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Schiavo G, Forgerini M, Varallo FR, Falavigna LO, Lucchetta RC, Mastroianni PDC. Application of trigger tools for detecting adverse drug events in older people: A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:576-589. [PMID: 38538516 DOI: 10.1016/j.sapharm.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/05/2024] [Accepted: 03/17/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To identify trigger tools applied to detect adverse drug events (ADEs) in older people and describe their utility and performance. METHODS A systematic review was conducted in the PubMed, Lilacs, and Scopus databases (January 2024). Studies that developed, applied, or validated trigger tools and evaluated their utility and/or performance for detecting ADEs in older people were considered. Direct proportion meta-analyses using the inverse-variance method were performed for prevalence of ADEs and positive predictive value (PPV). RESULTS Twenty-four studies (25 publications) were included. Twelve trigger tools were identified, of which six were developed for detecting ADEs in older population, four developed for general population and modified for older people, and two developed for general population. No tools for detecting ADEs in older people receiving palliative care or hospitalized in intensive or surgical care units were found. The performance of triggers was presented through PPV (11.5-71%), negative predictive values (83.3%), and sensitivity (30-94.8%). The overall PPV was 33.3% (95%CI: 32.5-34.2%). Triggers with good performance were changes in plasma levels of digoxin, glucose, and potassium; changes in international normalized ratio; abrupt medication stop; hypotension; and constipation. The prevalence of ADEs ranged from 2.8 to 66%, with overall prevalence of ADEs of 20% (95%CI: 19.3-20.8%). Preventability ranged from 8.4 to 94.4%. Metabolic or electrolyte disturbances induced by diuretics, constipation induced by opioids, and falls and delirium induced by benzodiazepines were the most prevalent ADEs. CONCLUSION The trigger tools are flexible and easy to apply, and they can contribute to the detection of ADEs, their associated risk factors, the level of harm, and preventability in different health settings. However, there is no consensus on good or poor values of PPV, which indicate the performance of triggers. Furthermore, there is limited evidence regarding the evaluation of performance through negative predictive value, sensitivity, and specificity. PROSPERO CRD42022379893.
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Affiliation(s)
- Geovana Schiavo
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Department of Drugs and Medicines, Araraquara, São Paulo, Brazil.
| | - Marcela Forgerini
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Department of Drugs and Medicines, Araraquara, São Paulo, Brazil.
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirão Preto, University of Sao Paulo (USP), Department Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil.
| | - Luiza Osuna Falavigna
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Department of Drugs and Medicines, Araraquara, São Paulo, Brazil.
| | | | - Patrícia de Carvalho Mastroianni
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Department of Drugs and Medicines, Araraquara, São Paulo, Brazil.
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Valkonen V, Haatainen K, Saano S, Tiihonen M. Evaluation of Global trigger tool as a medication safety tool for adverse drug event detection-a cross-sectional study in a tertiary hospital. Eur J Clin Pharmacol 2023; 79:617-625. [PMID: 36905428 PMCID: PMC10110725 DOI: 10.1007/s00228-023-03469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
The objective of this study is to describe and analyze adverse drug events (ADE) identified using the Global trigger tool (GTT) in a Finnish tertiary hospital during a 5-year period and also to evaluate whether the medication module of the GTT is a useful tool for ADE detection and management or if modification of the medication module is needed. A cross-sectional study of retrospective record review in a 450-bed tertiary hospital in Finland. Ten randomly selected patients from electronic medical records were reviewed bimonthly from 2017 to 2021. The GTT team reviewed a total of 834 records with modified GTT method, which includes the evaluation of possible polypharmacy, National Early Warning Score (NEWS), highest nursing intensity raw score (NI), and pain triggers. The data set contained 366 records with triggers in medication module and 601 records with the polypharmacy trigger that were analyzed in this study. With the GTT, a total of 53 ADEs were detected in the 834 medical records, which corresponds to 13 ADEs/1000 patient-days and 6% of the patients. Altogether, 44% of the patients had at least one trigger found with the GTT medication module. As the number of medication module triggers increased per patient, it was more likely that the patient had also experienced an ADE. The number of triggers found with the GTT medication module in patients' records seems to correlate with the risk of ADEs. Modification of the GTT could provide even more reliable data for ADE prevention.
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Affiliation(s)
- Ville Valkonen
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland.
| | - Kaisa Haatainen
- Kuopio University Hospital, Kuopio, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Susanna Saano
- Hospital Pharmacy, Kuopio University Hospital, Kuopio, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, P.O.B 1627, 70211, Kuopio, Finland
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Liu L, Zhang A, Su M, Sun X, Shao D, Cheng J, Yao N(A. The development and validation of a patient-reported outcome measure to assess financial hardship among older cancer survivors in China: hardship and recovery with distress survey. Front Oncol 2023; 13:1151465. [PMID: 37152015 PMCID: PMC10162643 DOI: 10.3389/fonc.2023.1151465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Background Financial hardship has been described as a patient's economic experiencefollowing cancer-related treatment. Standardized patient-reported outcome measures(PROM) to assess this distress has not been well-studied, especially among older cancer survivors. Objective The aim of this study was to develop and validate PROM for assessing the financial hardship of older cancer survivors in China. Methods Items were generated using qualitative interviews and literature review. Items were screened based on Delphi expert consultation and patients' opinions. Item response theory (IRT) and classical test theory (CTT) were used to help reduce items. Retained items formed a pilot instrument that was subjected to psychometric testing. A cut-off score for the new instrument for predicting poor quality of life was identified by receiver operating characteristic (ROC) analysis. Results Qualitative interviews and literature review generated 135 items, which were reduced to 60 items because of redundancy. Following Delphi expert consultation and patients' evaluation, 24 items with high importance were extracted. Sixteen items were selected due to satisfactory statistical analysis based on CTT and IRT. Ten items were retained and comprised 2 domains after loadings in exploratory factor analysis (EFA). Internal consistency was satisfactory (α = 0.838). Test-retest reliability was good (intraclass correlation, 0.909). The ROC analysis suggested that the cut-off of 18.5 yielded an acceptable sensitivity and specificity. Conclusions The PROM for Hardship and Recovery with Distress Survey (HARDS) consists of 10 items that specifically reflect the experiences of financial hardship among older Chinese cancer survivors, and it also showed good reliability and validity in clinical settings.
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Affiliation(s)
- Li Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Aihua Zhang
- School of Nursing, Shandong First Medical University, Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- *Correspondence: Mingzhu Su,
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Di Shao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Joyce Cheng
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Predicting adverse drug events in older inpatients: a machine learning study. Int J Clin Pharm 2022; 44:1304-1311. [DOI: 10.1007/s11096-022-01468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
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Liu M, Zheng C, Guan X, Ke Z, Zou P, Yang Y. Development of central venous access device-associated skin impairment assessment instrument. Nurs Open 2022; 9:2095-2107. [PMID: 35502576 PMCID: PMC9190675 DOI: 10.1002/nop2.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 11/12/2022] Open
Abstract
AIM To develop an assessment tool to assess the severity and healing of skin impairment with the central venous access device. DESIGN Delphi technique. METHODS The instrument domain list was developed through a systematic literature review and semi-structured interviews. Experts from China evaluated the relevance and significance of these items in assessing the degree of skin impairment surrounding central venous access device sites through two Delphi rounds. The APA Style JARS checklist for this article was used. RESULTS For the systematic literature review, 28 articles were included to develop the wound assessment instrument. From the articles and interview contents, 15 criteria were selected based on reporting frequency. After further screening via in-depth discussion, the central venous access devices associated with the skin impairment assessment tool were refined to include 14 major domains. Through a two-phase Delphi process, 71 items in 12 domains were ultimately retained.
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Affiliation(s)
- Min Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chonghao Zheng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiangyun Guan
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ziwei Ke
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, Canada
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Zerah L, Henrard S, Thevelin S, Feller M, Meyer-Massetti C, Knol W, Wilting I, O’Mahony D, Crowley E, Dalleur O, Spinewine A. Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial. Age Ageing 2022; 51:6430101. [PMID: 34794171 DOI: 10.1093/ageing/afab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA). OBJECTIVE to assess the performance of those triggers in detecting DRA. DESIGN retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial. SETTINGS four European medical centres. SUBJECTS multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up. METHODS the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole. RESULTS of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 [0.62-0.69]. CONCLUSIONS this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.
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Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O’Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy Department, Université Catholique de Louvain, CHU UCLNamur, Yvoir, Belgium
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Dong S, Millar R, Shi C, Dong M, Xiao Y, Shen J, Li G. Rating Hospital Performance in China: Review of Publicly Available Measures and Development of a Ranking System. J Med Internet Res 2021; 23:e17095. [PMID: 34137724 PMCID: PMC8277410 DOI: 10.2196/17095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 08/12/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, significant emphasis and investment in health care reform since 2009 has brought with it increasing scrutiny of its public hospitals. Calls for greater accountability in the quality of hospital care have led to increasing attention toward performance measurement and the development of hospital ratings. Despite such interest, there has yet to be a comprehensive analysis of what performance information is publicly available to understand the performance of hospitals in China. OBJECTIVE This study aims to review the publicly available performance information about hospitals in China to assess options for ranking hospital performance. METHODS A review was undertaken to identify performance measures based on publicly available data. Following several rounds of expert consultation regarding the utility of these measures, we clustered the available options into three key areas: research and development, academic reputation, and quality and safety. Following the identification and clustering of the available performance measures, we set out to translate these into a practical performance ranking system to assess variation in hospital performance. RESULTS A new hospital ranking system termed the China Hospital Development Index (CHDI) is thus presented. Furthermore, we used CHDI for ranking well-known tertiary hospitals in China. CONCLUSIONS Despite notable limitations, our assessment of available measures and the development of a new ranking system break new ground in understanding hospital performance in China. In doing so, CHDI has the potential to contribute to wider discussions and debates about assessing hospital performance across global health care systems.
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Affiliation(s)
- Shengjie Dong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ross Millar
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
| | - Chenshu Shi
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Minye Dong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyin Xiao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shen
- China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang X, Qi W, Chan S, Shi Z. Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia. J Clin Nurs 2020; 29:3414-3424. [DOI: 10.1111/jocn.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xingxing Wang
- Department of Nursing Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
| | - Wenwen Qi
- Department of Psychogeriatrics Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
| | - Sally Chan
- Singapore campus University of Newcastle CallaghanNSW Australia
| | - Zhongying Shi
- Department of Nursing Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
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Hu Q, Qin Z, Zhan M, Chen Z, Wu B, Xu T. Validating the Chinese geriatric trigger tool and analyzing adverse drug event associated risk factors in elderly Chinese patients: A retrospective review. PLoS One 2020; 15:e0232095. [PMID: 32343726 PMCID: PMC7188209 DOI: 10.1371/journal.pone.0232095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/07/2020] [Indexed: 02/05/2023] Open
Abstract
Objective The aim was to evaluate the performance of the initial Chinese geriatric trigger tool to detect adverse drug events (ADEs) in Chinese older patients, to attempt to shorten this list for improving the efficiency of the trigger tool, and to study the incidence and characteristics of ADEs in this population. Methods A sample of 25 cases was randomly selected per half a month from eligible patients who aged 60 years and older, hospitalized more than 24 hours, and discharged or died between January 1, 2015 and December 31, 2017 in West China hospital. A two-stage retrospective chart review of the included inpatients were conducted. ADEs were detected using a list of 42 triggers previously selected by an expert panel by means of a Delphi method. The number of triggers identified and ADEs detected were recorded and the positive predictive value (PPV) of each trigger was calculated to select the most efficient triggers. Several variables were recorded, including age, sex, number of diseases, length of hospital stay and so on, to analyze the risk factor of ADEs. Results Among 1800 patients, 1646 positive triggers and 296 ADEs were detected in 234 (13.00%) patients. Older patients who were younger, had more medications, longer stays or more admission, and did not experience surgical operation more likely experienced ADEs. Triggers with PPV less than 5% were eliminated, which resulted in the upgraded version of Chinese geriatric trigger tool of 20 triggers with a PPV of 28.50%. This upgraded tool accounted for 99.66% of all ADEs detected. Conclusions The upgraded version of Chinese geriatric trigger tool was an efficient tool for identifying ADEs in Chinese older patients. Future, the trigger tool could be incorporated into routine screen systems to provide real-time identification of ADEs, thereby enabling timely clinical interventions.
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Affiliation(s)
- Qiaozhi Hu
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
| | - Zhou Qin
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
| | - Mei Zhan
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
- * E-mail: (BW); (TX)
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Chengdu, Sichuan, China
- * E-mail: (BW); (TX)
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