Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals

Abstract

Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations.

Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

“…23 Our work builds on the IHI GTT as well as multiple pediatric trigger tools. [7][8][9][10] To our knowledge, no previous adult or pediatric study has conducted the detailed trigger-by-trigger analysis we conducted, leading to a robustly scrutinized set of manual and automatable triggers. This process and the resulting components of GAPPS may be informative in future efforts to refine adult, as well as pediatric, tools.…”

“…[8][9][10][11][12][13][14] In addition, we spoke with trigger developers, including those who developed PACHMT and the IHI GTT, to identify any additional triggers and inform GAPPS development. 7 From our review, we compiled a list of 78 candidate triggers for possible inclusion in GAPPS; this list of candidate triggers was compiled by the GAPPS team with input from the developers of PACHMT.…”

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

“…20 Any patients who were admitted for rehabilitation, to the normal newborn nursery, to day treatment areas, or with a primary discharge diagnosis related to psychiatric or obstetric care were excluded as is consistent with earlier study designs. [12][13][14][15][16][17] A random sample of 100 patients who met the inclusion criteria was selected from each site for review. Institutional review board waiver or approval for this study was granted at each site.…”

“…2,[6][7][8][9][10][11] These efforts have reinforced the perspective that the trigger tool approach is at present the most reliable and consistent harm detection method. 3,7,10 Although the IHI GTT was designed for the adult population, 1 children's hospital tested it on its pediatric inpatient records and identified [13][14][15][16][17] However, a single, pediatric-specific detection tool that can be applied across all settings, analogous to the IHI's GTT, has not been available. Until a comprehensive standard harm measure is established in pediatrics, improvement efforts will continue to focus on a fraction of the harm that occurs to patients, leaving countless harms within the system unrecognized and unaddressed.…”

Medication Reconciliation in the Pediatric Emergency Room

“…This process encompasses five steps: (1) make a list of current home medications; (2) develop a list of medications that will be prescribed; (3) the two lists should then be compared; (4) clinical decisions should be made based on the comparison; and (5) this new list should be conveyed to health professional and patient. 4 A recent study conducted in outpatient pediatrics evaluated the implementation of an organized process to improve medication reconciliation. This trial reviewed over 2.7 million visits over a five year period and showed an improvement in documentation of medication reconciliation, satisfying the goal of patient safety.…”