Systematic review of medication safety assessment methods

Abstract

All four medication safety assessment techniques-incident report review, chart review, direct observation, and trigger tool-have different strengths and weaknesses. Overlap between different methods in identifying DRPs is minimal. While trigger tool appeared to be the most effective and labor-efficient method, incident report review best identified high-severity DRPs.

Retrospective Analysis of Opioid Medication Incidents Requiring Administration of Naloxone

“…The second theme accounted for another 6 cases, which were determined to have occurred because of interactions between the opioid administered and patients' health condi- Morphine 5-10 mg IV q3h prn and P 6 ME order was used for several days, then 3 doses of codeine mg PO q4h prn 20 ME order were given within 8 h (n = 1) Two different opioids (both listed as prn orders on MAR) were Case 1: hydromorphone 1-2 mg IV/PO q3h prn P given at the same time (n = 3) and codeine mg PO q4h prn Case 2: codeine 30-60 mg PO q4h prn and morphine 5 mg PO q4h prn Case 3: morphine 2-5 mg IV q1h prn and morphine [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] mg PO q4h prn Previously scheduled opioid order was not stopped when new Hydromorphone SR 3 mg PO q12h and P regimen was initiated (n = 1) hydromorphone 2 mg SC q4h Previously scheduled opioid order was stopped by physician Hydromorphone SR 6 mg PO twice daily and E/T when new regimen was initiated but was still present on fentanyl 37 µg/h patch q72h MAR (n = 1) Theme 2: Interacting health conditions and drugs Morphine/meperidine metabolites accumulated in cases of Case 1: morphine 2.5-5 mg IV q4h prn P renal or liver dysfunction (n = 4)…”

“…8,14,15 Use of trigger tools has been shown to be one of the most efficient and inclusive incident tracking methods available, and antidotes such as naloxone are the most specific markers within the trigger tool method. 8,16 Thus, it is possible to use instances of naloxone administration as a method of identifying opioid incidents not identified through conventional incident tracking methods such as occurrence reporting.…”

“…This degree of overlap is in keeping with a recent systematic review of incident identification methods, which reported that trigger tools and occurrence reports identified the same incident in only 0.5%-10% of cases. 16 The review went on to reveal that occurrence reporting is the method least likely to identify drugrelated problems. 16 Given that occurrence reporting is currently the only incident tracking method available in the acute care centres where this study took place, a more effective process is needed.…”

“…16 The review went on to reveal that occurrence reporting is the method least likely to identify drugrelated problems. 16 Given that occurrence reporting is currently the only incident tracking method available in the acute care centres where this study took place, a more effective process is needed. In previous surveys, reasons for under-reporting among health care providers were uncertainty about what should be reported and who should do the reporting, as well as concerns about implicating colleagues, legal ramifications, and time constraints.…”

“…A recent systematic review reported the trigger tool method (used in this investigation) as the least labour-intensive and the least expensive of all conventional incident-tracking methods. 16 However, the trigger tool method discussed in the systemic review was a fully operationalized, automated process. In hospitals without the technology necessary to track medication administration, a fully automated trigger tool system would not be possible.…”