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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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El Saghir A, Dimitriou G, Scholer M, Istampoulouoglou I, Heinrich P, Baumgartl K, Schwendimann R, Bassetti S, Leuppi-Taegtmeyer A. Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital. Drug Healthc Patient Saf 2021; 13:251-263. [PMID: 34992466 PMCID: PMC8713708 DOI: 10.2147/dhps.s334987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs. METHODS We performed an investigator-driven, single-center study using retrospective and prospective patient data to develop ("development phase") and implement ("implementation phase") an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers ("e-trigger-tool") while Tool B employed an additional manually extracted trigger. The superior tool - taking efficiency into account - was applied prospectively to 19-22 randomly chosen charts per month for 26 months during the implementation phase. RESULTS In the development phase, 189 (19%) patients had ≥1 ADE (total 277 ADEs). The time needed to identify these ADEs was 15 minutes/chart. A total of 203 patients had ≥1 trigger (total 273 triggers - Tool B). The sensitivities and specificities of Tools A and B were 0.41 and 0.86, and 0.43 and 0.86, respectively. Tool A was more time-efficient than Tool B (4 vs 9 minutes/chart) and was therefore used in the implementation phase. During the 26-month implementation phase, 22 patients experienced trigger-identified ADEs and 529 did not. The median number of ADEs per 1000 patient days was 6 (range 0-13). Patients with at least one ADE had a mean hospital stay of 22.3 ± 19.7 days, compared to 8.0 ± 7.6 days for those without an ADE (p = 2.7×10-14). CONCLUSION We developed and implemented an e-trigger tool that was specific and moderately sensitive, gave consistent results and required minimal resources.
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Affiliation(s)
- Amina El Saghir
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Georgios Dimitriou
- Division of Internal Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Miriam Scholer
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - Ioanna Istampoulouoglou
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Patrick Heinrich
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - Klaus Baumgartl
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - René Schwendimann
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Anne Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
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Potential Adverse Drug Events and Nephrotoxicity Related to Prophylaxis With Omeprazole for Digestive Disorders: A Prospective Cohort Study. Clin Ther 2019; 40:973-982. [PMID: 29759903 DOI: 10.1016/j.clinthera.2018.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to assess whether prophylaxis for digestive disorders with omeprazole is a risk factor for adverse drug events (ADEs) and kidney impairment. METHODS This was a 9-month, prospective, double-blinded cohort study performed in a Brazilian public hospital. All inpatients 18 years or older admitted during the period of data collection were divided into 2 cohorts. The first group comprised 200 patients receiving prophylaxis for digestive disorders with omeprazole. A total of 54 inpatients who received treatment with omeprazole and whose indication was not approved by the Brazilian Sanitary Agency and the US Food and Drug Administration were excluded. The second group comprised 219 inpatients without a prescription for omeprazole. Follow-up was performed until discharge and included assessment of medical records, medical prescriptions, laboratory data, and pharmaceutical anamnesis. The primary end point was kidney impairment. The variables monitored were kidney function (serum creatinine and urea levels as well as glomerular filtration rate), hepatic function (alanine aminotransferase and aspartate aminotransferase levels), pharmacotherapy, magnesium levels, and imputation of ADEs. With the aid of algorithms of World Health Organization and the National Coordinating Council for Medication Error Reporting and Prevention, we assessed the causality of adverse drug reactions (ADRs) and the seriousness of medication errors (ADEs), respectively. FINDINGS Prophylaxis for digestive disorders with omeprazole (P = 0.019) and sex (P = 0.010) were considered risk factors for increased serum creatinine level via multivariate logistic regression even with concomitant use of nephrotoxic drugs (P = 0.252). Six ADEs related to omeprazole were identified: 2 ADRs (1 possible and 1 definite), 2 medication errors (nonserious), 1 therapeutic failure, and 1 drug-drug interaction. IMPLICATIONS Prophylaxis for digestive disorders with omeprazole and male sex may contribute to the development of kidney impairment because both result in increased serum creatinine levels. Therefore, pharmacotherapeutic follow-up of male patients diagnosed with kidney disorders should be considered to identify potential drug-drug interactions early. This follow-up can prevent worsening clinical conditions and/or contraindicate prophylactic use of omeprazole. ClinicalTrials.gov identifier: NCT02278432.
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Varallo FR, Lucchetta RC, Forgerini M, Mastroianni PDC. What would be a trigger tool with better performance for detecting drug-induced hyperkalemia? SAO PAULO MED J 2019; 137:386-387. [PMID: 31531593 PMCID: PMC9744011 DOI: 10.1590/1516-3180.2019.0081050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fabiana Rossi Varallo
- PhD. Pharmacist and Professor, Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Rosa Camila Lucchetta
- PhD. Pharmacist, Department of Pharmacy, Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil
| | - Marcela Forgerini
- BSc. Doctoral Student and Pharmacist, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil
| | - Patricia de Carvalho Mastroianni
- PhD. Pharmacist and Adjunct Professor, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil
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Varallo FR, Passos AC, Nadai TRD, Mastroianni PDC. Incidents reporting: barriers and strategies to promote safety culture. Rev Esc Enferm USP 2018; 52:e03346. [PMID: 30304197 DOI: 10.1590/s1980-220x2017026403346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting. METHOD Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled. RESULTS Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report. CONCLUSION Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety.
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Affiliation(s)
- Fabiana Rossi Varallo
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Campus Araraquara, Araraquara, SP, Brazil
| | - Aline Cristina Passos
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Campus Araraquara, Araraquara, SP, Brazil
| | - Tales Rubens de Nadai
- Hospital Estadual Américo Brasiliense, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Silva MDDG, Martins MAP, Viana LDG, Passaglia LG, de Menezes RR, Oliveira JADQ, da Silva JLP, Ribeiro ALP. Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study. Br J Clin Pharmacol 2018; 84:2252-2259. [PMID: 29874704 PMCID: PMC6138496 DOI: 10.1111/bcp.13665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS Adverse drug events (ADEs) can seriously compromise the safety and quality of care provided to hospitalized patients, requiring the adoption of accurate methods to monitor them. We sought to prospectively evaluate the accuracy of the triggers proposed by the Institute for Healthcare Improvement (IHI) for identifying ADEs. METHODS A prospective study was conducted in a public university hospital in 2015 with patients over the age of 18. Triggers proposed by IHI and clinical alterations suspected to be ADEs were searched daily. The number of days in which the patient was hospitalized was considered as unit of measure to evaluate the accuracy of each trigger. RESULTS A total of 300 patients were included in this study. Mean age was 56.3 years (standard deviation (SD) 16.0), and 154 (51.3%) were female. The frequency of patients with ADEs was 24.7% and with at least one trigger was 53.3%. From those patients who had at least one trigger, the most frequent triggers were antiemetics (57.5%) and 'abrupt medication stop' (31.8%). The sensitivity of triggers ranged from 0.3 to 11.8% and the positive predictive value ranged from 1.2 to 27.3%. Specificity and negative predictive value were greater than 86%. Most patients identified by the presence of triggers did not have ADEs (64.4%). No triggers were identified in 40 (38.5%) ADEs. CONCLUSIONS IHI Trigger Tool did not show good accuracy in detecting ADEs in this prospective study. The adoption of combined strategies could enhance effectiveness in identifying patient safety flaws. Further discussion might contribute to improve trigger usefulness in clinical practice.
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Affiliation(s)
- Maria das Dores Graciano Silva
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Maria Auxiliadora Parreiras Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de FarmáciaUniversidade Federal de Minas GeraisAv. Pres. Antônio Carlos, 6627, PampulhaBelo HorizonteMinas Gerais31270‐901Brazil
| | - Luciana de Gouvêa Viana
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Luiz Guilherme Passaglia
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Renata Rezende de Menezes
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - João Antonio de Queiroz Oliveira
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Jose Luiz Padilha da Silva
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
| | - Antonio Luiz Pinho Ribeiro
- Hospital das ClínicasUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 110, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisAv. Prof. Alfredo Balena, 190, Santa EfigêniaBelo HorizonteMinas Gerais30130‐100Brazil
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Shader RI. Risk Evaluation and Mitigation Strategies (REMS), Pemoline, and What Is a Signal? Clin Ther 2017; 39:665-669. [DOI: 10.1016/j.clinthera.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
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Risk Communication in a Pharmacovigilance Environment. Clin Ther 2017; 39:672-674. [DOI: 10.1016/j.clinthera.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 11/22/2022]
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