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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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Luiz RB, Raponi MBG, Pires PDS, Cantarino MSG, Barbosa MH. Educational video for teaching safe practices in the perioperative period: randomized controlled trial. Rev Lat Am Enfermagem 2024; 32:e4152. [PMID: 38865554 DOI: 10.1590/1518-8345.6878.4152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/25/2023] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE to assess the effectiveness of an educational video on hospitalized patients' knowledge of safe practices in the perioperative period. METHOD randomized, double-blind controlled trial carried out in a teaching hospital in the countryside of Minas Gerais. 100 participants undergoing elective orthopaedic surgery were randomly allocated (50 participants in the experimental group and 50 participants in the control group). Patient knowledge was assessed using a questionnaire constructed by the researchers and validated by specialists, before and after the intervention (educational video) or standard guidelines were applied. Descriptive statistics were used for quantitative variables and Student's t-test for independent samples to analyze the mean difference in knowledge between the experimental and control groups (α = 0.05). RESULTS 100 participants took part in the study, 50 participants in the experimental group and 50 participants in the control group. The experimental group showed a significantly higher gain in knowledge (t =3.72 ±1.84; p<0.001) than the control group. Cohen's d was 1.22, indicating a large magnitude of the effect. CONCLUSION the educational video was effective in improving patients' knowledge and can contribute to nurses in the practice of health education, optimizing time and disseminating knowledge about safe practices in the perioperative period. Brazilian Registry of Clinical Trials (REBEC): RBR-8x5mfq. (1) Development of a valid patient knowledge assessment questionnaire. (2) Production of a valid educational video on perioperative safety. (3) The final version of the educational video is 7 minutes and 50 seconds long. (4) The educational video was effective in improving patient knowledge. (5) It contributes to patient involvement in safe care.
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Affiliation(s)
| | | | - Patrícia da Silva Pires
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, BA, Brazil
| | | | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Schmied M, Buchberger W, Perkhofer D, Kvitsaridze I, Brunner W, Kapferer O, Siebert U. Detection of Adverse Events With the Austrian Inpatient Quality Indicators. J Patient Saf 2024:01209203-990000000-00227. [PMID: 38771664 DOI: 10.1097/pts.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
OBJECTIVES Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). METHODS We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. RESULTS In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. CONCLUSIONS Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.
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Affiliation(s)
| | - Wolfgang Buchberger
- Research Unit for Quality and Efficiency in Medicine, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol
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Xu X, Xie L, Wei L, Li M, Wang H, Zhou H, Sun M, Yang M, Xu Q, Yang K, Wei S. Efficacy and safety of monoclonal antibodies in neuromyelitis optica spectrum disorders: A survival meta-analysis of randomized controlled trials. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100064. [PMID: 37846287 PMCID: PMC10577852 DOI: 10.1016/j.aopr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2023]
Abstract
Background Monoclonal antibodies such as rituximab (RTX), eculizumab, inebilizumab, satralizumab, and tocilizumab have been found to be effective therapies for neuromyelitis optica spectrum disease (NMOSD) in several clinical randomized controlled trials. Objective The purpose of this meta-analysis of randomized controlled trials was to assess the efficacy and safety of monoclonal antibodies in the treatment of NMOSD. Methods We searched the following databases for relevant English language literature from the establishment of the database to June 2021: PubMed, Embase, Cohorane Library, the Central Register of Controlled Trials (CENTRAL), and Web of Science. Randomized controlled trials of monoclonal antibodies were the targets of the review. Results We included seven trials containing 775 patients (485 in the monoclonal antibody group and 290 in the control group). Patients in the monoclonal group (HR 0.24, 95% CI: 0.14 to 0.40, P < 0.00001), as well as patients with seropositive AQP4-IgG (HR 0.18, 95% CI: 0.11 to 0.29, P < 0.00001), both had a higher free recurrence rate than that in the control group. In the first year (HR 0.25, 95% CI: 0.09 to 0.71, P = 0.009) and the second year (HR 0.32, 95% CI: 0.13 to 0.81, P = 0.02), no relapses were documented. The average changes of the expanded disability status scale (EDSS) score decreased by 0.29 (95% CI: -0.09 to 0.51, P = 0.005). Upper respiratory tract infection (OR 1.52, 95% CI: 0.76 to 3.04, P = 0.24), urinary tract infection(OR 0.79, 95% CI: 0.51 to 1.21, P = 0.27), and headache (OR 1.30, 95% CI: 0.78 to 2.17, P = 0.31) were three most frequent adverse reactions. Conclusions Monoclonal antibodies are particularly effective treatments in avoiding recurrence for NMOSD patients, according to this meta-analysis. The associated adverse responses are not significantly different from those seen with traditional immunosuppressants.
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Affiliation(s)
- Xintong Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lindan Xie
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lili Wei
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Hao Wang
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, China
| | - Huanfen Zhou
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mo Yang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
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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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Eggenschwiler LC, Rutjes AWS, Musy SN, Ausserhofer D, Nielen NM, Schwendimann R, Unbeck M, Simon M. Variation in detected adverse events using trigger tools: A systematic review and meta-analysis. PLoS One 2022; 17:e0273800. [PMID: 36048863 PMCID: PMC9436152 DOI: 10.1371/journal.pone.0273800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. Objective This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Design Systematic review and meta-analysis. Methods To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Results Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9–37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4–164.7. Overall studies’ risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Conclusion Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.
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Affiliation(s)
- Luisa C. Eggenschwiler
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W. S. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sarah N. Musy
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- College of Health Care-Professions Claudiana, Bozen-Bolzano, Italy
| | - Natascha M. Nielen
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- * E-mail:
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Alpendre FT, Cruz EDDA, Batista J, Maziero ECS, Brandão MB. Translation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module. Rev Bras Enferm 2022; 75:e20210859. [PMID: 35858031 DOI: 10.1590/0034-7167-2021-0859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to translate, cross-culturally adapt and validate the Global Trigger Tool surgical module content for Brazil. METHOD this is methodological research, carried out between March/2018 and February/2019, following the steps of translation, synthesis, back-translation, validation by the Delphi technique, pre-test and presentation to developers. Two translators, two back-translators, six professionals participated in the expert committee. A pre-test was carried out with a retrospective analysis of 244 medical records of adult patients. The content validity index and Cronbach's alpha were determined for data analysis. RESULTS the translation and cross-cultural adaptation allowed adjustments of items for use in Brazil. The mean Content Validity Index was 1.38, and the degree of agreement among experts was 92.4%. Cronbach's alpha was 0.83 for the 11 surgical triggers and their guidelines. CONCLUSION the module was translated, cross-culturally adapted for Brazil, with high reliability to identify surgical adverse events.
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Marseau F, Prud'Homm J, Bouzillé G, Polard E, Oger E, Somme D, Osmont MN, Scailteux LM. The Trigger Tool Method for Routine Pharmacovigilance: A Retrospective Cohort Study of the Medical Records of Hospitalized Geriatric Patients. J Patient Saf 2022; 18:e393-e400. [PMID: 33949842 DOI: 10.1097/pts.0000000000000820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The main objective was to assess the feasibility of the trigger tool method for the retrospective detection of adverse drug reactions (ADRs) in the Rennes University Hospital. The secondary objective was to describe the performance of the method in terms of positive predictive values (PPVs) and severity or preventability of ADRs. METHODS Using the Rennes University Hospital clinical data warehouse, pharmacovigilance experts performed a retrospective review of a random sample of 30 inpatient hospital medical records per month using the triggers "fall" and "delirium" to identify related ADRs among patients 65 years and older in 2018 in the geriatrics department. Using the Z test, we compared the proportion of medical records with a positive (identified) trigger related to an ADR, which were reviewed within 20 minutes using the reference of 50% reviewed within 20 minutes. RESULTS Among the 355 medical records reviewed, 222 had at least 1 trigger and 98 at least 1 related ADR. Among the 222 positive trigger medical records, 99.6% were reviewed in under 20 minutes (P < 0.001). The pharmacovigilance assessment took 3 months. The PPVs reached 53.9% (46.0%-61.7%) for falls and 21.0% (14.3%-27.5%) for delirium. Among the ADRs, 80% were serious and 53% were preventable. CONCLUSIONS Given the low PPV of the triggers used and the considerable need for technical and human resources, the trigger tool method cannot be used as a routine tool at the pharmacovigilance center. However, it could be implemented occasionally for specific purposes such as monitoring the impact of risk minimization measures to prevent ADRs.
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Affiliation(s)
- Floriane Marseau
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | | | | | - Elisabeth Polard
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | | | | | - Marie-Noëlle Osmont
- From the Pharmacovigilance, Pharmacoepidemiology, and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
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Alpendre FT, Cruz EDDA, Batista J, Maziero ECS, Brandão MB. Tradução, adaptação transcultural e validação de conteúdo do módulo cirúrgico do Global Trigger Tool. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0859pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: traduzir, adaptar transculturalmente e validar o conteúdo do módulo cirúrgico do Global Trigger Tool para o Brasil. Método: pesquisa metodológica, realizada entre março/2018 e fevereiro/2019, seguindo os passos de tradução, síntese, retrotradução, validação pela técnica Delphi, pré-teste e apresentação para os desenvolvedores. Participaram dois tradutores, dois retrotradutores, seis profissionais para o comitê de especialistas. Realizou-se o pré-teste com análise retrospectiva de 244 prontuários de pacientes adultos. Determinou-se o índice de validade de conteúdo e alfa de Cronbach para análise dos dados. Resultados: a tradução e a adaptação transcultural permitiram ajustes dos itens para uso no Brasil. O Índice de Validade de Conteúdo médio foi 1,38, e grau de concordância entre os especialistas, 92,4 %. O alfa de Cronbach foi 0,83 para os 11 triggers cirúrgicos e respectivas orientações. Conclusão: o módulo foi traduzido e adaptado transculturalmente para o Brasil, com alta confiabilidade para identificar eventos adversos cirúrgicos.
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Ortner J, Vives A, Moya D, Torres M, Grau N, Farrús X, Manzanera R, Mira JJ. [Use of the Trigger Tool to detect security incidents in an occupational mutual insurance company in Spain]. J Healthc Qual Res 2021; 37:125-126. [PMID: 34598905 DOI: 10.1016/j.jhqr.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - A Vives
- MC Mutual, Barcelona, España
| | - D Moya
- MC Mutual, Barcelona, España
| | | | - N Grau
- MC Mutual, Barcelona, España
| | | | | | - J J Mira
- Universidad Miguel Hernández, Elche, Alicante, España; Departamento de Salud de Alicante-Sant Joan, Alicante, España
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Kaibel Val R, Ruiz López P, Pérez Zapata AI, Gómez de la Cámara A, de la Cruz Vigo F. [Detection of adverse events in thyroid and parathyroid surgery using trigger tool and Minimum Basic Data Set (MBDS)]. J Healthc Qual Res 2020; 35:348-354. [PMID: 33115613 DOI: 10.1016/j.jhqr.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/28/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the ability of the trigger tool) and the Minimum Basic Data Set (MBDS) in detecting adverse events (AE) in hospitalized surgical patients with thyroid and parathyroid disease. METHODS A descriptive, cross-sectional observational study, retrospective and cross-sectional study was conducted from May 2014 to April 2015 analysing retrospectively data on of patients submitted to thyroidectomy and parathyroidectomy in order to detect AE through the identification of triggers (an event often associated to an AE) and the MBDS. triggers and AE were located by systematic review of clinical documentation. The MBDS was got from the data base. Once an AE was detected, it was characterized. RESULTS 203 AE were identified in 251 patients, being the 90.04% detected by trigger tool and 10.34% by MBDS. 126 patients had at least one AE (50.2%). Without the cases in which uncontrolled pain was the only AE, the percentage of patients that suffering AE was 38.65%. 187 AE were considered preventable and 16 AE were considered unpreventable. The trigger tool and the MBDS demonstrated a sensitivity of 91.27 and 13.49%, a specificity of 4.8 and 100%, a positive predictive value of 49,15 and 100%, and a negative predictive value of 35.29 and 53.42%, respectively. The triggers with more predictive power in AE detection were «antiemetic administration» and «calcium administration». CONCLUSIONS Trigger tool shows higher sensitivity for detecting AE than the MBDS. All the detected AE were considered low severity and most of them were preventable.
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Affiliation(s)
| | - P Ruiz López
- Unidad de Calidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - A I Pérez Zapata
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España.
| | - A Gómez de la Cámara
- Unidad de Apoyo a la Investigación, Hospital Universitario 12 de Octubre, Madrid, España
| | - F de la Cruz Vigo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
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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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Batista J, Silva DPD, Cruz EDDA. IMPLEMENTATION AND PERFORMANCE OF TRACKERS FOR THE DETECTION OF SURGICAL ADVERSE EVENTS. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0163] [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
ABSTRACT Objective: to identify the frequency and performance of the Canadian Adverse Events Study tracking criteria for the confirmation of surgical adverse events in adult patients. Method: a descriptive and retrospective study conducted in a public hospital in the state of Paraná from May to November 2017. A retrospective review of 192 medical records was conducted using 16 tracking criteria; and the confirmation of adverse events was in charge of a committee of experts composed of a physician and nurses. Data was analyzed by means of descriptive statistics. Results: the mean performance of the trackers was 73.3%. A total of 70 trackers were confirmed in 21.8% of the medical records with adverse events. The mean number of trackers was 0.4 per medical record (varying from zero to three). Adverse reaction to the medication; unplanned return to the operating room; unplanned removal, injury or correction of an organ or structure during surgery or invasive procedure; cardiopulmonary arrest reversed and hospital infection/sepsis were classified as high performance trackers (100.0%). Eight trackers did not contribute to the identification of adverse events. Conclusion: high-performance trackers can assist in detecting adverse events; there is potential to improve the tracking tool, contributing to its performance as a research method in Brazilian hospitals.
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Development of a trigger tool for the detection of adverse drug events in Chinese geriatric inpatients using the Delphi method. Int J Clin Pharm 2019; 41:1174-1183. [PMID: 31254152 DOI: 10.1007/s11096-019-00871-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 06/20/2019] [Indexed: 02/05/2023]
Abstract
Background The global trigger tool is a method of retrospective medical record review that identifies possible harm in hospitalized patients using "triggers". Elderly patients with multiple co-morbid illnesses are especially vulnerable to adverse drug events (ADEs) that have high prevalence rates. Objective The purpose of this study was to develop an appropriate trigger tool to detect ADEs in Chinese geriatric inpatients by combining a literature review with the Delphi method. Setting Chinese geriatric inpatients. Methods Two steps were used to develop the trigger tool. First, we conducted a comprehensive literature review for existing ADE triggers (adult or elderly) to form the initial triggers for the Delphi process. Second, a group of clinical experts, including physicians, clinical pharmacists and nurses, was established to score candidate triggers for utility according to the usefulness and feasibility of implementing triggers in clinical practice. Main outcome measures The frequency of the full mark, arithmetic mean and coefficient of variation of each trigger. Results An initial set of 51 triggers was selected by literature review for evaluation. The group of experts was composed of 18 clinical experts: 13 physicians, 4 clinical pharmacists, and 1 nurse. Based on the two-phase Delphi process, 42 triggers in five categories (laboratory index, plasma concentration, antidotes, clinical symptoms and intervention) were retained. Conclusion The 42-trigger tool was developed to identify ADEs in Chinese geriatric inpatients. A pilot study that tests the list of triggers to identify ADEs in Chinese geriatric inpatients is the next step for establishing a specific trigger tool for Chinese geriatric inpatients.
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