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Meng X, Wu Y, Liu Z, Chen Y, Dou Z, Wei L. Active monitoring of antifungal adverse events in hospitalized patients based on Global Trigger Tool method. Front Pharmacol 2024; 15:1322587. [PMID: 39005936 PMCID: PMC11239385 DOI: 10.3389/fphar.2024.1322587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/04/2024] [Indexed: 07/16/2024] Open
Abstract
Background The increasing prevalence of fungal infections necessitates broader use of antifungal medications. However, the prevalence of adverse drug events (ADEs) restricts their clinical application. This study aimed to develop a reliable ADEs trigger for antifungals to enable proactive ADEs monitoring, serving as a reference for ADEs prevention and control. Methods This investigation comprises two phases. Initially, the trigger was established via a literature review, extraction of relevant items, and refinement through Delphi expert consultation. Subsequently, the validity of the trigger was assessed by analyzing hospital records of antifungal drug users from 1 January 2019 to 31 December 2020. The correlation between each trigger signal and ADEs occurrence was examined, and the sensitivity and specificity of the trigger were evaluated through the spontaneous reporting system (SRS) and Global Trigger Tool (GTT). Additionally, risk factors contributing to adverse drug events (ADEs) resulting from antifungal use were analyzed. Results: Twenty-one preliminary triggers were refined into 21 final triggers after one expert round. In the retrospective analysis, the positive trigger rate was 65.83%, with a positive predictive value (PPV) of 28.75%. The incidence of ADEs in inpatients was 28.75%, equating to 44.58 ADEs per 100 admissions and 33.04 ADEs per 1,000 patient days. Predominant ADEs categories included metabolic disturbances, gastrointestinal damage, and skin rashes. ADEs severity was classified into 36 cases at grade 1, 160 at grade 2, and 18 at grade 3. The likelihood of ADEs increased with longer stays, more positive triggers, and greater comorbidity counts. Conclusion This study underscores the effectiveness of the GTT in enhancing ADEs detection during antifungal medication use, thereby confirming its value as a monitoring tool.
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Affiliation(s)
- Xiao Meng
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaozhou Wu
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zixuan Liu
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yifan Chen
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhizhou Dou
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li Wei
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Wu S, Yin Q, Wu L, Wu Y, Yu N, Yan J, Bian Y. Establishing a trigger tool based on global trigger tools to identify adverse drug events in obstetric inpatients in China. BMC Health Serv Res 2024; 24:72. [PMID: 38225629 PMCID: PMC10789046 DOI: 10.1186/s12913-023-10449-z] [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: 12/07/2022] [Accepted: 12/06/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Pregnant women belong to the special population of drug therapy, and their physiological state, pharmacokinetics and pharmacodynamics are significantly different from the general population. Drug safety during pregnancy involves two generations, which is a hot issue widely concerned in the whole society. Global Trigger Tool (GTT) of the Institute for Healthcare Improvement (IHI) has been wildly used as a patient safety measurement strategy by several institutions and national programs, and the effectiveness had been demonstrated. But only one study reports the use of GTT in obstetric delivery until now. The aim of the study is to establish triggers detecting adverse drug events (ADEs) suitable for obstetric inpatients on the basis of the GTT, to examine the performance of the obstetric triggers in detecting ADEs experienced by obstetric units compared with the spontaneous reporting system and GTT, and to assess the utility and value of the obstetric trigger tool in identifying ADEs of obstetric inpatients. METHODS Based on a literature review searched in PubMed and CNKI from January of 1997 to October of 2023, retrospective local obstetric ADEs investigations, relevant obstetric guidelines and the common adverse reactions of obstetric therapeutic drugs were involved to establish the initial obstetric triggers. According to the Delphi method, two rounds of expert questionnaire survey were conducted among 16 obstetric and neonatological physicians and pharmacists until an agreement was reached. A retrospective study was conducted to identity ADEs in 300 obstetric inpatient records at the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from June 1 to September 30, 2018. Two trained junior pharmacists analyzed the first eligible records independently, and the included records reviewed by trained pharmacist and physician to identify ADEs. Sensitivity and specificity of the established obstetric triggers were assessed by the number of ADEs/100 patients and positive predictive value with the spontaneous reporting system (SRS) and GTT. Excel 2010 and SPSS22 were used for data analysis. RESULTS Through two rounds of expert investigation, 39 preliminary triggers were established that comprised four modules (12 laboratory tests, 9 medications, 14 symptoms, and 4 outcomes). A total of 300 medical records were reviewed through the obstetric triggers, of which 48 cases of ADEs were detected, with an incidence of ADEs of 16%. Among the 39 obstetric triggers, 22 (56.41%) were positive and 11 of them detected ADEs. The positive predictive value (PPV) was 36.36%, and the number of ADEs/100 patients was 16.33 (95% CI, 4.19-17.81). The ADE detection rate, positive trigger rate, and PPV for the obstetric triggers were significantly augmented, confirming that the obstetric triggers were more specific and sensitive than SRS and GTT. CONCLUSION The obstetric triggers were proven to be sensitive and specific in the active monitoring of ADE for obstetric inpatients, which might serve as a reference for ADE detection of obstetric inpatients at medical institutions.
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Affiliation(s)
- Shan Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Maternal and Child Health Hospital of Shuangliu District, Chengdu, China
| | - Qinan Yin
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liuyun Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yue Wu
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Nan Yu
- Chengdu First People's Hospital, Chengdu, China
| | - Junfeng Yan
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yuan Bian
- Department of Pharmacy, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Augustino M, Rowcliffe M, Feemster A, Smith J, Duncan R. Analysis of medication-related triggers to determine adverse drug events. Eur J Hosp Pharm 2023; 30:92-95. [PMID: 35177534 PMCID: PMC9986914 DOI: 10.1136/ejhpharm-2021-003078] [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: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Voluntary event reporting systems continue to be the most common method used to identify adverse events in most US hospitals; however, this method fails to capture more than 90% of adverse drug events (ADEs). The purpose of this study is to examine which medication-related triggers have the highest positive predictive values (PPV) for detecting ADEs at a large academic medical centre. METHODS A 1-year, single-centre, retrospective quality improvement study was conducted to assess the PPV of four medication-related triggers: flumazenil, naloxone, glucose <70 mg/dL or dextrose 50%. Retrospective chart review was conducted on a random sample of eligible patients to establish if an ADE occurred and determine its preventability. Assessed triggers were also compared against the hospital's voluntary event reporting system to determine whether the events were previously reported. RESULTS A total of 161 triggers were reviewed. PPV values for detection of ADEs were 0.55, 0.58, 0.76 and 0.68 for flumazenil, naloxone, glucose <70 mg/dL and dextrose 50%, respectively. PPV values for detection of preventable ADEs were 0.09, 0.16, 0.32 and 0.34 for flumazenil, naloxone, glucose <70 mg/dL and dextrose 50%, respectively. Of the 107 ADEs identified, three events were reported through the hospital's voluntary event reporting system (2.8%). CONCLUSIONS Trigger tools successfully detected both preventable and non-preventable ADEs. Events detected using trigger tools are unlikely to be reported through voluntary event reporting systems; therefore, trigger tools can serve as a useful adjunct for adverse event detection.
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Affiliation(s)
- Melissa Augustino
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Pharmacy, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Meghan Rowcliffe
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Agnes Feemster
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Jacob Smith
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rosemary Duncan
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Reinhart RM, Safari-Ferra P, Badh R, Bhattarai S, Abera S, Saha A, Herstek J, Shah RK, Parikh K. A Customized Triggers Program: A Children's Hospital's Experience in Improving Trigger Usability. Pediatrics 2023; 151:190495. [PMID: 36660853 DOI: 10.1542/peds.2022-056452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the growth of patient safety programs across the United States, errors and adverse events remain a source of patient harm. Many hospitals rely on retrospective voluntary reporting systems; however, there are opportunities to improve patient safety using novel tools like trigger programs. METHODS Children's National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events. Our team defined a measure to quantify clinical utility of triggers, termed "trigger signal," as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). Our key driver diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness, and supporting multidisciplinary end user engagement. Using the model for improvement, we aimed to double overall trigger signal from 8% to 16% and sustain for 12 months. RESULTS The trigger signal increased from 8% to 41% and sustained during the coronavirus disease 2019 pandemic. A balancing measure of time to implement a new trigger decreased. Key interventions to increase trigger signal were change in the program structure, increasing stakeholder engagement, and development of self-service reports for end users. CONCLUSIONS Children's National Hospital's triggers program highlights successful evolution of an iterative, customized approach to increase clinical utility that hospitals can implement to impact real-time patient care. This triggers program requires an iterative, customized approach rather than a "1-size-fits-all," static paradigm to add a new dimension to current patient safety programs.
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Garzella PMB, Bueno D, Heineck I. Cross-cultural adaptation, validation and reliability of the Medication Safety Thermometer tool for use in Brazil. Rev Bras Enferm 2022; 75:e20210839. [PMID: 35894412 DOI: 10.1590/0034-7167-2021-0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to perform cross-cultural adaptation, face and content validation and reliability analysis of the Medication Safety Thermometer tool for use in Brazil. METHODS the process of cross-cultural adaptation and validation followed the stages of translation, synthesis of translations, back-translation, content validation performed by experts, and face validation through pre-testing. Reliability was determined by calculating the Kappa coefficient. RESULTS the two translated versions were synthesized into a single version, which was back-translated and showed no divergences. The expert committee judged the adapted tool as equivalent, reaching a Content Validity Index higher than 0.8. The mean global understanding was 1.82, demonstrating face validity. The assessed items had Kappa coefficient greater than 0.61, showing agreement between observers. CONCLUSIONS the cross-cultural adaptation of the tool was performed following an established methodology. The adapted tool showed inter-rater reliability and validity for use in Brazil.
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Affiliation(s)
| | - Denise Bueno
- Universidade Federal do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil
| | - Isabela Heineck
- Universidade Federal do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil
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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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Garzella PMB, Bueno D, Heineck I. Adaptação transcultural, validação e confiabilidade da ferramenta Medication Safety Thermometer para uso no Brasil. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0839pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: realizar adaptação transcultural, validação de face e conteúdo e análise da confiabilidade da ferramenta Medication Safety Thermometer para uso no Brasil. Métodos: o processo de adaptação transcultural e validação seguiu as etapas de tradução, síntese das traduções, retrotradução, validação de conteúdo realizada por especialistas e validação de face mediante o pré teste. A confiabilidade foi determinada pelo cálculo do coeficiente de Kappa. Resultados: as duas versões traduzidas foram sintetizadas em uma única versão, que foi retrotraduzida e não demonstrou divergências. O comitê de experts julgou a ferramenta adaptada como equivalente, alcançando Índice de Validade de Conteúdo maior que 0,8. A média de compreensão global foi de 1,82, demonstrando validade de face. Os itens avaliados apresentaram coeficiente de Kappa maior que 0,61, evidenciando concordância entre observadores. Conclusões: a adaptação transcultural da ferramenta foi realizada seguindo metodologia estabelecida. A ferramenta adaptada mostrou confiabilidade entre observadores e validade para utilização no Brasil.
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Affiliation(s)
| | - Denise Bueno
- Universidade Federal do Rio Grande do Sul, 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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Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol 2021; 78:159-170. [PMID: 34611721 PMCID: PMC8748358 DOI: 10.1007/s00228-021-03213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.
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Affiliation(s)
- O Laatikainen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland. .,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.
| | - S Sneck
- Oulu University Hospital, Oulu, Finland
| | - M Turpeinen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland.,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Vaghani V, Wei L, Mushtaq U, Sittig DF, Bradford A, Singh H. Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. J Am Med Inform Assoc 2021; 28:2202-2211. [PMID: 34279630 DOI: 10.1093/jamia/ocab121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/26/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Diagnostic errors are major contributors to preventable patient harm. We validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs). METHODS Using two frameworks, the Safer Dx Trigger Tools Framework and the Symptom-disease Pair Analysis of Diagnostic Error Framework, we applied a symptom-disease pair-based e-trigger to identify patients hospitalized for stroke who, in the preceding 30 days, were discharged from the ED with benign headache or dizziness diagnoses. The algorithm was applied to Veteran Affairs National Corporate Data Warehouse on patients seen between 1/1/2016 and 12/31/2017. Trained reviewers evaluated medical records for presence/absence of missed opportunities in stroke diagnosis and stroke-related red-flags, risk factors, neurological examination, and clinical interventions. Reviewers also estimated quality of clinical documentation at the index ED visit. RESULTS We applied the e-trigger to 7,752,326 unique patients and identified 46,931 stroke-related admissions, of which 398 records were flagged as trigger-positive and reviewed. Of these, 124 had missed opportunities (positive predictive value for "missed" = 31.2%), 93 (23.4%) had no missed opportunity (non-missed), 162 (40.7%) were miscoded, and 19 (4.7%) were inconclusive. Reviewer agreement was high (87.3%, Cohen's kappa = 0.81). Compared to the non-missed group, the missed group had more stroke risk factors (mean 3.2 vs 2.6), red flags (mean 0.5 vs 0.2), and a higher rate of inadequate documentation (66.9% vs 28.0%). CONCLUSION In a large national EHR repository, a symptom-disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.
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Affiliation(s)
- Viralkumar Vaghani
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Li Wei
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Umair Mushtaq
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Dean F Sittig
- University of Texas-Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Andrea Bradford
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Causality assessment of adverse drug reactions by applying a global introspection method in a high complexity hospital. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100064. [PMID: 35480605 PMCID: PMC9032013 DOI: 10.1016/j.rcsop.2021.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/19/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Causality assessment of adverse drug reactions (ADRs) is an essential approach in pharmacovigilance. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) system has been considered one of the most adequate method for establishing causal relationship in hospitalized patients. Objective To describe the causality of potential ADRs in hospitalized patients assessed by the WHO-UMC system and by different healthcare professionals. Methods Three healthcare professionals, with different backgrounds, acted as judges to adjudicate the causality categories for potential ADRs according to WHO-UMC system, in a Brazilian high complexity hospital. Judges' agreement was evaluated by using Fleiss' and Cohen's kappa coefficients. Results Ninety potential ADRs identified in 300 participants were adjudicated by each judge, comprising a total of 270 assessments. Most potential ADRs were classified as probable or possible (77.8%). Fleiss´ kappa revealed slight concordance among judges (k = 0.096;CI:95%;0.01–0.18). Conclusions Diverse backgrounds may have influenced the results for causality assessment of ADRs by employing the WHO-UMC system. Despite the slight concordance found for the method, this result suggests potential opportunity to enrich the ADRs management by engaging multiprofessional teams in the process. Further studies should be considered to investigate the performance of methods for ADRs assessment in hospitalized patients in low- and middle-income countries.
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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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