Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients

Abstract

BackgroundThe extent of outpatient adverse drug events (ADEs) remains unclear. Trigger tools are used as a screening method to identify care episodes that may be ADEs, but their value in a population with high chronic-illness burden remains unclear.MethodsThe authors used six abnormal laboratory triggers for detecting ADEs among adults in outpatient care. Eligible patients were included if they were >18 years, sought primary or urgent care between November 2008 and November 2009 and were prescribed at least one medication. The authors then used the clinical / administrative database to identity patients with these triggers. Two physicians conducted in-depth chart review of any medical records with identified triggers.ResultsThe authors reviewed 1342 triggers representing 622 unique episodes among 516 patients. The trigger tool identified 91 (15%) ADEs. Of the 91 ADEs included in the analysis, 49 (54%) occurred during medication monitoring, 41 (45%) during patient self-administration, and one could not be determined. 96% of abnormal international normalised ratio triggers were ADEs, followed by 12% of abnormal blood urea nitrogen triggers, 9% of abnormal alanine aminotransferase triggers, 8% of abnormal serum creatinine triggers and 3% of aspartate aminotransferase triggers.ConclusionsThe findings imply that other tools such as text triggers or more complex automated screening rules, which combine data hierarchically are needed to effectively screen for ADEs in chronically ill adults seen in primary care.

Development of a standardized chart review method to identify drug‐related hospital admissions in older people

“…Twenty‐three studies on common causes of DRA in older people and 12 trigger tools studies were reviewed . Based on the information from the literature and their own clinical expertise, the research team compiled a preliminary list of 29 triggers and two screening questions for non‐triggered events related to ADR, overuse, underuse or misuse of medications.…”

Performance of trigger tools in identifying adverse drug events in emergency department patients: a validation study

“…Most previous attempts at validating trigger tools have focused on their positive predictive value, the proportion of flagged or trigger positive records containing the outcome of interest [33,35,37,39,41,[43][44][45][46]. This metric is useful in providing an estimate of the yield within the flagged records and enables an estimate of the excess workload generated by false positive flags [35].…”

Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency care: a time series analysis

“…These desirable characteristics have led to the successful development of trigger tools within a variety of disciplines, including general healthcare [7], surgical care [20], primary care [21], intensive care [22], paediatric care [23] as well as pharmacy [24] and laboratory services [25]. However, integrating such a system into regular operation can be a complex task and should be viewed as equally important as the content of the tool itself [11, 12].…”