Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool

Abstract

The measurement and examination of adverse events (AEs) that occur in children during hospital admissions is essential if we are to prevent, reduce or ameliorate the harm experienced. The UK Paediatric Trigger Tool (UKPTT) is a method of retrospective case note review that measures harm in hospitalised children.ObjectivesTo examine the harm resulting from the processes of healthcare in hospitalised children from centres providing data to the National Health Service (NHS) Institute UKPTT data portal, to understand the positive predictive values of triggers and to make recommendations for the further development of the trigger tool.Setting25 hospitals across the UK, including secondary, tertiary and quaternary paediatric centres.ParticipantsRandomly selected children who were admitted to hospital for longer than 24 h.Outcome measuresThe primary outcome measure was the rate of harm (the percentage of children experiencing one or more AEs during a hospital admission). Secondary measures were the severity of harm and performance of triggers.ResultsData from 3992 patient admissions were reviewed across the hospitals and submitted to the trigger tool portal from February 2008 to November 2011. At least one AE was reported for 567 (14.2%) patients, with 211 (5.3%) experiencing more than one event. There were 1001 AEs identified. Where harm occurred, it was considered temporary for 923 (92.2%) AEs; however, 43 (4.3%) AEs resulted in the need for life-sustaining interventions, 18 (1.8%) AEs led to permanent harm and for 17 children (1.7% of AEs) the AE was believed to have contributed to death.ConclusionsThere is a significant, measurable level of harm experienced by children admitted to hospitals in the UK. While most of this harm is temporary, some of it is serious. The UKPTT offers organisations the means to measure and examine the AEs occurring in their hospital in order to reduce harm.

Establishment of a Pediatric Trigger Tool Based on Global Trigger Tool to Identify Adverse Drug Events of Children: Experience in a Chinese hospital

“…The data in NADRMS showed that, in Sichuan Provincial People's Hospital, only 2 cases of pediatric ADR/ADE were reported from January 1 to September 30, 2017. The rate of positive triggers, PPV and ADE detection rate in our research, were higher than many previous studies which used trigger tools to detect pediatric ADE [7][8][9][10][11][12][13][14][15][16][17]36].…”

“…45 literatures were retrieved through the literature search process, and 11 of them were in accordance with the inclusive criteria[7][8][9][10][11][12][13][14][15][16][17] . The quality level of one literature was grade B (score 5.5)[17] , and the other 10 were grade A (score 6 to 7)[7][8][9][10][11][12][13][14][15][16] . The included literatures which detected ADEs in pediatric inpatients by trigger tools were from Canada, Britain, United States, Australia, Sweden, Netherlands and China.…”

Top 10 Interventions in Paediatric Patient Safety

“…Some have been adapted to specific paediatric settings and patient groups while others have focused on general (global) care. Trigger tools are designed and weighted towards the identification of common causes of harm, but they may also pick up other causes when broad definitions of harm are used [6]. What is emerging from the application of trigger tools is how frequently harm occurs in the paediatric inpatient hospital setting.…”

“…Measuring harm locally is important so that improvement efforts to reduce it can be guided and verified; however, these data can also be pooled to create a big picture view [6]. Other sources of big data include collaborative improvement networks that use multisite data to drive state-wide safety initiatives [12•].…”

Building a Culture of Safety in Pediatrics and Child Health

“…Pediatric trigger tools have been found to be more effective than traditional incident management systems [3••, 4,33,34]. In the UK, the UK Pediatric Trigger Tool (UKPTT) has been developed as a way to measure harm in admitted pediatric patients [35]. The study, although retrospective, showed that there is a significant and measurable level of harm occurring to pediatric patients in the UK.…”