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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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Schulze C, Toni I, Moritz K, Eberl S, Rascher W, Neubert A. Development and Adjustment of an Algorithm for Identifying Drug-Related Hospital Admissions in Pediatrics. J Patient Saf 2022; 18:421-429. [PMID: 35113507 DOI: 10.1097/pts.0000000000000951] [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 Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drug-related hospital admissions in pediatrics. METHODS A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children's hospital. Subsequently, the tool was further improved by combining different modules as a novel approach. RESULTS The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%-100%) and a specificity of 16.5% (95% CI, 11.9%-21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%-63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%-93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%-32.3%). CONCLUSIONS The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.
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Affiliation(s)
- Christopher Schulze
- From the Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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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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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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Caetano SCRDC, Silva LFED, Guaraldo L, Giordani F. Identifying adverse drug events in patients at a pediatric ward in a Brazilian hospital: application and performance of the triggers. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to evaluate the performance of a trigger tool in identifying adverse drug events (ADE) in hospitalized children. Methods: a retrospective cohort study review on 133 medical records at a federal maternal and child reference hospital in Rio de Janeiro in 2016. A list of 14 triggers was developed to detect ADE in the pediatric population. Three steps were performed: (1) search for triggers; (2) selection of suspected cases of ADE and (3) final determination of ADE by experts’ consensus. Results: 360 triggers were identified in 100 hospitalizations (75.2%), with an average of 2.7 triggers/ hospitalization. The most frequent triggers were “abrupt medication stop” (79.7%); “antiemetics use” (8.9%) and “laxatives use” (7.2%); while the “diphenhydramine use”, “phytomenadione use” and “excessive sedation/lethargy/fall/hypotension” obtained the highest performance indicating ADE every time they occurred. Thirty-one ADE were identified in 12.8% of the hospitalizations; 11 (35.5%) ADE were detected without the aid of the triggers thus, pruritus and diarrhea were the most frequent. Conclusion: the trigger tool proved to be useful in identifying ADE in hospitalized children, especially if high performance and high frequency triggers are used in identifying the events. The inclusion of the triggers “diarrhea” and “pruritus”, may favor the identification of ADE in patients at pediatric wards.
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Menat U, Desai CK, Panchal JR, Shah AN. An evaluation of trigger tool method for adverse drug reaction monitoring at a tertiary care teaching hospital. Perspect Clin Res 2021; 12:33-39. [PMID: 33816207 PMCID: PMC8011521 DOI: 10.4103/picr.picr_30_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/02/2019] [Accepted: 06/21/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives: The objective of this study is to evaluate the trigger tool method (TTM) in detection, monitoring, and reporting of adverse drug reactions (ADRs) at Civil Hospital Ahmedabad, India. Materials and Methods: A prospective, single-center, observational cum intervention study was conducted in two phases in the Department of Medicine over 15 months. In phase I, preliminary trigger tool list (PTTL) comprising 55 triggers was evaluated by pharmacologist in terms of detection of ADR in 400 patients and then, modified trigger tool list (MTTL) was prepared. In Phase II, the TTM using MTTL was compared with the spontaneous method of ADR monitoring after educational interventions in resident doctors of the two units of medicine department. Results: Of the 55 triggers in PTTL, 34 triggers were observed in 327 patients, of which 19 triggers lead to the detection of 66 ADRs. The rate of ADEs was 16.5%/100 patients. Positive predictive value (PPV) of each trigger ranged from 0% to 100%. PPV for drug trigger, laboratory trigger, and PT was 14.4%, 4.5%, and 23.3%, respectively. Overall, PPV of PTTL was 19.27%. Sensitivity and specificity were 100% and 21.66%, respectively. MTTL consists of these 19 triggers. In Phase II, resident doctors reported 16 ADRs, using spontaneous method and 23 ADRs using MTTL. The rate of ADEs per 100 patients was 1.63 and 2.13, respectively, with these methods. A total of 105 ADRs were reported during both phases. Conclusion: TTM is an effective method of ADR reporting if it is utilized by a trained person. This method could be used as add-on method to spontaneous method to improve ADR reporting.
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Affiliation(s)
- Urmila Menat
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - Chetna K Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - Jigar R Panchal
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - Asha N Shah
- Department of Medicine, GCS Medical College, Ahmedabad, Gujarat, India
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Sahilu T, Getachew M, Melaku T, Sheleme T. Adverse Drug Events and Contributing Factors Among Hospitalized Adult Patients at Jimma Medical Center, Southwest Ethiopia: A Prospective Observational Study. Curr Ther Res Clin Exp 2020; 93:100611. [PMID: 33296443 PMCID: PMC7689274 DOI: 10.1016/j.curtheres.2020.100611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background Adverse drug events (ADEs) are common complications of clinical care resulting in significant morbidity, mortality, and high clinical expenditure. Population-level estimates of inpatient ADEs are limited in Ethiopia. Objective This study aimed to assess the incidence, contributing factors, severity, and preventability of ADEs among hospitalized adult patients at Jimma Medical Center, Ethiopia. Methods A prospective observational study design was conducted among hospitalized adult patients at tertiary hospital in Ethiopia. A structured data collection tool was prepared from relevant literatures for data collection. Data were analyzed using statistical software. Logistic regression was performed to identify factors contributing to ADE occurrence. P values < 0.05 were considered statistically significant. Results A total of 319 patients were included with follow-up period of 5667 person-days. About 50.5% were women. The mean (SD) age of patients was 43 (17.6) years. One hundred sixteen ADEs were identified with the incidence of 36.4 (95% CI, 30.1-43.6) per 100 admissions and 20.5 (95% CI, 16.9-24.6) per 1000 person-days. Antituberculosis agents (adjusted odds ratio [aOR] = 2.52; 95% CI, 1.06-5.98; P = 0.036), disease of the circulatory system (aOR = 2.67; 95% CI, 1.46-4.89; P = 0.001), disease of the digestive system (aOR = 2.84; 95% CI, 1.45-5.57; P = 0.002), being on medication during admission (aOR = 3.09; 95% CI, 1.77-5.41; P < 0.001), and hospital stay more than 2 weeks (aOR = 3.93; 95% CI, 1.39-11.12; P = 0.010) were independent predictors of ADE occurrence. Conclusions One in every 4 patients admitted to the hospital experienced ADEs during their hospital stay. Most ADEs were moderate in severity. About two-thirds of the ADEs identified were deemed probably or definitely preventable. Therefore, it is high time to reinforce large-scale efforts to redesign safer, higher quality health care systems to adequately tackle the problem.
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Affiliation(s)
- Tamiru Sahilu
- Department of Pharmacy, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Mestawet Getachew
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tadesse Sheleme
- Department of Pharmacy, College of Public Health and Medical Science, Mettu University, Metu Zuria, Ethiopia
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Bradbury J, Avila C, Grace S. Practice-Based Research in Complementary Medicine: Could N-of-1 Trials Become the New Gold Standard? Healthcare (Basel) 2020; 8:E15. [PMID: 31936355 PMCID: PMC7151123 DOI: 10.3390/healthcare8010015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Complementary medicines and therapies are popular forms of healthcare with a long history of traditional use. Yet, despite increasing consumer demand, there is an ongoing exclusion of complementary medicines from mainstream healthcare systems. A lack of evidence is often cited as justification. Until recently, high-quality evidence of treatment efficacy was defined as findings from well-conducted systematic reviews and meta-analyses of randomized controlled trials. In a recent and welcome move by the Oxford Centre for Evidence-Based Practice, however, the N-of-1 trial design has also been elevated to the highest level of evidence for treatment efficacy of an individual, placing this research design on par with the meta-analysis. N-of-1 trial designs are experimental research methods that can be implemented in clinical practice. They incorporate much of the rigor of group clinical trials, but are designed for individual patients. Individualizing treatment interventions and outcomes in research designs is consistent with the movement towards patient-centered care and aligns well with the principles of holism as practiced by naturopaths and many other complementary medicine practitioners. This paper explores whether rigorously designed and conducted N-of-1 trials could become a new 'gold standard' for demonstrating treatment efficacy for complementary medicine interventions in individual patients in clinical practice.
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Affiliation(s)
- Joanne Bradbury
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD 4225, Australia
| | - Cathy Avila
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia; (C.A.); (S.G.)
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia; (C.A.); (S.G.)
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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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Varallo FR, Dagli-Hernandez C, Pagotto C, de Nadai TR, Herdeiro MT, de Carvalho Mastroianni P. Confounding Variables and the Performance of Triggers in Detecting Unreported Adverse Drug Reactions. Clin Ther 2017; 39:686-696. [DOI: 10.1016/j.clinthera.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
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Birriel TJ, Uchino R, Barry N, Butryn T, Sabol DM, Valenza PL, Stawicki SP. Adverse drug reactions in the era of multi-morbidity and polypharmacy. J Basic Clin Pharm 2015; 6:122-3. [PMID: 26692740 PMCID: PMC4660485 DOI: 10.4103/0976-0105.168052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- T Javier Birriel
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Reina Uchino
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Noran Barry
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Tracy Butryn
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Donna M Sabol
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Pamela L Valenza
- St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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