application of a readyto-use tool at Hue University of Medicine and Pharmacy Hospital

Background: Adverse drug event (ADE) is one of the most common causes of injury to patients, accounting for 19% of adverse events (AEs), particularly among the elderly due to their sensitivity to ADE. Thus, taking ADE detection is the first vital step in improving medication safety. Objective: This study aimed to develop an appropriate modified triggers tool based on Institute for Healthcare Improvement (IHI) Global Trigger tool for Adverse Events detecting potential ADEs in patients at Hue University Hospital. Materials and methods: Using a retrospective study on the medical records of inpatients treated in Hue University of Medicine and Pharmacy Hospital in 2020. Results: The modified ADE trigger tool encompassed 13 triggers. In the screening stage, the ADEs were found in 18 medical records (1.9% of total screening records), and 22 ADEs were identified, in which 19 ADEs were determined as adverse drug reactions (ADRs). The study also found that 17/19 ADRs had not been reported via a spontaneous reporting system (89.5%). The modified ADE Trigger tool’s positive predictive value (PPV) was 0.06. Conclusion: A modified ADE Trigger tool for detecting ADE has been constructed and applied at Hue University of Medicine and Pharmacy Hospital. This study would be the first motivation for further studies that attempt to apply this tool into daily clinical pharmacy activities and emphasize the role of Clinical Pharmacists at the hospital. Key words: Adverse Drug Event, adverse event, geriatrics, clinical pharmacy.

A Systems Approach to Identify Factors Influencing Adverse Drug Events in Nursing Homes.

The objectives of the study were to identify the incidence rate and characteristics of adverse drug events (ADEs) in nursing homes (NHs) using the ADE trigger tool and to evaluate the relationships between resident and facility work system factors and incidence of ADEs using the System Engineering Initiative for Patient Safety (SEIPS) model. The study used 2 observational quantitative methods, retrospective resident chart extraction, and surveys. The participating staff included Directors of nursing, registered nurses, certified nurse assistants (CNAs). Data were collected from fall 2016 to spring 2017 from 11 NHs in 9 cities in Iowa. Binary logistic regression with generalized estimated equations was used to measure the association between ADE incidence and resident and facility characteristics. We extracted data from 755 medical charts and conducted 33 staff surveys. There were 6.13 ADEs per 100 residents per month. More than half were fall-related (51.1%), and half of those were due to hypotension. Regression analysis revealed significant associations between ADEs and opioid analgesics, psychotropic medications, warfarin, skilled care, consultant pharmacist accessibility, nurse-physician collaboration, CNA vital sign assessment skills, number of physician visits, nurse workload, and use of electronic health records. Five resident characteristics (skilled care, dementia, use of opioids, warfarin, psychotropics) and variables from 5 domains of the facility work system (organization, task, environment, person, technology) had significant associations with ADE incidence. The SEIPS model successfully identified work system factors influencing ADEs in NHs.

The type and incidence of adverse drug events in ageing medical inpatients and their effect on length of hospital stay

AbstractAimsTo determine the proportion of older medical patients who have an adverse drug event (ADE) during admission to hospital and assess the association with hospital length of stay (LOS).MethodsA retrospective evaluation of eligible patients, aged greater than 65 years, consecutively admitted to a medical ward at the Royal Brisbane and Women's Hospital, Australia. Patient medication charts, medical notes and laboratory results were reviewed using an ADE trigger tool to identify potential ADEs during admission. A clinical panel examined and confirmed any true ADEs and the corresponding causative agents. LOS was compared between patients who did and did not have an ADE.ResultsA total of 164 patients were recruited over 30 days. The trigger tool identified a total of 69 triggers from 40 patients (24.3%) with a potential ADE during admission, of which 12 patients (7.3%) had a true ADE. The main drug categories implicated included cardiovascular, anti‐infective and haematological agents. The group of patients with an ADE had a longer median (25th, 75th percentile) LOS when compared to patients without an ADE: 6.5 (3.75, 11) versus 4 (2, 7) days (p = 0.043).ConclusionApproximately 7% of older in‐patients experience an ADE, which has a significant association with an increase in their LOS. To minimise patient harm, undesirable high‐risk drugs should be avoided and vigilant monitoring must occur if they need to be prescribed. An adequately powered, multi‐site study is required and preventative strategies should be further explored.

Identifying Medication-Related Adverse Drug Events in Nursing Facilities in East Texas.

The purpose of this study was to identify the rate of adverse drug events (ADEs) and the percentage that cause harm in east Texas nursing facilities. In 2014, there were 1.4 million nursing facility residents in the United States, and approximately half take nine or more prescribed medications daily. Twenty percent of medication doses administered results in an error, putting almost half of all nursing home residents at risk for two or more medication errors daily. Close to two million medication error-related ADEs are estimated to occur in nursing facilities each year. Many ADEs lead to emergency department visits and hospitalization. A two-month retrospective medical chart review was completed in two medium-sized for-profit nursing facilities in rural east Texas on residents who consented or whose proxy consented to the study. The Nursing Home Adverse Drug Event trigger tool was used for chart reviews. This tool primary uses laboratory values and resident assessments to identify medication-related ADEs. A total of 58 charts were reviewed. There were from 2 to 13 ADEs identified per month at the nursing facilities during the study. This was extrapolated to 7.41 to 27.59 ADEs per 100 resident months. While no permanent harm or hospitalizations resulted from the identified ADEs, these findings in such a small sample size contribute to an elevated level of concern about ADE occurrence and prohibit generalizability of results. Further research is needed on a larger sample, as well as types of medication errors occurring, leading to strategies for preventing ADEs.

Impact of a Swiss adverse drug event prevention collaborative.

The Hospital Federation of Vaud (Switzerland) used a Breakthrough Collaborative with the aim of reducing adverse drug events (ADEs) by 20% in 10 participating hospitals. A set of interventions (covering patient identification, high-alert medication and medication preparation in the ward) was deployed over 18 months starting in October 2010. All hospitals monitored discrepancies between drugs prescribed and those prepared for administration, as well as the occurrence of ADEs using the ADE Trigger Tool for 18 months (cohort 1). A subset of five hospitals continued this monitoring for 12 additional months (cohort 2). In cohort 1, pill box discrepancies were present in 5.9% of doses (n = 9772) in 2011 and in 5.8% (n = 2251) in the first 3 months of 2012 (no statistical significance). There were no significant differences in the rate of ADEs/1000 doses across time (1.2 in 2010, 1.0 in 2011 and 1.0 in 2012). In cohort 2, pill box discrepancies were reduced from 6.5% (n = 4846 doses) in 2011 to 4.4% (n = 7355) in 2012 (P < 0.001) to 3.0% for the first 3 months of 2013 (n = 2251; P = 0.004). The rate of ADEs/1000 doses decreased (1.8 in 2010, 1.1 in 2011 and 0.6 in 2012/13 (P = 0.008 for 2010-2011, and P < 0.001 for 2011-2012/2013). Reductions in drug discrepancies and ADEs occurred in the cohort with the longer monitoring duration. Factors contributing to success may include the strategic status of the project, executive support, perseverance in post-intervention measurement, and institution-wide rather than partial deployment.

Efficacy of Trigger Tool in Identification of Suspected ADR in Secondary Hospital in Cape Verde

Background: Adverse drug events (ADEs) are a major health and economic problem. There is no information regarding incidence of ADEs in Cabo Verde and trigger tools are an efficient active data collection method. Objective: To identify efficacy of the trigger tool in identification of suspected ADRs. Method: The Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI) was used for a retrospective review of medical records. The ADE trigger tool included 21 triggers. 383 records were randomly selected, 190 in a first period and 194 in second period. Hospitalization for less than 48h, time spent in intensive care unit and lack of drug administration records was excluded. Results: 287 triggers and 182 ADEs were found. Medical records with at least one trigger were 67.7% and 42.7%, respectively. In the same periods, 28.4% and 19.6% of total patients presented at least one ADE but it was 50% and 67.9% when calculating for the records with a trigger. In both periods, most common and robust trigger was nurse description. The least robust were abrupt medication stop and use of antiemetic drug. Conclusion: The trigger tool had a good performance detecting ADE. The GTT is not feasible as routine PV method but an option to complement spontaneous notification. Further studies are needed using prospective method and extended period.

Development of an electronic patient prioritization tool for clinical pharmacist interventions

A software-based tool to help prioritize inpatients for adverse drug event (ADE) prevention initiatives is described. The clinical pharmacy department of a New Zealand hospital developed the Assessment of Risk Tool (ART), an application for monitoring prespecified clinical "flags" (some derived from the Institute for Healthcare Improvement's ADE trigger tool) for high-risk medication use and other ADE risk factors. The ART permits ADE risk assessment in virtual real time (i.e., medication-use data and other clinical information are updated multiple times daily). Each of the 38 flags captured by the ART is assigned a weighted score; the item scores are summed to provide a total ART score indicating low, medium, or high ADE risk, and patients are prioritized by the ART score for pharmacist interventions such as clinical review and discharge coordination. In the first 18 months after ART implementation, the average number of patients receiving medication reconciliation each month increased from 280 to 500. During one 8-month period, 765 high-risk patients were prioritized for discharge services and 526 medication errors (MEs) were prevented, including 174 errors deemed to pose a threat of moderate-to-major patient harm. The tool has been well received by clinicians and has generated interest among other New Zealand hospitals. By facilitating the identification and monitoring of patients at high risk for MEs and ADEs, the ART has enabled one hospital's clinical pharmacists to conduct interventions such as medication reconciliation and clinical review in a more timely and targeted manner.

Performance of the Adverse Drug Event Trigger Tool and the Global Trigger Tool for Identifying Adverse Drug Events: Experience in a Belgian Hospital

Medication-related harm can be detected using the adverse drug event (ADE) trigger tool and the medication module of the Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI). In recent years, there has been some controversy on the performance of this method. In addition, there are limited data on the performance of the medication module of the GTT as compared with the ADE trigger tool. To evaluate the performance of the ADE trigger tool and of the medication module of the GTT for identifying ADEs. The methodology of the IHI was used. A random sample of 20 adult admissions per month was selected over a 12-month period in a teaching hospital in Belgium. The ADE trigger tool was adapted to the Belgian setting and included 20 triggers. The positive predictive value (PPV) of each trigger was calculated, as well as the proportion of ADEs that would have been identified with the medication module of the GTT as compared with the ADE trigger tool. A total of 200 triggers and 62 ADEs were found, representing 26 ADEs/100 admissions. Nineteen ADEs (31%) were found spontaneously without the presence of a trigger. Three triggers never occurred. The PPVs of other triggers varied from 0 to 0.67, with half of them having PPVs less than 0.20. If we had used the medication triggers included in the GTT (n = 11), we would have identified 77% of total ADEs and 67% of preventable ADEs. Applying the trigger tool method proposed by the IHI to a Belgian hospital led to the identification of one ADE out of 4 admissions. To increase performance, refining the list of triggers in the ADE trigger tool and in the medication module of the GTT would be needed. Recording nontriggered events should be encouraged.

A targeted method for standardized assessment of adverse drug events in surgical patients

This study demonstrates the development, reliability and outcome of a targeted method for standardized assessment of adverse drug events (ADEs) in surgical patients. Initial practice evaluation of this ADE assessment method was carried out in a prospective single centre cohort study. In total, 262 electively admitted surgical patients were included. The surgical trigger tool was applied to patients' medical records by two independent reviewers, and subsequent assessment of causality, severity and preventability of ADEs was carried out by two independent expert panels consisting of a consultant surgeon and a clinical pharmacologist. The surgical trigger tool and causality assessment method were each tested on reliability in a separate group of 50 randomly selected patients using Fleiss and Cohen's kappa statistics and percentages of agreement. Comparison of this method with an existing trigger tool method for ADEs was performed. Our surgical trigger tool contains 51 triggers. The inter- and intra-rater calculations showed substantial to almost perfect levels of agreement (kappa range 0.71-0.83), with a 97.8-98.5% percentage of agreement. Fair to substantial levels of agreement were calculated for causality, severity and preventability (kappa range 0.38-0.79). The percentages of inter- and intra-rater agreement were 68.9 and 70.5% for causality, 67.0 and 82.0% for severity, and both 98.4% for preventability, respectively. Compared with the existing trigger tool method for ADEs, we found an additional 363 triggers, 18 ADEs (an extra 20%) and 3 preventable ADEs in our surgical cohort. This targeted trigger tool for standardized assessment of ADEs in surgical patients shows excellent agreement between reviewers. The assessment of medication-related harm had acceptable agreement. Compared with an existing ADE trigger tool method, the present method found almost 20% extra ADEs. This method can be a useful alternative to existing trigger tool methods, in particular to assess medication safety in surgical patients.

Utility of an Adverse Drug Event Trigger Tool in Veterans Affairs Nursing Facilities

To determine the utility (i.e., positive predictive value [PPV] and time requirement) of an adverse drug event (ADE) trigger tool in Veterans Affairs (VA) nursing facilities and to describe the most common types of potential ADEs detected with the trigger tool. Retrospective chart review. Veterans residing in three VA nursing facilities between September 29, 2010, and October 29, 2010. We used the Institute for Healthcare Improvement-endorsed nursing facility ADE trigger tool, modified to enhance its clinical relevance to detect potential ADEs. Electronic medical records were screened to identify residents with one or more abnormal laboratory values specified in the trigger tool. A potential ADE was defined as the concurrent administration of medication that could cause the abnormal laboratory value. An overall PPV, or proportion of residents with an abnormal laboratory value who had a potential ADE, and average time required to complete each trigger tool assessment, were calculated. Among 321 veterans, 50.5% (n = 162) had at least one abnormal laboratory value contained in the trigger tool. Ninety-nine potential ADEs involving 146 medications were detected in 65 veterans. The overall PPV of the ADE trigger tool was 40.1% (65/162), and the average time to complete resident assessments was 8.8 (standard deviation ± 5.7) minutes. The most common potential ADEs were acute kidney injury (n = 30 residents), hypokalemia (n = 18), hypoglycemia (n = 13), and hyperkalemia (n = 10). The modified nursing facility trigger tool was shown to be an effective and efficient method for detecting potential ADEs.

Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care

Objective:To evaluate the performance of a trigger tool for identifying adverse drug events (ADEs) among older adults in ambulatory primary care practices.Methods:Manual 12-month retrospective chart review at six practices using...

Investigation of Trigger Tools for Detecting Adverse Drug Reactions

ABSTRACTBackgroundDespite the high morbidity and mortality associated with adverse drug events (ADEs) and adverse drug reactions (ADRs) the ability to detect and report them systematically remains inefficient.AimTo investigate if the use of a modified ADE trigger tool could improve the identification of ADRs in hospitals.MethodRetrospective review of patients' discharge summaries was conducted at a tertiary care facility over a 5‐week period. A modified ADE trigger tool (based on a previous model) was used to assess four high‐risk medicines (warfarin, heparin, morphine, benzodiazepines). ADEs identified were classified using both the Naranjo probability scale and the WHO ADR classification.ResultsData from 528 patients were reviewed, of which 286 (54%) received at least 1 of the 4 high‐risk medicines. 45 patients (8.5%) were identified using the modified trigger tool as having had an ADE during their hospital stay. The modified ADE trigger tool improved the identification of ADRs compared with the spontaneous reporting system, regardless of the classification method used. Both the WHO and Naranjo classification scales yielded higher rates than the spontaneous reporting rate of 0.07% recorded by the New Zealand Centre for ADR Monitoring.ConclusionThe modified ADE trigger tool appears to be a sensitive method for identifying ADRs. The results indicate that using the modified trigger tool yields significantly higher ADR reporting rates than the traditional spontaneous reporting system.