Testing a trigger tool as a method of detecting harm from medication errors in a UK hospital: a pilot study

Franklin, Bryony Dean; Birch, Sylvia; Schachter, Mike; Barber, Nick

doi:10.1111/j.2042-7174.2010.00058.x

Cited by 54 publications

(64 citation statements)

References 22 publications

(61 reference statements)

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“…A recent study from the United Kingdom reported that the Global Trigger Tool has a limited ability to detect medical errors and may not be an attractive alternative to record review. 22 There is a consensus that no "gold standard" exists for the detection and classification of medical errors. The selected approach is often determined by the users' constraints and purposes.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have compared the 3 main methods of detecting medical errors: voluntary reporting of sentinel events as mandated by oversight bodies, the commonly used AHRQ' s Patient Safety Indicators or other methods based on administrative discharge ICD-CM codes, and the newer Global Trigger Tool that uses specific methods for reviewing medical charts that lead to further investigation to confirm medical errors. [21][22][23][24] Voluntary reporting and administrative databases were found to underestimate medical errors. 23 Although the Global Trigger Tool seems to capture more medical errors than voluntary reporting and administrative discharge data based on ICD-9-CM codes, the tool's approach is too resources-intensive to be implemented nationally.…”

Section: Discussionmentioning

confidence: 99%

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Medical Errors in US Pediatric Inpatients With Chronic Conditions

2012

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WHAT'S KNOWN ON THIS SUBJECT: Iatrogenic medical errors are an important medical care issue in the United States. Errors may be particularly important in children with chronic health conditions, especially as the prevalence of chronic conditions is increasing in children. WHAT THIS STUDY ADDS:In a nationally representative sample, we found that pediatric inpatients with chronic conditions were at a significantly higher risk for medical errors than inpatient children without chronic conditions, controlling for severity of illness, length of stay, and other potential confounders. abstract OBJECTIVE: To investigate the association between chronic conditions and iatrogenic medical errors in US pediatric inpatients. METHODS:The 2006 Kids' Inpatient Database (KID) was analyzed. Medical errors were defined by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Medical error rates per 100 hospital discharges and per 1000 inpatient days were calculated. Logistic regression models were fitted to study the association between number of chronic conditions and medical errors, controlling for patient characteristics, hospital characteristics, disease severity, and length of stay. RESULTS:In the 2006 KID, 22.3% of pediatric inpatients had 1 chronic condition, 9.8% had 2 chronic conditions, and 12.0% had $3 chronic conditions. The overall medical error rate per 100 discharges was 3.0 (95% confidence interval [CI]: 2.8-3.3); it was 5.3 (95% CI: 4.9-5.7) in children with chronic conditions and 1.3 (95% CI: 1.2-1.3) in children without chronic conditions. The medical error rate per 1000 inpatient days was also higher in children with chronic conditions. The association between chronic conditions and medical errors remained statistically significant in logistic regression models adjusting for patient characteristics, hospital characteristics, disease severity, and length of stay. In the adjusted model, the odds ratio of medical errors for children with 1 chronic condition was 1.40 (95% CI: 1.32-1.48); for children with 2 conditions, the OR was 1.55 (95% CI: 1.45-1.66); and for children with 3 conditions, the OR was 1.66 (95% CI: 1.53-1.81). CONCLUSIONS:The number of chronic conditions was significantly associated with iatrogenic medical errors in pediatric inpatients. Pediatrics 2012;130:e786-e793 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medical Errors in US Pediatric Inpatients With Chronic Conditions

2012

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“…A revisão retrospectiva de prontuários é outra abordagem para identificar EAM; en tretanto, tem o inconveniente de demandar, em excesso, tempo e recursos humanos 7 . Como estratégia a ser massificada, pode não ser viável para monitorar a prática assistencial 8 12,13 . O objetivo do artigo é oferecer elementos para o emprego de rastreadores na vigilância dos eventos adversos a medicamentos em hospitais, apresentando o processo de apli cação de uma lista de rastreadores, assim como o desempenho de cada um deles, em um hospital público geral.…”

Section: Introductionunclassified

Vigilância de eventos adversos a medicamentos em hospitais: aplicação e desempenho de rastreadores

Giordani

Rozenfeld

Oliveira

et al. 2012

Rev. bras. epidemiol.

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Os eventos adversos a medicamentos (EAMs) são causa importante de comprometimento da qualidade da atenção ao paciente hospitalizado e, por isso, devem ser identificados e caracterizados. Para tanto surgiram listas de rastreadores, entre elas a proposta pelo Institute for Healthcare Improvement. Aqui é apresentado o processo da aplicação dos rastreadores e o seu desempenho em um hospital de ensino. As informações sobre os rastreadores e os EAM foram coletadas por meio de revisão retrospectiva dos prontuários de pacientes com alta hospitalar de janeiro a junho de 2008. Foram identificados 497 rastreadores em 177 prontuários, onde cada prontuário apresentou, em média, 2,33 (DP = 2,7) rastreadores. Os encontrados com mais frequência foram: "antiemético" (72,1/100 prontuários), "interrupção abrupta da medicação" (70,0/100 prontuários) e "sedação excessiva, sonolência, torpor, letargia, queda e hipotensão" (34,6/100 prontuários). Os mais eficientes na captura de EAM (rendimento), isto é, aqueles que uma vez identificados sinalizaram possíveis eventos foram "antagonista de benzodiazepínico", "antidiarréicos" e "rash cutâneo". Os EAM mais encontrados foram relacionados aos rastreadores "interrupção abrupta da medicação" (8,3/100 prontuários), "antiemético" (4,6/100 prontuários) e "rash cutâneo" (2,1/100 prontuários). Essas considerações apontam para a utilidade do emprego da lista de rastreadores e podem contribuir para decidir sobre ajustes na sua aplicação.

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“…Using signs, or triggers, is a recent approach, and they act as clues in identifying adverse events and are used within hospitals, both prospectively 5 and retrospectively, 10 in intervention studies 6 or in the emergency services. 22 ADE have been shown to be promising in a variety of environments and using different approaches.…”

mentioning

confidence: 99%

Eventos adversos a medicamentos em hospital terciario: estudo piloto com rastreadores

Rozenfeld¹,

Giordani²,

Coelho³

2013

Rev. Saude Publica

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OBJECTIVE:To estimate the frequency of and to characterize the adverse drug events at a terciary care hospital. METHODS:A retrospective review was carried out of 128 medical records from a hospital in Rio de Janeiro in 2007, representing 2,092 patients. The instrument used was a list of triggers, such as antidotes, abnormal laboratory analysis results and sudden suspension of treatment, among others. A simple random sample of patients aged 15 and over was extracted. Oncologic and obstetric patients were excluded as were those hospitalized for less than 48 hours or in the emergency room. Social and demographic characteristics and those of the disease of patients who underwent adverse events were compared with those of patients who did not in order to test for differences between the groups. RESULTS: Around 70.0% of the medical records assessed showed at least one trigger. Adverse drug events triggers had an overall positive predictive value of 14.4%. The incidence of adverse drug events was 26.6 per 100 patients and 15.6% patients suffered one or more event. The median length of stay for patients suffering an adverse drug event was 35.2 days as against 10.7 days for those who did not (p < 0.01). The pharmacological classes most commonly associated with an adverse drug event were related to the cardiovascular system, nervous system and alimentary tract and metabolism. The most common active substances associated with an adverse drug event were tramadol, dypirone, glibenclamide and furosemide. Over 80.0% of events provoked or contributed to temporary harm to the patient and required intervention and 6.0% may have contributed to the death of the patient. It was estimated that in the hospital, 131 events involving drowsiness or fainting 33 involving falls, and 33 episodes of hemorrhage related to adverse drug effects occur annually. CONCLUSIONS:Almost one-sixth of in-patients (16,0%) suffered an adverse drug event. The instrument used may prove useful as a technique for monitoring and evaluating patient care results. Psycothropic therapy should be critically appraised given the frequency of associated events, such as excessive sedation, lethargy, and hypotension.

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Testing a trigger tool as a method of detecting harm from medication errors in a UK hospital: a pilot study

Cited by 54 publications

References 22 publications

Medical Errors in US Pediatric Inpatients With Chronic Conditions

Medical Errors in US Pediatric Inpatients With Chronic Conditions

Vigilância de eventos adversos a medicamentos em hospitais: aplicação e desempenho de rastreadores

Eventos adversos a medicamentos em hospital terciario: estudo piloto com rastreadores

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